Stan checketts vsim

1. What signs and symptoms did Stan present with that may indicate that he is dehydrated? What nursing care and management is required for the patient presenting with dehydration?

Stan has sign and symptoms of poor skin turgor,dry oral mucous membrane,vomiting, less frequent urination and fatigue.Managing dehydration

ehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks containing caffeine such as coffee, tea, and sodas.

Underlying conditions that are causing dehydration should also be treated with the appropriate medication. This may include medication available to purchase over-the-counter or online, such as anti-diarrhea medicines, anti-emetics (stop vomiting), and anti-fever medicines.

Prevention is really the most important treatment for dehydration. Consuming plenty of fluids and foods that have high water content (such as fruits and vegetables) should be enough for most people to prevent dehydration.

People should be cautious about doing activities during extreme heat or the hottest part of the day, and anyone who is exercising should make replenishing fluids a priority.

Since the elderly and very young are most at risk of being dehydrated, special attention should be given to them to make sure they are receiving enough fluids.

Medical News Today (2017). What you should know about dehydration, Retrived from: https://www.medicalnewstoday.com/articles/153363.php

Appropriate management of the severely dehydrated and uraemic patient is challenging and there is no specific guidance in the literature. Clinicians must use their judgement and discretion when tailoring alternative available guidelines for use in individual patient cases.

Since at least 1949, it has been understood that the mainstays of treatment for uraemia included the meticulous correction of water and electrolyte disturbance, with water balance taking precedence over electrolytes.1 Today’s clinician has a greater ability to monitor, measure and modify fluid and electrolytes, but this still must be done with caution and an awareness of the potential risks.

There are, broadly, two theoretical approaches one could take to correcting this patient’s severe dehydration and uraemia:

1. Management of hypernatraemia by estimating and correcting the fluid deficit according to serum sodium levels and managing the patient as per existing management of hypernatraemia guidelines (e.g. Adrogué),2 or

2. Managing and correcting the hyperosmolar state, but the only available guidance here is the hyperosmolar hyperglycaemic state (HHS) guideline where the hyperosmolar state is secondary to an elevated glucose (although these patients are additionally profoundly dehydrated and may have an elevated sodium too).3

Formulae hypothetically allow a clinician to calculate a patient’s free water deficit by utilising the extracellular sodium concentration as a surrogate marker of hydration status. Hypotonic solutions (5% dextrose in water, 0.2% sodium chloride in 5% dextrose in water and 0.45% sodium chloride in water) are recommended as the intravenous resuscitation fluids in the accompanying guidance excepting in the presence of ‘frank circulatory compromise’, when ‘isotonic’ solutions such as 0.9% sodium chloride are advised. The theory is that dehydration culminating in a relative water deficit is visible to the clinician via the measured sodium concentration.

NCBI, (2017 , Management of severe dehydration,Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665131/

2. One complication of dehydration is hypovolaemic shock. What indicators would you be looking for in a patient with hypovolaemic shock and what would your nursing care be for a patient with this condition?

mild symptoms

Mild symptoms can include:

· headache

· fatigue

· nausea

· profuse sweating

· dizziness

Severe symptoms

Severe symptoms, which must be taken seriously and warrant emergency medical attention, include:

· cold or clammy skin

· pale skin

· rapid, shallow breathing

· rapid heart rate

· little or no urine output

· confusion

· weakness

· weak pulse

· blue lips and fingernails

· lightheadedness

· loss of consciousness

The sign of external hemorrhaging is visible, profuse bleeding from a body site or area of injury.

Signs and symptoms of internal hemorrhaging include:

· abdominal pain

· blood in the stool

· black, tarry stool (melena)

· blood in the urine

· vomiting blood

· chest pain

· abdominal swelling

While some symptoms like abdominal pain and sweating can point to something less urgent like a stomach virus, you should seek immediate medical attention when seeing groupings of these symptoms together. This is especially true for the more serious symptoms. The longer you wait, the more damage can be done to your tissues and organs.

If you have any signs of hemorrhaging or of hemorrhagic shock, seek medical attention immediately.

once at a hospital, a person suspected of having hypovolemic shock will receive fluids or blood products via an intravenous line, to replenish the blood lost and improve circulation. Treatment revolves around controlling loss of fluid and blood, replacing what’s been lost, and stabilizing damage that both caused and resulted from the hypovolemic shock. This will also include treating the injury or illness that caused the shock, if possible.

These include:

blood plasma transfusion

platelet transfusion

red blood cell transfusion

intravenous crystalloids

Doctors may also administer medications that increase the heart’s pumping strength to improve circulation and get blood where it’s needed. These include:

dopamine

dobutamine

epinephrine

norepinephrine

Antibiotics may be administered to prevent septic shock and bacterial infections.

Close cardiac monitoring will determine the effectiveness of the treatment you receive.

Health line,(2017) Hypovolemic shock, Retrieved from:https://www.healthline.com/health/hypovolemic-shock#emergency-care

*monitor for signs and symptoms of hypokalemia,fatigue,muscle weakness,decreased bowel motility,dysrhythmias, shallow breathing,weak thread post, monitor continuous intake output* ssist client in selecting foods rich in potassium as such as banana, fruit juices, melon, citrus fruits, and fresh vegetables

SCRIBD, (2018), Nursing care plan for hypokalaemia,https://www.scribd.com/document/278680359/Hypokalemia-Nursing-Care-Plan

3. Stan is diagnosed with a Small bowel obstruction (SBO), what is the nursing care and treatment of a person with a small bowel obstruction (SBO)?

· In the stable patient a thorough assessment is the next step including a detailed history, a detailed examination, blood tests including FBC, EUC, LFTs, lipase, BSL, an ECG and a CXR. Beta-HCG in women of childbearing age, VBG for lactate.

· If an alternative diagnosis is made at this time then the steps further down the pathway can be curtailed

Plain films: Initial imaging should include upright CXR and erect/supine AXR films (or lateral decubitus film if the patient cannot sit upright) - these have a sensitivity of 70-83% and specificity of 67-83% for small bowel obstruction. Plain film findings that suggest small bowel obstruction include:

· Dilated loops of bowel with air fluid levels - presence of >5 fluid levels.

· Proximal bowel dialation with distal bowel collapse - proximal small bowel dilated more than >2.5cm.

· Gasless abdomen

· CT abdomen: provides more information than plain films. May be useful to identify the specific site (i.e. transition point) and severity of the obstruction (partial vs complete). It will also give information about the aetiology, by identifying hernias, masses or inflammatory changes, and potential complications, such as ischaemia or perforation.

Management

Emergency surgery is indicated in:

· Perforation or impending perforation

· Strangulated small bowel obstruction

Patients considered for emergency surgery should be receive preoperative antibiotic prophylaxis and made NBM in preparation for surgery in addition to supportive case detailed below.

All patients should receive supportive care:

· NBM until surgical review

· IV fluids

· Monitoring of urine output

· Analgesia

· Anti-emetics can be a useful for emesis and/or nausea in cases where surgery is contraindicated (ondansetron 4mg IV q8H prn)

· NG tube for gastric decompression only when vomiting or severe symptoms as a result of gastric distention

Patients who do not require emergency surgery are initially treated conservatively for 48-72 hours. Failure to respond to conservative treatment would lead to consideration for surgery.

Gastrografin may be diagnostic and therapeutic in SBO due to surgical adhesions. The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction. While gastrografin does not reduce the need for surgery it does reduce hospital stay in those patients who do not require surgery.

Emergency care Institute NSW, (2028), Small bowel obstructions, Retrieved from: https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/abdominal-emergencies/bowel-obstruction/small-bowel-obstruction

4. In evaluating Stan Checketts’ laboratory results, what might his lab results indicate in relation to Stan’s condition? These lab results can be found in the vSim simulation or below.

High creatinine

The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly reliable indicator of kidney function. Elevated creatinine level signifies impaired kidney function or kidney disease, As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. It is for this reason that standard blood tests routinely check the amount of creatinine in the blood. Blood urea nitrogen (BUN) level is another indicator of kidney function. Urea is also a metabolic byproduct which can build up if kidney function is impaired. The BUN-to-creatinine ratio generally provides more precise information about kidney function and its possible underlying cause compared with creatinine level alone. BUN also increases with dehydration.

MedicineNet, (2018), Creatinine. Retrieved from: https://www.medicinenet.com/creatinine_blood_test/article.htm#what_is_creatinine

A high hemoglobin count indicates an above-normal level of hemoglobin in your blood. Hemoglobin (often abbreviated as Hb or Hgb) is the oxygen-carrying component of red blood cells.

A high hemoglobin count is somewhat different from a high red blood cell count, because each cell may not have the same amount of hemoglobin proteins. Therefore, you could have a high hemoglobin count even if your red blood cell count falls within the normal range.