'Advanced pathophysiology Essay\r'

'If forthcoming lab results, I would like to see the resulted sail through personal credit line count with differential and complete metabolic profile. Possibly supplying the enduring with supplemental atomic number 8 if deemed so by her oximetry and perfusion status polish. As much(prenominal)(prenominal)(prenominal) the following would be the initial assessment and discussion:\r\nObtain vital shortens: origin pressure, temperature, pulsation, respiratory post with auscultation, as well as trouble exfoliation rating Note her capillary refill magazine and skin saturation and turgor, especially around lips for color and for turgor Seeing if she has sunken eyes or alter mucous membranes indicative of dehydration. Place a beat oximeter on her finger for oxygenation levels. Place EKG all oversee for heart lay out and meter analysis.\r\nPlace IV for obtaining lineage works and order stat CBC, CMP, PT/INR/PTT, ABG, CXR, cardiac and liver enzyme profiles. Perform blo od glucose varaning\r\nwith glucometer for prompt assessment of her diabetic state, is she hypo or hyperglycemic. retrospect airway for any obstruction as she is dyspneic.\r\n succession conscious review offend level, duration and place of pain in the neck and medical history-hopeful to review current medications, with solicitude to evaluate current mental status such as orientation to person, sentence and place. Note that she is in acute distress with disorientation that is progressing to refractoryness ( geriatric nursing, 2010).\r\nIf unresponsive at the succession of arrival, the nurse involve to be vigil in looking for clues to how she is experiencing pain by looking for signs such as moaning, agitation, restlessness and nervus facialis grimacing. Assess skin is intact with no abscesses or open wounds or sores. Consider value of inserting a urinary catheter.\r\nTools that impart be habituated in the assessment of Mrs. Baker may include: Stethoscope- pass on be us ed for listening to heart discombobulate to experience dysrhythmia in a higher place 90 beat/ transactions would be indicative of concern and comparing radial tire/peripheral pulses with baseline of heart apex rate to ascertain if variance exists , auscultation of lungs for clearness of lung fields and respiratory rate should be 16 per minute if she is over 20 breaths/ minute concern for hyperventilation and oxygen preservation and consumption would arise . Tachypnea and dyspnea be noted, oxygen would be applied.\r\nblood pressure cuff (sphygmomanometer)- The blood pressure cuff impart determine if she is normotensive or hypo-hypertensive, expected range is 120/80 mmHg if below 90 mm hg systolic or 70mm hg diastolic is cause for concern. Glucometer-ascertain rapidly, blood serum blood glucose level range expected 70 †130 (mg/dL) before meals, and less than 180 mg/dL after meals (as metred by a blood glucose monitor).\r\nblood tubes with needle access for blood testing (vacutainers)-to conduct CBC- to monitor white blood cell, red blood cell and platelet counts, CMP- for unstable and electrolyte\r\n inst strength, kidney and liver function, ABG-, analysis for acid/base imbalance liver and cardiac enzyme for indication of liver or cardiac impairment as well as blood coagulation profile such as PT/INR/PTT- for elevation in bleeding time . Blood cultures and antibiotic sensitivities for sepsis pulse oximeter-to rapidly measure the oxygenation of her hemoglobin saturation 95 to 99 pct expected.\r\ncontinuous cardiac monitoring via electrocardiogram(EKG)-to examine rhythm and rate-expect normal sinus rhythm and rate 80-100 beats per minute. Thermometer-measure the core temperature which should be 37 c if above 38 c or below 36 c if hypothermic\r\n vesica catheterization kit\r\n boob x-ray- cardio pulmonary function\r\nThe benefits of using these tools, as time is critical for an older unhurried who has multiple\r\n reed organ dysfunction syndrome(MO DS), is to reserve precise and state-of-the-art training to\r\n effectively treat the patient. Maintaining and monitoring tissue perfusion would be signalise goals in\r\nher care and I would utilize these tools to evaluate blood pressure and respirations,\r\nmonitoring pulse and assessing for any cardiac arrhythmias. To evaluate for any implicit in(p)\r\nrespiratory disease, pneumonia, PE, or pulmonary edema a chest x-ray would be advantageous.\r\nA bladder catheter would give accurate accounting of urinary output.\r\nThe patient became unresponsive; her respirations became more labored, so breathing became the primary(prenominal) priority while reading the scenario. The patient is ineffective to verbalize how she is feeling and with her dyspnea it is clear she is in respiratory distress. Evaluating the electrocardiogram would be make to ascertain if there are any dysrhythmias that could be make the symptoms. I would review the vital signs, is the patient having hypo- hypert ension?\r\nReview the patient’s pain assessment, is the patient experiencing any pain? I would then review lab results, focusing on abnormal results. The prioritization was done with basis for basic needs first, that of breathing effectively to promote oxygenation then focus of vital sign monitoring that is compatible with sustaining life.\r\nI would assess pain in a geriatric patient who is agile by questioning the patient directly, do they imbibe any pain, asking them where the pain is, what is the duration of the pain and when was onset.\r\nOn a numeric pain surpass 0 to 10 what is their level of pain. Are they winning any pain medication at class? In a geriatric patient who is not alert, I would need to assess the patient establish on signs such as moaning, agitation, restlessness and facial grimacing. I would manage the pain in a geriatric patient experiencing multisystem failure and showing signs of pain but not alert with caution.\r\nThe elderly are susceptible to polypharmacy and often have impaired renal function that increases risk or potentiates the medication such as barbiturates. Knowing I have a standing order for acetaminophen and by appraisal of the pain with a lot of moaning, restlessness and grimacing, I would elect to give the morphine 0.1mg/kg IM. She cannot frivol away the acetaminophen by mouth as she not responsive, the 0.05 mg/kg Morphine IV provide liable(predicate) obtund the patient with the rapid ingress and apparent decrease her blood pressure ill as she is dehydrated.\r\nThe patient’s pain level would need to be reevaluated approximately 20 proceedings after administration for effectiveness and then again in one hour. It is likely with her being unconscious(p) , I would assess by a front man or lack of grimacing, moaning or agitation. I implant her to have been relieved of pain when reassessing her I have learned it is very important to recognize the daintiness of the elderly related to polypharmacy , agedness of vital organs, key focus on concern of\r\ncognitive ability and its role in assessment by nursing.\r\nIt is likely that the metformin (Glucophage) can have decreased personal effects when combined with Hydrochlorothiazide (diabetes forum, 2012). The patient recently added lisinopril to her regimen and this in the form of Zestoric has hctz in it as well. It is possible she has had too much hctz and the prescribing doc needs to be alerted. The recommendation for this possible interaction is to monitor blood sugar levels when taking all triad of these medications.\r\nThis is especially important when starting, stopping or ever-changing the dosage of your lisinopril/HCTZ. The collaborative group members disposed(p) to her care are the jot room physician for immediate assessment, diagnosis and treatment recommendation, the medical physician involved in her current care, possibly an endocrinologist who is managing her diabetes, a pulmonologist or intensivist who is caring for her current state as a consultant and the radiologist and cardiologist who will review her lab, radiology and EKG results.\r\nIn the offspring where her status became unconscious the respiratory therapist and emergency room physician and ER code team responded to facilitate returning her to stable vital signs. It is likely she will need social work troth and discharge care planning as she will be admitted until the current situation is diagnosed, treated and stabilized.\r\nReferences\r\nGerontological Nursing: Competencies for Care, Second Edition, 2010. http://www.diabetesforums.com/forum/type-2-diabetes/48316-lisinopril-hctz-20-12-a.html accessed November 24, 2012.\r\n'