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Directions: Complete the attached case study and upload into Canvas. A 22-year-old patient was admitted to a cardiac stepdown unit for right upper quadrant pain, nausea, and vomiting. The patient states the pain is a 9 out of 10 to RLQ and radiates to their right flank area. The patient stated, “I’m in so much pain, I took all the acetaminophen extra strength tablets I could find before I came to the Emergency Department.” The patient has a medical history of kidney stones, bipolar depression, and primary hypertension. Their surgical history reveals a tonsillectomy two years ago. VS are BP 160/100, P 90, R 20, T 99.2 °F, and O2 sat is 98%. ECG monitor shows a normal sinus rhythm with slight ST elevation and a rate of 92. Current home medications are acetaminophen 500 mg 1 to 2 tablets PRN pain, sertraline 100 mg one PO daily, quetiapine 200 mg one PO q HS and lisinopril 20 mg one PO daily. HCP orders home medications, a CT scan of the abdomen and hydrocodone 5 mg/acetaminophen 325 mg one or two tablets PO every 6 hours PRN for moderate pain and morphine 2-4 mg IVP q 2 hours PRN for severe pain. Highlight the above assessment findings that require immediate follow up by the nurse. (10-points) Use an X to indicate which potential assessment finding is associated with each of the listed patient’s health problems. All assessment findings should be used and can be used only once. (7-points) Assessment Finding Elimination (urinary) Perfusion Pain of 9 out of 10 to RLQ     History of kidney stones     BP 160/100     ECG shows NSR with ST elevation     Lisinopril 325 mg PO daily     Morphine 2-4 mg IVP q 2 hours     Nausea and vomiting       The patient stated that “all that acetaminophen I took at home is not working anymore.” Upon further questioning, the patient states they took over 30 acetaminophen. The patient requests something for pain and said their pain is now above a 10/10 to their RUQ and RLQ. The patient states they are also very nauseated and feels lightheaded when standing. The patient states they have not been able to void for the past 6 hours. Bladder is felt during palpation of abdomen. The CT scan reveals a large kidney stone in the left ureter. 3. Based on the patient’s condition, the patient’s priority need will be to prevent _______1________. In addition, he will need interventions to prevent potentially life-threatening complications of urinary elimination especially __________2________ and __________2___________. (3-points) Options for 1 Options for 2 acetaminophen toxicity ureteral reflux vomiting urinary retention kidney stones acetaminophen toxicity an accidental suicide acute kidney failure a bipolar episode urinary incontinence fever urinary tract infection   The patient stated that “all that acetaminophen I took at home is not working anymore.” Upon further questioning, the patient states they took over 30 acetaminophen. The patient requests something for pain and said their pain is now above a 10/10 to their RUQ and RLQ. The patient states they are also very nauseated and feels lightheaded when standing. The patient states they have not been able to void for the past 6 hours. Bladder is felt during palpation of abdomen. The CT scan reveals a large kidney stone in the left ureter. 4. Use an X for the nursing actions listed below that are Indicated (appropriate or necessary), Contraindicated (could be harmful), or Non-essential (makes no difference or not necessary) for the patient’s care at this time. Only one selection can be made for each nursing action. (10-points) Nursing Action Indicated Contraindicated Non-essential Draw an acetaminophen level       Give Zofran 4 mg IVP for nausea       Obtain a 12-lead ECG       Administer hydrocodone 5 mg/acetaminophen 325 mg PO       Administer morphine IVP       Teach urinary self-catheterization       Serve a regular food diet         The patient’s lab work is back and exhibits these abnormals: WBC is 14, K is 2.8, BUN is 17, creatinine is 1.9, AST is 145 and ALT is 219, acetaminophen level is 438 mcg/mL, albumin is 2.8, and BNP is 120. The nurse assessed that the patient’s last acetaminophen ingestion at home was more than 5 hours ago. The patient has vomited clear, greenish liquid twice. Current VS reveal BP 170/108, P 100, R 24, T 100.8 °F, O2 sat 96%. IV ½ NS with 20 KCL was started, and patient received morphine 2 mg IVP for pain 40 minutes ago. The 12-lead ECG shows normal sinus rhythm. Bladder scan exhibits 620 mL of urine. 5. Use an X to indicate which actions listed in the left column would be implemented. (10-points) Actions Implemented Perform a 24-hour diet recall   Teach on acetaminophen use   Bolus ½ NS with 20 KCL at 500 mL/hr   Give acetylcysteine 140 mg/kg now   Reassess pain in 20 minutes   Give acetaminophen for T 100.8 °F   Call HCP regarding lab work   Start IV heparin 18 units/kg/hr     The patient’s lab work is back and exhibits these abnormals: WBC is 14, K is 2.8, BUN is 17, creatinine is 1.9, AST is 145 and ALT is 219, acetaminophen level is 438 mcg/mL, albumin is 2.8 and BNP is 120. The nurse assessed that the patient’s last acetaminophen ingestion at home was more than 5 hours ago. The patient has vomited clear, greenish liquid twice. Current VS reveal BP 170/108, P 100, R 24, T 100.8 °F, O2 sat 96%. IV ½ NS with 20 KCL was started, and patient received morphine 2 mg IVP for pain 40 minutes ago. The 12-lead ECG shows normal sinus rhythm. Bladder scan exhibits 620 mL of urine. The HCP prescribes an antidote for acetaminophen toxicity, NPO status and has surgical lithotripsy and ureteral stent placed. An IV of ½ NS is at 75 mL/hr and furosemide 20 mg IV push given. 6. The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply. (10-points) Pain is reported 6/10 UA is obtained Vomit x 2 Fever of 101.4 °F Urinary strainer shows crystals Acetaminophen level is 180 Normal sinus rhythm noted on monitor BP 160/100 Urinary_Elimination_Unfolding_Case_Study.docx 
SCIENCE
HEALTH SCIENCE
NURSING
NURSING 100

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