iHuman Patient Alfred Manning
iHuman-Patient Alfred Manning
iHuman:Patient Alfred Manning
iHuman Patient Alfred Manning
Prework
A 25 year-old male
... [Show More] paraplegic who arrives at the emergency department via private car. Over the past two days, he has experienced an increase in nasal congestion, headache, and diaphoresis.
1. What are your primary concerns for this patient and what assessments and interventions would be associated with your concerns? Why?
My primary concern will be associated with the headache. Maybe he has an increase in intracerebral blood pressure. So I will first assess his mental status, senses, and balance. Sometimes we can tell high intracranial pressure by looking at the eyes with an ophthalmoscope. (spinal tap (lumbar puncture) can also be done.
The patient can also be assessed for ingrown toenail, constipation, hemorrhoids, UTI, sexual stimulation and kidney stones (Lewis et al., 2017).
Interventions:
• Blood pressure needs to be monitored frequently because of paroxysmal hypertension (unstable high blood pressure)
• identify and monitor what precipitated the symptoms
o sit up patient straight (this helps move more blood to the lower body and ease blood pressure) or in bed with neutral head position
o loosen or take off any tight clothing or accessories
o empty bladder
o in case of constipation use digital stimulation to empty bowel
• observe for changes in vital signs such as bradycardia or tachycardia.
• Assess for chest pain, nausea, blurred vision
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2017). Medical surgical nursing: Assessment and management of clinical problems (10th ed.). Mosby.
2. What do you anticipate the patient’s home medications prior to admission might be? Why?
Vitamins, laxative, skin barrier, baclofen because of its antispasmodic effect.
Stool softener, blood pressure medication, antacid, blood thinner, antianxiety meds, anti-depressive meds.
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis's drug guide for nurses (16th ed.). F.A. Davis.
3. What medications do you anticipate the healthcare provider would prescribe while the patient is in the hospital? Why?
Antihypertensive, calcium channel blocker such as nifedipine, or ACE Inhibitor such as captopril, or an alpha blocker such as prazosin. These medications work by relaxing the blood vessels so that blood can flow more easily through the body.
Antihistamine plus some of home medication.
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis's drug guide for nurses (16th ed.). F.A. Davis.
4. What medications do you anticipate the healthcare provider prescribing for the patient’s discharge? Why?
Antihypertensive.
Meds from questions 2 and 3.
Nurses note
Alfred Manning, a 25 year old male is paraplegic. He arrived at the emergency department via private. Over the past 2 hours, he has had an increase in nasal congestion, headache, and diaphoresis. Alfred suffered a spinal cord injury at T44 4 years ago in a snowmobile accident which was surgically stabilized.
Height/weight: 6’2’ 176 lbs
Temp: 37.c
Pulse: 42
RR: 30
SpO2: 94%
BP: 202/104
Pain: 7/10
Skin: diaphoresis above the nipple line, red botches on the skin above the nipple line, cold, clammy skin below the nipple. Capillary refill less than 3 seconds in toes and fingers, skin rapidly returns to baseline after pinch test.
HEENT: no visible scaliness, edema, masses, lumps, deformities, scars, rashes, nevi or other lesions. Non tender.
Head is normocephalic, atraumatic, no deformities, facial feature symmetric, temporal arteries non-tender to palpation, frontal and maxillary sinuses non-tender.
Eyelids: no ptosis erythema or swelling, conjunctivae is pink, no discharge. Sclerae is anicteric, orbital area has no edema, redness, tenderness or lesions noted.
Ears: no deformities, edema, or discharge noted. Tympanic membrane translucent, non-injected and pinkish gray in color. No scarring, discharge or purulence noted.
Nose: no discharge or polyps, no edema or tenderness over the frontal or maxillary sinuses.
Lymphatic: no pathologically enlarged lymph nodes in the cervical supraclavicular, axillary or inguinal chains.
Chest wall and lungs: chest is symmetrical, excursion with respiration is symmetrical and there are no abnormal retractions or use of accessory muscles. No distention, scars, masses or rashes. Lungs are clear x all lobes.
Cardiac: bradycardic at 42bpm, regular rhythm and 2+
Musculoskeletal: the patient is wearing compression stockings which are wrinkled behind the calves. No rigidity noted.
Neurological: none of the following involuntary movements: fibrillations, fasciculations, asterixis, tics myoclonus, dystonias, chorea, athetosis, hemiballismus, nor seizures.
GI: abdomen is flat and symmetric with no scars, deformities, striae or lesions. No hepatosplenomegaly, no distension noted to bladder.
GU: no masses or urethral discharge
Rectal: no visible fissures, induration or lesions.
Recommendations: administer antihypertensive, monitor blood pressure closely, send labs. Physician needs to see the patient. [Show Less]