online solution: Roberts Case Study Health History: Maria Roberts, an 80-year

Roberts Case Study Health History: Maria Roberts, an 80-year-old… Roberts Case StudyHealth History: Maria Roberts, an 80-year-old female, underwent exploratory laparotomy with colon resection and colostomy earlier today. She has an epidural for pain management in place. The PACU nurse reports that Maria’s blood pressure has been “lower than usual”.  Maria’s history also indicates she has Type 2 diabetes mellitus, which is generally well-controlled, osteoarthritis, and that she is hard of hearing but doesn’t wear hearing aids.Personal/Social History: Mrs. Roberts is a widow who lives in her own home. She resides with her only child, Simon, who is 60 years old. Simon has Down’s syndrome and is developmentally delayed; however, he tries very hard to be helpful to his mother. They live in a small farming community about an hour from the hospital.While at the hospital Maria Robert was applied a heat pack that caused a burn on her lower back that required treatment. Maria had planned to be discharged home on Wednesday. Because of the burns, she will need dressing changes. During an assessment, Maria indicates all she wants to do is go home and resume her life. She is also concerned about her son and how he is coping with her extended stay. After the nurse consults with the physician about Maria’s concerns, a decision is made to discharge her with home health support. Simon will serve as Maria’s primary caregiver, with the home health nurse checking in periodically.Roberts Case Study – Part 2Maria is discharged home on Monday with daily home health visits for dressing changes. On Friday, you are assigned to work in the Emergency Room. Shortly before lunch, Maria arrives via an ambulance. When the visiting nurse arrived earlier in the day, Maria was not sure what day it was and was very weak. An ambulance was called for transport to the hospital. Your physical assessment reveals the following:Vital Signs:Temperature101.5 F/38.8 C (oral)Pulse110 (supine) & 132 (standing); pulse is regular regardless of positionRespirations22 (Regular)Blood pressure103/50 (supine) w/ MAP = 6896/42 (standing) w/ MAP = 6002 sat97% (room air)PainRight flank achiness, rates it a 5/10, continuous, nothing seems to make it better or worseCurrent Assessment:General appearance – resting quietly, no obvious distress noted, becomes fatigued with minimal activityRespiratory – Breath sounds clear and equal bilaterally, respirations are not laboredCardiac – pulses strong and equal with palpation, no edema noted, regular S1 & S2,Neuro – Alert & oriented x2. Patient not consistently oriented to date and place, c/o dizziness when she sits up.GI – abdomen soft & nontender to palpation. Positive bowel sounds in all four quadrants.GU -Upon palpation, right flank tenderness noted. Increased frequency of urination noted.Skin – Other than the surgical site, her skin integrity is intact, although her lips and oral mucosa are dry.Surgical wound – Edges of the wound are closely approximated and slightly red in color. Staples present. No drainage or foul odor noted.Lab Results:LabCurrentRecent ValueSodium (135 – 145 mEq/L)141138Potassium (3.5 – 5.0 mEq/L)3.93.8Glucose (70 – 110 mg/dL)192122Creatinine (0.6 – 1.2 mg/dL)1.61.0WBC (5 – 10 3/µl)13.28.5Neutrophil % (42 – 72%)9870Hgb (12 – 16 g/dL)14.414.2Platelets (150 – 450 x 103/µl)262150Lactate (0.5 – 2.2 mEq/L)3.3n/aMg (1.7 – 2.2 mg/dL)1.72.0Chest x-rayNo change from previous report.No infiltrates or other abnormalities noted.UrinalysisYellow cloudy urine. Specific gravity = 1.032. +2 protein.          + nitrite & RBCs. WBCs > 100. Few epithelial cells.n/aQuestionsAfter reviewing the relevant data from the emergency room, the physician diagnoses the patient with urosepsis.  What is the pathophysiology of this problem in your own words?You receive the following physician orders. What is the rationale for each one as well as the expected outcome?Infuse 1000 ml 0.9% NS bolus via IV650 mg Acetaminophen POCeftriaxone 1 g IVPB Q 12 hours – administer the first dose after blood & urine cultures obtained.Morphine 2 mg IV push Q 2 hours as needed for painWhat are the nurse’s top two priorities for this patient at this point in time?  NOTE: the prioritization should focus on the patient rather than the nurse’s actions (i.e., obtaining blood cultures before administering antibiotics). Include the nursing interventions that you will implement as well as the desired outcome. Any safety issues should be addressed in Question 4.Given that Maria is alert & oriented x2, what safety concerns should you consider? Identify how you will address those to keep her safe.Incorporate sources to every question, cite in-text and reference page within 5 years old.  Health Science Science NursingNURS 451W

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