Emergency Nursing Blog: April 2013

Sunday, April 21, 2013

Pediatric HW 3

For EN II
HW 3
The deadline is 28/4/2013

Please answer the following questions

Ali is 6 months old and presents to your busy clinic accompanied by his father. His father describes Ali as being unwell throughout the day with a history of intermittent vomiting. He thinks that he might have some pain as he has been crying and drawing up his legs. Ali is the first child in the family and Dad is very concerned.

1. What are your first impressions – describe your ‘hands off’ assessment at this point?
(20 Marks)
2. What potential differential diagnosis could you be thinking of at this time any why? (20 Marks)
Physical examination and history reveal the following:
History: Full term breast fed baby, immunizations up to date, no illnesses or health problems to date.
O/E: pale, slightly lethargic infant
Temp 38, HR 160, RR 35, BP: difficult to obtain, SaO2 98% CR > 2sec Weight, 6.5 kg
Urine Output: 2 wet nappies in the last 24hrs, no diarrhea
Abdomen: no masses palpable, examination appears to aggravate the baby

3. Does your examination alter your initial impression or priority assigned to Ali? Why?
(20 Marks)
4. Construct five nursing Diagnoses for Ali (15 Marks)

5. What would your course of management be for Ali? Include any interventions, investigations, consultation. (25 Marks)

Adult I HW 3

For EN I
HW 3
The deadline is 28/4/2013
please answer the following questions

Fatma, age 45, was admitted to the emergency room following a major automobile accident in which her husband was killed. She had massive abdominal injuries and a fractured femur. She was taken immediately to surgery for repair of a lacerated liver and perforated ileum. She had two units of blood during surgery and two units while she was in the recovery room. The fifth unit of blood was discontinued in surgical intensive care because she developed a transfusion reaction.
On the day after surgery, her urine output declined to 10-20 ml/hr. Increasing her fluid intake with plasma expanders and blood did not increase her urine output. Lab results indicated an elevated urinary sodium, BUN 70 mg/dl, and serum creatinine 4 mg/dl.
Her urine output stabilized at 20-25 ml/hr on the third day after surgery. She was diagnosed as having acute tubular necrosis.
Because of a persistently elevated serum potassium and severe hypertension (BP 190/120), she was started on hemodialysis using an external cannula. She resented all the “plumbing” in her body and expressed a desire to die.

1. What are the possible causes of acute tubular necrosis that Fatma developed? (20 Marks)
2. What clinical indicators that Fatma is in the oliguric phase of acute renal failure?
3. What are the critical nursing assessments indicated when caring for Fatma?
4. What are the priority nursing diagnoses for Fatma?
5. How could you assist Fatma in dealing with her depression?
6. What are the usual indications for using hemodialysis in the management of acute renal failure?
7. Fatma wants to know if she is going to be on hemodialysis for the rest of her life. How would you answer this question?
8. What is the nursing care of the external cannula when not in use?
9. What is the goal of medical and nursing management of this patient?