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Ms. Jimenez (Part 1 of Case Study)

Client Profile: Ms. Jimenez is a 56-year-old, Hispanic woman who has been having financial difficulties since her divorce five years ago. She was recently involved in an MVA (motor vehicle accident) where she drove over a curb and hit a telephone pole. She did not sustain any significant injuries in the MVA. Today, Ms. Jimenez’s daughter Maria returned home at 9:00 p.m. to find Ms. Jimenez sitting on the floor with a decreased level of consciousness. Maria was able to shake her mother awake. With slurred speech, Ms. Jimenez told her daughter that she drank three large glasses of antifreeze (ethylene glycol) around 7:00 p.m. Maria called 911 and emergency medical services transported Ms. Jimenez to the local emergency department (ED).

Case Study: Upon arrival to the ED, Ms. Jimenez is afebrile with a rectal temperature of 97°F. Her other vital signs are BP 135/85, HR 68, and RR 24. Her initial ABG (arterial blood gas) on a 15 liters per minute non-rebreather revealed a pH of 7.19, PaCO2 of 13 mmHg, PaO2 of 359 mmHg, bicarbonate (HCO3-) of 5 mEq/L and oxygen saturation of 100%. Ms. Jimenez is sedated in the ED using etomidate (0.3 mg/kg IV) succinylcholine chloride (1.5 mg/kg IV), lorazepam (1-4 mg IV bolus) and propofol (1.5 mg/kg IV). Her oxygen saturation is 92% on an FIO2 of 70%. The health care provider’s physical examination reveals no abnormal findings. The neurological exam is deferred because Ms. Jimenez is intubated and sedated. An EKG shows that Ms. Jimenez is in a normal sinus rhythm. A chest x-ray shows no infiltrate and proper endotracheal tube placement.

A UA shows a specific gravity of 1.010, a small amount of occult blood, 3-5 WBCs, a few bacteria and moderate amount of uric acid crystals and urine calcium oxalate crystals. A urine culture and colony count was negative (no growth). Her blood alcohol is less than 10mg/dL. Her ethylene glycol level is 36 mg/dL. Her CBC was within normal limits except for an MCV of 79.2 µm3. Troponin level is 0 ng/mL, creatine kinase (CK) is 182 U/L and creatine kinase cardiac isoenzyme (CK-MB) is WNL. Serum osmolality is 392 mOsm/Kg. Her electrolytes are WNL except for a serum bicarbonate of 7 mEq/L. She has an anion gap of 29 mEq/L, BUN of 25 mg/dL and creatinine of 1.4 mg/dL. Her liver function tests are WNL.

Ms. Jimenez is admitted to the intensive care unit and prescribed IVF of NS with 2 ampules of bicarbonate at 125 ml/hr. The medications prescribed for her

include 4-methylpyrazole 15mg/kg IV every 12 hours to infuse over 30 minutes, pyridoxine 5 mg IM Q day, thiamine 100 mg IM Q day and levalbuterol 0.63 inhalation via nebulizer Q 6 hr. Lab work ordered includes CBC, electrolytes, ethylene glycol levels, BMP, creatinine level, acetone level and UA.

In the ICU at bedside, a Quinton dialysis catheter is surgically inserted in the right internal jugular vein for emergency dialysis and placement is confirmed by chest x-ray (Ankner, 2012, pp. 21-23).

 

1. Priority Areas/Systems for Focused Assessment (Explain Why)

 

2. Priority Potential Complications

(Explain Why)

 

3. What Labs and/or Diagnostics Should be Ordered for this patient?

(Explain Why)

 

4. Prioritize 3 Medications this Patient has been/or Should be Ordered. (Explain why)

 

5. Prioritize Nursing Interventions

(Explain Why)

 

6. Prioritize Patient/Family/Caregiver Teaching

 

7. Consults for this patient 

 

8. Prioritize Goals/Expected Outcomes

 

 

SCIENCE
HEALTH SCIENCE
NURSING
RNSG 2535

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