Group 1 Scenario: Medical Surgical Nursing
L.S., a 31-year-old owner of a childcare center, sought care 2 days ago at an outpatient clinic because of increasing weakness, fatigue, and weight loss. She thought her symptoms were caused by her rigorous physical work schedule/activities. However, she became lightheaded and dizzy and almost fell with an infant in her arms. This alarmed her enough to go in for an examination. She denied pain but c/o loss of appetite and occasional nausea. She lost about 20 pounds in the last 2 months. She said her husband encouraged her to sell the center because she is so overworked that she doesn’t have any interest in activities with him, including sex. She tested herself with a home pregnancy test last month because she had missed a couple of menstrual periods, but the test was negative. The health care provider suspected adrenocortical insufficiency and ordered laboratory tests. L.S. was sent home from the clinic with instructions to rest and drink lots of salty fluids, such as broth or milk, but no fruit or vegetable juices, until laboratory results available. medical surgical nursing. Lab results showed lower than normal levels of cortisol and sodium. Slightly increased levels were noted for Potassium and BUN.
Two days later L.S. is admitted to the hospital with acute adrenal insufficiency (addisonian crisis). You review adrenal dysfunction and begin by comparing the manifestations of Addison’s disease (hypofunction) with those of Cushing syndrome (hyperfunction).
- What are the manifestations of Addison’s disease and how do they differ from Cushing’s syndrome?
- Patients with adrenocortical insufficiency are at risk for acute adrenal insufficiency (addisonian crisis). What is the treatment focus for patients with Addison’s disease and those in addisonian crisis?
- What are the side effects and adverse reactions associated with corticosteroid therapy?
- Explain with rationale four priority nursing interventions (not teaching points, what are you as the RN going to do?) for this patient? medical surgical nursing
- What 3 key points, specific to this disorder, would you teach the patient as part of discharge? ORDER NOW
Group 2 Scenario: Medical surgical nursing
In the ER, A mother has brought in her 20-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting (N/V). She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin. Because C.J. is unsteady, you bring her to the examining room in a wheelchair. While assisting her onto the examining table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet-smelling. C.J. is drowsy and unable to answer your questions. Her mother states, “She keeps telling me she’s so thirsty, but she can’t keep anything down.” medical surgical nursing
The mother also tells you the following:
- “Blood glucose monitor has been reading ‘high.’ ”
- “C.J. has had sips of ginger ale but that’s all.” medical surgical nursing
- “She has been vomiting about every other time she drinks.”
- “When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don’t think she has gone today.”
- “She went to bed early last night, and I could hardly wake her up this morning. That’s why I brought her in.”
- Blood pressure 90/50 mm Hg
- Heart rate 124 beats/min
- Respiratory rate 36 and deep
- Temperature 101.3° F (38.5° C) (tympanic)
Laboratory Test Values
- Glucose 577 mg/dL
- Potassium 5.8 mEq/L
After evaluating C.J., the ED physician admits the patient with DKA.
- Describe the pathophysiology of diabetic ketoacidosis (DKA) and how it differs from hyperglycemic-hyperosmolar state (HHS).
- Explain the rationale for C.J.’s presenting signs and symptoms.
- What medical treatments are appropriate for this patient?
- List five priority nursing interventions and the rationale for each.
- The physician orders an insulin drip infusion at 4 units per hour. The label on the bag reads, “100 units regular (Humulin R) insulin in 250 mL of normal saline.” At how many milliliters per hour will you set the infusion pump? ORDER NOW
Group 3 Scenario Medical surgical nursing
You are the RN for Mr. PC recently admitted from the clinic by his primary care physician. He was at the clinic for a visit complaining of waking up with a severe headache at least 2-3 times per week over the last 3 months. The headaches have begun to start throughout the day over the last week. He also states that he has begun to wake up in the morning “in a pool of sweat” and gets flushed during the day at least once a week. The PCP found that he had an elevated BP. medical surgical nursing. Labs were obtained and the results included elevated catecholamine levels.
Mr. PC’s immediate orders included a CT of the abdomen and a 24-hour urine collection.
Your assessment included:
P 78 RR 18 BP 160/99 T 99.2 Pain 4/10
Neuro: A&O X 4; agitated, equal grips, slight tremors in the left hand
Cardiac: regular rate and rhythm (RRR), S1S2, peripheral pulses present (PPP), no edema
Pulmonary: clear to auscultation (CTA), equal and bilateral chest excursion, no use of accessory muscles
GI: bowel sounds present, abdomen soft/flat/nontender, patient states occasional constipation
MS: ambulatory without assistance
Skin: no breakdown, normal turgor, appropriate color, warm
CT results report a tumor on the left adrenal gland and the 24-hour urine also showed elevated catecholamine levels.
- Based on the information provided in the scenario, what is Mr. PC’s diagnosis and what are the key features that led you to this decision?
- While assessing Mr. PC, what other signs and symptoms might you expect him to report? What foods and beverages in his diet would you investigate?
- What is important to remember while performing your physical exam? Why?
- As you suspected, Mr. PC’s physician consults a surgeon to remove the tumor. What will be the course of action in preparation for surgery?
- What are you nursing actions after Mr. PC has surgery? Provide rationales for each. ORDER NOW
Group 4 Scenario: Medical surgical nursing
M.C is a 45-year-old male patient in the Neurology intensive care unit who was admitted 2 days ago after falling from a 10 ft. ladder while working. M.C. reportedly hit his head on impact and is being treated for swelling in his brain. The nurse arrives to the unit for her shift and discovers during hand off report that the patient’s output has been 5 liters over the last 24 hours. In addition, the NA+ level has been increasing and is now at 155 mEq/L. The nurse suspects that the patient has developed diabetes insipidus. medical surgical nursing. The patient’s current vital signs are HR 133, BP 90/65, RR 20, Temp 98.9, and O2 Sat 98 on Room Air.
- What signs and symptoms are the patient exhibiting that would cause you to consider DI?
- What is the pathophysiology of DI?
- The nurse prepares to notify the physician regarding the patient’s status; what would you include in your conversation and what recommendations would you make?
- The Neurologist then orders a serum osmolarity and a urine osmolarity lab test. What significance would these tests offer for the proper diagnosis?
- What is the treatment for this condition? What is priority for the nurse to include in the plan of care and how would you know that the patient is responding appropriately? ORDER NOW
Helpful Tip: Use the required textbook as a reference, paraphrase in your own words (do not plagiarize!) and cite the reference in APA format. Your syllabus has the correct APA reference for the textbook on page 2. medical surgical nursing.