Passport Case Study Joann S. is a

Passport Case Study Joann S. is a 71-year-old female patient who is a direct admit to the medical surgical unit after being sent from her physician’s office for further evaluation with a diagnosis of “weakness and failure to thrive.” She is accompanied by her spouse of 53 years, Anthony, with whom she resides. She is a retired office manager with several adult children and prior to this admission lived at home without medical assistance. She appears confused and cannot stand even though she moves all extremities. Her speech is slurred, but Anthony reports, “The doctor said something about her liver. That’s weird to me because she doesn’t drink or take any medicine except vitamins. How could there be anything wrong with her liver? I don’t understand. She stopped being able to walk a few days ago and really isn’t eating or drinking.” (1pt) Prioritize what assessments the nurse should perform and the rationale for each The nurse obtains vital signs from the patient and performs a focused physical assessment: Temp 36.6°C – BP 90/50 mmHg- HR 120 bpm- RR 28 -SpO2 90% on Room Air Ht 172.7 cm / Wt 89.6 kg The patient is oriented to self only. Her skin appears tan with a yellowish tinge, and she complains of itching. She has many bruises in various stages of healing on her extremities and her sclera are bright yellow. The abdomen is distended and tender with palpation. The physician orders laboratory studies that include blood alcohol content, urine drug screen, complete blood count, hepatic panel, coagulation studies, Hepatitis C Virus Antibody, and an abdominal ultrasound. The labs result with the following values: Blood Alcohol Count (BAC): 0.0 percent Urine Drug Screen (UDS): Negative for amphetamines, methamphetamines, benzodiazepines, barbiturates, marijuana, cocaine, PCP, methadone, opioids WBC 14,000/mm3 HGB 9.2 g/dL HCT 27.6% Platelets 40,000 cells/µL (40 x 109/L) Albumin 2.6 g/dL Aspartate Aminotransferase (AST) 701 U/L Alanine Aminotransferase (ALT) 501 U/L Ammonia 150 mcg/dL Bilirubin (total) 5 mg/dl Partial thromboplastin time (PTT) 50 seconds Prothrombin time (PT) 18 seconds International Normalized Ratio (INR) 1.6 Hepatitis C virus (HCV) Antibody: reactive The abdominal ultrasound shows an enlarged liver and fluid accumulation in the abdomen (ascites). Critical Thinking Check (1pt) Based on the diagnostic data above, what 3 priority nursing interventions would be implemented and the rationale for each (1pt) What is the best way to explain the patient’s decreased level of consciousness and appearance to her family? (2pts) The provider has written an order for Cephulac 20mg orally every 6hrs – first dose now. The nurse removes the medication from the Pyxis and notes that the concentration is 10mg/15ml. (0.5pts) How many milliliters should the nurse give? (0.5pts) What is the rationale for this medication? (1pt) What are some nursing considerations for administration of this medication to the patient? SCIENCE HEALTH SCIENCE NURSING NRN 21

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