Question

Case Narrative

Case details given to participants (can be given freely or must be asked for by participants)

Patient Description& Chief complaint:

A 68-year-old woman is admitted with fever, nausea, vomiting, and abdominal pain. She informs you that she is a “borderline diabetic” and “only has to watch what she eats.” She tells you that she has not eaten for 3 days and has had difficulty “keeping liquids down.” While doing the nursing history, she describes her urine as dark and foul smelling. Upon further questions, she states she does have some burning upon urination. She describes her abdominal pain as constant, generalized, and rates it as a 5 or 6 on a scale of 0 to 10.

Weight: 75

Height: 183

History of Current Illness: 3 days

Pertinent Past Medical History: Diabetes Mellitus

Past surgical History: Free

Family/Social History: Free

Medication History Profile and Allergies: Nothing known about

Lifestyle: (occupation, diet, income, educational level, marital statues): Nothing known about

Critical thinking questions: -

Pre starting any scenario the student will prepare to answer the following questions: -

1. What was your initial assessment?

2. When measuring client’s capillary blood glucose, you do not obtain enough blood to cover indicator square on reagent strip. What could be possible reasons and what should you do

3.Laboratory work returns with following results: WBC =17 × 103/mL3 with neutrophils = 80%; Hct = 43.2. Based on these results, what are your nursing interventions?

4. Doctor orders IV fluids and an antibiotic with first dose to be given STAT. You have not obtained urine specimen yet. Which has priority (e.g., starting IV, administrating antibiotic, or obtaining urine specimen) and why?

Answer 1

1.The initial assessment which can be made from the patient are

• Abdominal pain which is constant (rate 5-6 in pain scale)
• Altered gastrointestinal functios like nausea and vomiting
• Fluid alterations or imbalance due to vomiting (unable to keep down liquid)
• Poor or reduced otal intake for last 3days (can suspect for hypoglycemia, dehydration )
• Dark urine ,burning micturition,foul smelling urine (are sign of urinary tract infection)

2.The possible reason for no enough blood could be because of reduced intake which could have decreased the blood volume resulting in decreased capillary perfusion

Any defects in the device, positioning can also be a probable reason for no enough blood in the reagent strip

It can be corrected by warming the skin.This will improve capillary refill and aid in blood circulation to collect the adequate sample in the reagent strip.

3.The laboratory report shows the patient has infection,so it indicates the necessity of antibiotics to control the infection but this cannot be done first because the patient is ordered for a urine sample. Generally urine sample has to be collected before admiyif antibiotics to avoid errors in report. As the patient is dehydrated due to vomiting and reduced intake first intravenous fluid has to be administered to increase the fluid volume or balance ,then urine sample to be collected and finally administer the antibiotic.