Please answer each highlighted red question with at least 150 words. No references are needed unless you find supporting details or quotes to support your answer. You can type the answer under the highlighted question on the template I give you or you can copy the question into a different Word document and answer them that way, totally up to you. Sometimes these case studies are already completed online by other students.
Requirements: 150 words per question
SEPSIS CASE STUDY
OVERVIEW OF PATIENT
Ida May is a 75-year-old female who was sent by ambulance to the Emergency Room from her place of residence at a skilled nursing facility. Staff was unable to awaken her this morning and her BP was 78/42. She has a history of heart failure, COPD, hypertension, and osteoarthritis. She has a wound on her sacral area that is now a stage 3 ulcer. She is nonverbal and unresponsive to any verbal stimuli. She does respond to painful stimuli. Ida has resided in the skilled nursing facility for the past two years (after falling and breaking her hip) but is bed and wheelchair bound.
WHAT IS THE RELEVANT INFORMATION FROM PATIENT OVERVIEW? WHY?
PATIENTS VITAL SIGNS AND ASSESSMENTS
CARDIAC RHYTHM- WHAT RHYTHM IS THE PATIENT IN? WHAT DO YOU THINK IS HAPPENING?
WHAT IS THE RELEVANT INFORMATION FROM VITALS SIGNS AND ASSESSMENTS? WHY?
ASSESS GLASGOW COMA SCALE- WHAT IS HER SCORE AND WHY IS THIS ASSESSMENT RELEVANT?
GCS SCORE __________
LAB RESULTS
CBC WITH DIFFERENTIAL
WBC 18.5 X10e3/Ul 4.0 – 10.5
RBC 5.02 X10e3/Ul 4.10-5.60
Hemoglobin 13.1 g/dl 12.5-17.0
Hematocrit 45.2 % 36.0-50.0
MCV 94 fL 80-98
MCH 30.6 pg 27.0-34.0
MCHC 32.7 g/dL 32.0-36.0
RDW 13.2 % 11.7-15.0
Platelets 250 x10e3/Ul 140-215
Neutrophils 85.2 % 40-74
Lymphs 44 % 14-46
Monocytes 9 % 4-13
COMP. METABOLIC PANEL
Glucose 172 mg/dL 65-99
Sodium 147 mmol/L 135-145
Potassium 5.2 mmol/L 3.5-5.0
Chloride 96 mEq/L 96-109
Calcium 9.0 mg/dl 8.5-10.5
Magnesium 1.5 mEq/L 1.4-2.1
BUN 10 mg/dL 5-26
Creatinine, Serum 1.6 mg/dL 0.76-1.27
eGFR 45 mL/min/1.73 >59
OTHER
Lactic Acid 7.4 mg/dL 0.4-2.0
Blood Cultures * results pending *
Wound Culture * results pending *
Urine Culture * results pending *
WHAT IS RELEVANT ABOUT THE RESULTS? WHY?
IMAGING RESULTS
WHAT IS RELEVANT ABOUT THE RESULTS? WHY?
REVIEW PATIENT ORDERS. EXPLAIN WHY MEDICATIONS WERE ORDERED AND HOW THEY WILL AFFECT THE PATIENT.
Aspen Simulated Hospital
Provider Orders
WHICH PATIENT FINDINGS ARE OF MOST CONCERN TO YOU AND WHY?
CONTINUE………….
PATIENT IS TRANSFERRED TO ICU. UPDATE ON PATIENT STATUS:
The patient had all cultures drawn and Vancomycin started in the ED. The patient had a central line placed and received the bolus in the ED. Norepinephrine is at 6mcg/kg/min currently running and the MAP is maintained >65. She transferred up to the ICU about 2 hours ago and appears to be resting comfortably.
PATIENTS VITAL SIGNS AND ASSESSMENT ARE UPDATED.
GCS SCORE ________
WHAT IS THE RELEVANT INFORMATION FROM THESE UPDATED VITALS SIGNS AND ASSESSMENTS? WHY?
YOUR SHIFT IS ENDING- COMPLETE THE SBAR FOR THE NEXT SHIFT.
S:
B:
A:
R:
COPD EXACERBATION CASE STUDY
OVERVIEW OF PATIENT
Linda Jones is a 64 year old patient who is admitted for the 2nd time this year for an acute exacerbation of her COPD. She complains of productive cough, fatigue, fever and chills over the past few days. She thinks it is her chronic bronchitis that is “acting up”. She just feels lousy and thinks she just needs some antibiotics for her infection.
WHAT IS THE RELEVANT INFORMATION FROM PATIENT OVERVIEW? WHAT OTHER INFORMATION DO WE NEED?
WHAT FURTHER QUESTIONS WOULD YOU ASK THE PATIENT?
PATIENTS VITAL SIGNS AND ASSESSMENTS
WHAT IS THE RELEVANT INFORMATION FOR PATIENTS VITAL SIGNS? WHY?
-Oxygenation is compromised due to COPD exacerbation as evidenced by pulse oximetry at 90% on 2L.
.
WHAT IS THE RELEVANT INFORMATION FOR THE PATIENTS ASSESSMENT? WHY?
-A productive cough with thick, dark green secretions is indicative of bacterial pneumonia, interfering with effective gas exchange.
CARDIAC RHYTHM- WHAT RHYTHM IS THE PATIENT IN? WHAT DO YOU THINK IS HAPPENING?
CHEST XRAY RESULTS
WHAT DO YOU THINK THE CHEST XRAY SHOWS?
LAB RESULTS
CBC WITH DIFFERENTIAL
WBC 14.5 X10e3/Ul 4.0 – 10.5
RBC 5.02 X10e3/Ul 4.10-5.60
Hemoglobin 13.1 g/dl 12.5-17.0
Hematocrit 39.2 % 36.0-50.0
MCV 94 fL 80-98
MCH 30.6 pg 27.0-34.0
MCHC 32.7 g/dL 32.0-36.0
RDW 13.2 % 11.7-15.0
Platelets 200 x10e3/Ul 140-215
Neutrophils 87.2 % 40-74
Lymphs 74 % 14-46
Monocytes 9 % 4-13
COMP. METABOLIC PANEL
Glucose 78 mg/dL 65-99
Sodium 140 mmol/L 135-145
Potassium 3.9 mmol/L 3.5-5.0
Chloride 96 mEq/L 96-109
Co2 42 mmol/L 25-35
Calcium 9.0 mg/dl 8.5-10.5
Magnesium 1.5 mEq/L 1.4-2.1
BUN 10 mg/dL 5-26
Creatinine, Serum 1.6 mg/dL 0.76-1.27
WHAT IS RELEVANT ABOUT THE RESULTS? WHY?
REVIEW PATIENT ORDERS. EXPLAIN WHY MEDICATIONS WERE ORDERED AND HOW THEY WILL AFFECT THE PATIENT.
Aspen Simulated Hospital
Provider Orders
WHO WOULD YOU WANT TO CONSULT FOR THIS PATIENT AND WHY?
LIST AT LEAST 3 TOPICS FOR PATIENT EDUCATION FOR THIS PATIENT
Patient has been on your unit for about 2 hours. Linda still feels short of breath. These are the current vital signs:
WHAT WILL YOU DO WITH THIS UPDATED INFORMATION?
The respiratory therapist provides a breathing treatment and draws ABG’s. Interpret the following results:
ABG’s
Ph 7.29
Co2 67
HCO3 24
INTERPRET THE RESULTS? WHAT DO THEY MEAN?
REVIEW OXYGEN ADJUNCTS
BiPap and CPAP are based on pressures. Briefly explain what BiPap and CPAP are.
The patient has been medicated and appears to be resting comfortably. However, the patient is now on a simple mask at 8L. Repeat ABG’s show that the patient condition is worsening, and the physician wants to improve oxygenation without intubating the patient.
WHAT WOULD BE BEST FOR THIS PATIENT? BIPAP OR CPAP? EXPLAIN YOUR ANSWER?
WHAT WOULD BE A BEST CASE SCENARIO FOR THIS PATIENT?
WHAT WOULD BE THE WORST CASE SCENARIO FOR THIS PATIENT?
YOUR SHIFT IS ENDING- COMPLETE THE SBAR FOR THE NEXT SHIFT.
S:
B:
A:
R: