[Institution Title]
Clinical Case: Patient W.R.
The priorities of care
The first priority in relation to provision of care in the case of patient W.R is relieving him of the discomfort brought about by perceived unrelieved indigestion. The second priority is to address the elevated blood pressure of the patient. Finally, the third concern would be to transfer W.R to the Regional Medical Center so that he could be subjected to cardiac catheterization and given proper medical attention.
The Admission VS
For a man his age, the vital signs of W.R., in particular of his blood pressure recorded at 200/124 is not normal. The blood pressure of the patient is highly elevated which can potentially put the patient at risk for a heart attack or a stroke.
Five Priority Problems for dealing with Patients like W.R
The five priority problems in the case of the patient include the following: (a) high blood pressure, (b) possible emphysema, (c) obesity, (d) possible ingestion or heartburn, and (e) behavioral health issues.
Lab Tests that Might be Ordered to Investigate W.R’s Condition
Personally, I would recommend that the Stat 12 lead EKG be conducted to the patient to assess the patient’s heart and what caused the client’s elevated blood pressure. There is the necessary to know and why the heart has trouble relaxing
Significant Lab Test that is Missing in the Previous List
I would recommend an ECG to check whether the client I encountering any problems relating to the electrical activity of the heart. This would help determine the reason for the patent elevated blood pressure.
Responding to W.R’s Angry Demand for Cigarettes
Reasons for the use of Morphine in the case of W.R and Precautions taken
The major reason for prescribing morphine in this case is to relieve W.R of the indigestion problem he is experiencing. In certain cases, morphine is used to manage problems resulting from blockage in the stomach or challenges experienced as a result of bowel obstruction. Mr. W.R is also experiencing addiction to smoking cigarettes; in this aspect, morphine could have been used to improve his brain performance and modify how he feels as result of lack of cigarettes.
Special Consideration in the Administration of Morphine
The precautions considered before administering morphine in the case of W.R include: Determination of whether he has any heart problems such as rhythm challenges, breathing problems and if he is suffering from any kidney problems (Sneddon, 2003). It would also be appropriate to determine whether W.R is epileptic before administration of morphine. Morphine is habit forming particularly among drug addicts; hence it would be imperative to ensure that the drug is administered with extra caution on W.R, informing him of the risks associated the use desire to use more morphine (Sneddon, 2003).
Symptoms of Angina and why this Information is important to W.R
The symptoms of angina that I would want to inform W.R about include: Dizziness, shortness of breath, fatigue, sweating, chest pain and nausea. These are the symptoms that I would describe to W.R. Informing him of these symptoms is crucial as it will lead to prevention of unstable angina that may lead to heart attack.
Safety Instructions that I would give W.R before leaving his room
I would advice W.R to ensure that he gets maximum rest; in addition, I would inform him to raise the alarm in case of any abnormal pain. Consequently, I would information W.R not to interfere with any medical equipment in his room or consume any medication apart from the ones that have been prescribed for his use.
Responding to the House-keeper
I would inform the house-keeper of the importance of restricting treatment to specific guidelines applicable in the provision of care to patients such as W.R. I would also ensure that I provide advice in regard to the impacts of giving a cigarette addict patches of nicotine in the event of treatment.
Dosing Nicotine Patches
In relation to provision of nicotine patches in the case of W.R, the first step involves provision of 14mg patches over a period of 24 hours. The next step involves provision of 14 clear patches, followed by a two-week kit where the major focus would be subjecting W.R to the STOP SMOKING AID programs accompanied with behavior modification program.
Response to Mrs. R
It is important to acknowledge that W.R did not suffer from heart attack; in this regard, the first response would involve informing Mrs. R that her husband did not suffer from a heart attack. In addition, it would be crucial to advice Mrs. R that heart attacks can be prevented through proper medical care and healthy lifestyle and since her husband is under the watch of medical professionals, there is no need to panic.
Information that I would gather
In an event that I enter W.R’s room and he mentions that is left shoulder is aching, I would ensure that I inquire whether there are other pains or challenges he is experiencing apart from the aching of the left arm. I would also check his blood pressure and palpitation. Some of the most important questions I would ask W.R in this regard include: Do you feel shortness of breath? How long have you been feeling the pain? Do you feel any chest pain? What other challenges are you experiencing?
Information that would be reported to the Physician
I would inform the physician of the challenges experienced by W.R, for instance: The pain on the left shoulder, any other pain or medical challenges he might have experienced, medications or care that had been provided to W.R before he began to experience the challenges and the approximate time at which he began feeling the challenges. Provision of this information is important as it provides an appropriate platform for the physician to determine the most effective course of action to be taken in the case of W.R.
“Medically” treating W.R. and other approaches that could be used to treat Coronary Artery Disease
Treating W.R medically entails the use of drugs and other relevant medical technologies in order to manage his condition. Other approaches that could be used to treat W.R include: Provision of behavioral therapy where he is guided on how he can lead a healthy lifestyle, how to quit smoking and engaging in physical exercise.
Characteristics of W.R that makes him vulnerable to Coronary Artery Disease
J.B’s Clinical Case
1. Five Major Risks and Potential Complications for J.B
2. Expecting Drainage after Abdominal Surgery
Yes. The drainage should be expected after the surgery. This is because whenever there is a space in the human body, it reacts by filling the space or gap with fluids referred as serious fluids. In certain cases, the drainage is usually left at the surgical area in order to reduce the potential of seroma development.
3. Reasons for traditionally performing the first Post-Op Dressing
There are two major reasons why the physician performed the first post-op dressing change; it reduces the chances of developing blisters around the wound surgical wound. In addition, it reduces the probability of surgical wound infection.
4. Findings on the Colostomy Rosebud
The findings do not concern me. This is because the dark edge of the colostomy is an indication of drying skin and other waste products that might have emerged from the wound. However, the middle section of the rosebud that looks pink because it might have been in contact with the intestines, which is usually pink in color.
5. Five Nursing Management Activities that could be implemented in order to Prevent or Reduce Potential Side Effects for J.B
One of the nursing activities that I would implement in order to reduce potential side effects for J.B involves limiting her mobility. In addition, I would ensure that J.B does not consumer large amounts of fluids in order to prevent over-hydration that could facilitate internal bleeding. Furthermore, I would assess and determine whether J.B is experiencing certain condition such as nausea or any abnormality that might affect her health condition; this will ensure that appropriate actions is taken in order to reduce or prevent identified conditions. It would also be important to provide J.B with the best nutritional advice. Consequently, I would ensure that J.B is provided with appropriate medication in order to prevent occurrence of certain side-effects.
6. Taking Action in Relation to Delayed Delivery of TPN Infusion
In relation to delays of TPN infusion bottles, it would be pertinent to explore alternative courses of actions that would still fulfill similar roles as the infusion bottle. It is important to acknowledge that at this point, J.B’s case is not considered urgent, although it is crucial to ensure that strict medical guidelines are followed for her successful recovery.
7. Actions taken
8. Responding to J.B’s regrets
It is apparent that a significant number of patients, particularly those that have been subjected to surgical treatment are usually worried about their successful recover. Such incidences require proper counseling characterized with encouraging the patients that they have been provided with the best medical care and they will recover effectively. This is the type of response that I would apply in the case of J.B, informing her that the medical care she has received was effective, she will recover and live a normal as well as a happy life.
References
Després, J. P., Lemieux, I., & Prud'Homme, D. (2001). Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ: British Medical Journal, 322(7288), 716.
Sneddon, L. U. (2003). The evidence for pain in fish: the use of morphine as an analgesic. Applied Animal Behaviour Science, 83(2), 153-162.
