Managing Care of Multiple Patients
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Managing Care of Multiple Patients
You are assigned to care for the following 5 patients on a medical-surgical unit. Your team consists of yourself, a new LPN still on orientation, and a UAP.
Patients
© Luevanos/iStock/Thinkstock. M.S. is an 81-yr-old woman who came to the United States from India 4 years ago with her daughter, son-in-law, and their 4 children. She speaks minimal English, relying on her oldest granddaughter to translate. M.S., who has a history of diabetes, was admitted to the hospital yesterday with a diagnosis of heart failure. © Thomas M Perkins/ Shutterstock. M.L. is a 60-yr-old Asian woman who was admitted to the hospital with a diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD). She is receiving O2 at 2 L/min via nasal cannula. Her condition is currently stable. © azndc/iStock/ Thinkstock. C.L. is a 73-yr-old Taiwanese woman who was brought to the ED by her son. Her chief complaint is shortness of breath. She has a history of COPD, hypertension, and diabetes. She was diagnosed with community-acquired pneumonia, which is being treated with IV antibiotics. © azndc/iStock/Thinkstock. K.C. is a 280-lb (127-kg) 68-yr-old black man with diabetes who was admitted for incision and drainage of a right abdominal abscess. He is being discharged on his second postoperative day. His daughter will assist with dressing changes at home. © JPC-PROD/iStock/Thinkstock. C.M. is a 78-yr-old woman who was admitted from the ED after falling and fracturing her right hip. She is in Buck’s traction and is scheduled to undergo surgical repair later this morning. She has a history of substance use, and her blood alcohol content (BAC) was 120 mg/dL (0.12 %) on admission. The night nurse reports that she has been confused and restless overnight.
Discussion Questions
Priority Decision: After receiving report, which patient should you see first? Provide rationale.
Collaboration: Which morning task(s) could you delegate to the LPN (select all that apply)?
Obtain a capillary blood glucose reading on K.C.
Assess C.L.’s IV site for signs of phlebitis or infiltration.
Access the hospital’s available translation services for M.S.
Provide discharge teaching on wound care for K.C. and her daughter.
Titrate M.L.’s O2 to obtain a pulse oximetry reading of 95% (as ordered by the HCP).
Priority and Collaboration: When you and the LPN enter M.S.’s room, you find her sitting up in bed with labored respirations. Although you cannot understand what she is saying, you note that she is unable to say more than a few words without stopping for a breath. Which initial action would be the most appropriate?
Give M.S.’s cardiac and respiratory medications and reassess her in 30 minutes.
Ask the LPN to stay with M.S. while you go to the nurse’s station to call the HCP.
Have the LPN find M.S.’s granddaughter so that she can translate what M.S. is trying to tell you.
Ask the LPN to obtain an O2 saturation and vital signs while you perform a respiratory assessment.
Case Study Progression
M.S.’s assessment reveals bibasilar crackles, 2+ dependent pitting edema, BP 175/84, pulse 116, RR 32, temp 36.8°C, and pulse oximetry 88% on room air. You apply O2 at 4 L/min via nasal cannula and obtain an order from M.S.’s HCP for furosemide 40 mg IV stat. After giving the diuretic, M.S.’s granddaughter arrives and you discuss her grandmother’s condition. She tells you that her grandmother asked her to bring in potato chips and soda yesterday. She did not think her grandmother should be eating salt, but M.S. insisted that the dietitian said that she could eat them.
On further investigation, the dietitian tells you that an interpreter (translator) was not available when she saw M.S. yesterday. Because the dietitian did not understand what the patient was saying, she could not respond to her questions. She planned to visit M.S. today when the granddaughter is present. Being a culturally competent nurse, you realize that M.S. most likely interpreted the dietitian’s silence as
agreement with what A.Z. was asking.
demonstrating a lack of respect for A.Z.’s wishes.
a lack of understanding by the dietitian as to what she was asking.
a need for the dietitian to get more information before answering her questions.
Which assessment findings may suggest elder mistreatment by C.L.’s son with whom she lives (select all that apply)?
2 sacral ulcers
Asking when her son is coming to visit
Multiple small bruises on her forearms and shins
Matted hair, poor oral hygiene, overgrown toenails
C.L. becomes totally silent when her son comes to visit
Knowing that C.M.’s confusion and restlessness overnight may indicate acute alcohol withdrawal, you perform a more thorough assessment. Your assessment reveals a score of 11 on the Clinical Institute Withdrawal Assessment for Alcohol Scale. To prevent alcohol delirium, you plan to give which medication per the HCP’s order?
morphine
naloxone
lorazepam
IV thiamine
Priority Decision: You assess C.M. and find her trying to pull out the IV line and remove the Buck’s traction. What action should you do first?
Have the UAP stay with C.M.
Ask C.M.’s daughter to stay with her.
Obtain a restraint order from the HCP.
Move C.M. to a room closer to the nurse’s station.
Management Decision: The UAP informs you that the LPN is not following C.L.’s fall risk protocol. What is your most appropriate action?
Notify the unit manager as soon as possible.
Ask the UAP to explain hospital protocol to the LPN.
Write up the LPN’s actions so they will be included in her evaluation.
Talk to the LPN about the importance of following protocol to prevent C.L. from sustaining a fall-related injury.
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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