MS JIMENEZ FAILED SUICIDE ATTEMPT CASE STUDY
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
GENDER Female
AGE 56
SETTING Hospital
ETHNICITY Hispanic
CULTURAL CONSIDERATIONS
PREEXISTING CONDITIONS Motor vehicle crash (MVC) eight weeks ago with no injury; depression
COEXISTING CONDITIONS Suicide attempt; metabolic acidosis
COMMUNICATION
DISABILITY
Ms. Jimenez (Part 1)
SOCIOECONOMIC Financial difficulties secondary to divorce five years ago; nonsmoker
SPIRITUAL/RELIGIOUS
PHARMACOLOGIC
4-methylpyrazole (Fomepizole; Antizol); pyridoxine hydrochloride (Vitamin B6); thiamine (Vitamin B1); succinylcholine chloride (Anectine); levalbuterol (Xopenex); lorazepam (Ativan); propofol (Diprivan, Disoprofol); etomidate
LEGAL
ETHICAL
ALTERNATIVE THERAPY
PRIORITIZATION
Medical stabilization
DELEGATION
Overview: This case addresses the medical consequences of a failed suicide attempt. The nurse’s understanding of the effects of ingesting ethylene glycol (antifreeze) is essential for prioritizing care, interpreting lab and arterial blood gas results, and identifying the purpose of prescribed medications.
Client Profile
Ms. Jimenez is a 56-year-old woman who has been having financial difficulties since her divorce five years ago. She was recently involved in a motor vehicle crash (MVC) in which she drove over a curb and hit a telephone pole. She did not sustain any significant injuries in the MVC. Today, Ms. Jimenez’s daughter Maria returned home at 8:00 p.m. to find Ms. Jimenez sitting on the floor with a decreased level of consciousness. Maria was able to shake her mother awake. With slurred speech, Ms. Jimenez told her daughter that she drank three large glasses of antifreeze (ethylene glycol) at around 7:00 p.m. Maria called 911 and emergency medical services transported Ms. Jimenez to the local emergency department.
Case Study
Upon arrival to the emergency department, Ms. Jimenez is afebrile with a rectal temperature of 97°F (36.1°C). Her other vital signs are blood pressure 135/85, pulse 68, and respiratory rate 24. Her initial arterial blood gases (ABGs) on a 15 liters per minute non-rebreather revealed a pH of 7.19, partial pressure of carbon dioxide (PaCO2) of 13 mmHg, partial pressure of oxygen (PaO2) of mmHg, bicarbonate (HCO32) of 5 mEq/L, and oxygen (O2) saturation of 100%. Ms. Jimenez is sedated in the emergency department using etomidate. She is intubated and put on a mechanical ventilator. A Foley catheter is inserted. She receives succinylcholine chloride, lorazepam, and propofol. Her oxygen saturation is 92% on an FIO2 (fraction of inspired oxygen) of 70%. The health care provider’s physical examination reveals no abnormal findings. The neurological exam is deferred because Ms. Jimenez is intubated and sedated. An electrocardiogram (ECG, EKG) shows that Ms. Jimenez is in a normal sinus rhythm. A chest X-ray (CXR) shows no infiltrate and proper endotracheal tube placement. A urinalysis shows a specific gravity of 1.010, a small amount of occult blood, 3 to 5 white blood cells per high-power field (HPF), a few bacteria per HPF, and a mod-erate amount of uric acid crystals and urine calcium oxalate crystals. A urine culture & colony count was negative (no growth). Her blood alcohol level is less than 10 mg/dL. Her ethylene glycol level is 36 mg/dL. Her complete blood count (CBC) is within normal limits except for a mean cell volume (MCV) of 79.2 μm3. Troponin level is 0 ng/mL, creatine kinase (CK) is 182 U/L, and creatine kinase cardiac isoenzyme (CK-MB) is within normal limits (WNL). Serum osmolality is 392 mOsm/Kg. Her elec-trolytes are WNL except for a serum bicarbonate of 7 mEq/L. She has an anion gap of 29 mEq/L, blood urea nitrogen (BUN) of 25 mg/dL, and creatinine of 1.4 mg/dL. Her liver function tests are WNL. Ms. Jimenez is admitted to the intensive care unit (ICU) and prescribed intrave-nous (IV) fluids of normal saline with 2 ampules of bicarbonate at 125 mL per hour. The medications prescribed for her include 4-methylpyrazole IV every 12 hours, thiamine 100 mg IM, and levalbuterol treatments. Lab work prescribed includes CBC, electrolytes, ethylene glycol levels, basic metabolic panel (BMP), creatinine level, acetone level, and urinalysis. In the ICU at the bedside, a Quinton dialysis catheter is surgically inserted in the right internal jugular vein for emergency dialysis and placement of the Quinton catheter is confirmed by CXR.
Questions
- What is ethylene glycol? What products contain ethylene glycol?
- Discuss the potential effects of ingesting ethylene glycol (antifreeze).
- What is a “half-life”? Explain the half-life of ethylene glycol and how ethylene glycol is cleared from the body.
- Jimenez’s ethylene glycol level is 36 mg/dL. What is the lethal dose of ethylene glycol?
- Discuss the rationale for why Ms. Jimenez is receiving 4-methylpyrazole. What is a drawback of this medication?
- If 4-methylpyrazole is not available, what is the next most effective treatment for ethylene glycol poisoning? Discuss how this treatment is admin-istered and what should be monitored during administration.
- If Maria had come home earlier and Ms. Jimenez was found within half an hour of drinking the anti-freeze, what three interventions could have been considered to decrease the progression of the toxic effects of the ethylene glycol?
- Briefly describe the indication for each of the following medications Ms. Jimenez received during her initial medical treatment: thiamine, succinylcho-line chloride, levalbuterol, lorazepam, propofol, and etomidate.
- Why were intravenous (IV) fluids of normal saline with 2 ampules of bicarbonate at 125 mL per hour prescribed as part of the medical management of Ms. Jimenez?
- Complete an analysis of Ms. Jimenez’s initial arterial blood gas (ABG) results while on 15 liters of oxygen via non-rebreather. Are her ABG’s consistent with those expected for a person with an ethylene glycol overdose?
- Why was Ms. Jimenez intubated and placed on a mechanical ventilator?
- Jimenez is on a mechanical ventilator set on assist-control of 14, respiratory rate of 28, volume 650, oxygen 40%, and a PEEP of 5. What does each ventilator setting indicate?
- The respiratory rate on a mechanical ventilator is usually set between 10 and 14 breaths per minute. Why is the rate for Ms. Jimenez set at 28 breaths per minute?
- Which of Ms. Jimenez’s laboratory results below are most significant in the determination of a diagnosis of ethylene glycol poisoning?
- Urinalysis: specific gravity of 1.010, small amount of occult blood, 3 to 5 white blood cells per HPF, a few bacteria per HPF, and a moderate amount of uric acid crystals and urine calcium oxalate crystals.
Urine culture & colony count was negative (no growth)
Serum osmolality is 392 mOsm/Kg
Bicarbonate of 7 mEq/L
Anion gap of 29 mEq/L
BUN of 25 mg/dL
Creatinine of 1.4 mg/Dl
- Explain how a Wood lamp could be used to help confirm the ingestion of ethylene glycol.
- Briefly explain what Ms. Jimenez’s troponin, CPK, and CK-MB indicate.
- Why did Ms. Jimenez’s prescribed laboratory tests include an assessment of her liver function?
- What is a Quinton catheter and why was one inserted?
- Prioritize three nursing diagnoses that are appropriate to include in Ms. Jimenez’s plan of care
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). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. 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. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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