Question

Case Study X 1. Ida Parker, a 67-year-old patient, was admitted to the intensive care unit with the diagnosis of lung cancer and underwent a left lower lobectomy. The patient has a history of Parkinson disease. The patient was 2 days postoperative when the nurse noted that she had not received her anti-Parkinson medications for 2 days. The patient was frozen and unable to move or talk to the nurse. (Learning Objective 4)

a. What actions should the nurse take next?

b. The physician reorders the carbidopa-levodopa (Sinemet) and benztropine meysylate (Cogentin). The physician orders an enteral feeding tube placed and confirmed by chest x-ray. Once the radiologist has confirmed correct placement, tube feeding with the specified formula that is higher in carbohydrates and lower in protein will begin. What is the rationale for the enteral feeding tube? How should the nurse administer the medications?

c. What laboratory values will the nurse monitor to evaluate the client’s nutritional status?

d. What postoperative risks is this patient prone to and how can nurses prevent them? (include 3 risks and treatmenst to prevent them)

e. On post-op day 4, the arterial blood gasses are: Ph 7.37 PaCO2 48, bicarb 25, PaO2 70, O2 sat 91%. a. How would you interpret this ABG? b. What are nursing priorities for this patient based on the ABG’s along with her 2 diagnosis?

f. The patient’s condition is improving, and she is ambulating in the halls at least 3 times per day. When walking with her, you not she has dyskenisia of the head. What is the likely cause of the dyskenisia?

g. The patient is preparing to discharge to home with her husband. What patient teaching will you do regarding dosing and administration of Sinemet?

h. Besides medications, what are 4 topics that you would want to include in her discharge education and how would you provide that information to the patient/family.

1.

2.

3.

4.

Answer 1

Parkinsonism is a neurological disorder characterized by loss of the nerve cells in the substantia nigra of the brain. This leads to deficiency of chemical dopamine. Dopamine is a neurotransmitter that helps to control and coordinate the movement.

In this scenario: da Parker, a 67-year-old patient, was admitted to the intensive care unit with the diagnosis of lung cancer and underwent a left lower lobectomy. The patient has a history of Parkinson disease. The patient was 2 days postoperative when the nurse noted that she had not received her anti-Parkinson medications for 2 days. The patient was frozen and unable to move or talk to the nurse.

The skipping of levodopa and carbidopa causes parkinsons like symptoms. The immediate action to be taken by the nurse is to report immediately to the physician regarding the patients worsened symptoms.

What is the rationale for the enteral feeding tube?

The enteral tube is a method of giving essential nutrients to the patient directly into the gastrointestinal tract. It is used for patient unable to take food by mouth, with lack of swallowing ability, esophageal stricture,tumors, congenital anomalies, postoperative patients.

Sinemet is the first line medication to treat parkinsonism. It has a onset of action of 15-30 minutes. The drugs can be crushed and administered via NG tube, It shpuld not be administered along with enteral feeds as there is a risk for drug interaction.

Lobectomy refers to the removal of portion of the affected lung. The common risks are air leak.It can be managed by suture closure of identified leaks.Pneumonia is a second risk occurs as a result of excess mucous plugging,impaired coughing. It can be managed by chest physiotherapy that includes coughing and percussion,ambulation and usage of incentive spirometry. Chylothorax can occur as a result of injury to the thoracic duct. It can be managed by drainage of effusion,maintaining nil per oral status,tube thoracostomy.

On post-op day 4, the arterial blood gasses are: Ph 7.37 PaCO2 48, bicarb 25, PaO2 70, O2 sat 91%. a. How would you interpret this ABG?

ABG analysis helps to understand the acid base balance and oxygen saturation. Ph refers to acis base balance the normal value ranges from 7.35-7.45. in the given scenario ph value is 7.37 indicates a normal range. The paco2 value is 35-45 mmhg , the given value of 48 reveals respiratory acidosis. Oxygen saturation of 91% indicates hypoxemia.