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Topic: a case study
Details: Case Study #1 –
A 69-year-old client in the medical intensive care unit has been diagnosed with acute respiratory distress and altered mental status. The client’s medical history includes asthma, hypertension, and diabetes. She is intubated and receiving multiple vasopressor medications for hypotension.
At 1200 hours: The client’s ventilator alarm sounds with the high-pressure alarm, and is found to be agitated, unresponsive to commands, demonstrating extreme facial grimaces localized to pain, and restless, with excessive movement of extremities noted. Vital signs include heart rate 125 beats/min (100 beats/min at 0800), respiratory rate 35 breaths per minute, BP 150/99 mm Hg (120/75 mm Hg at 0800), and SpO2 85% (down from 100% at 0800).
At 1205 hours: BP increases to 185/110 mm Hg, with a mean arterial pressure of 135 mm Hg. The monitor displays sinus tachycardia at a rate of 140 beats/min. The client has prescribed medication infusions of norepinephrine (10 mcg/min), fentanyl (75 mcg/hr), and lorazepam (2 mg/hr).
Fill in the matrix below. Then write up your rationales for each, in paper format, utilizing the case study rubric. * Do not copy and paste the case study in your paper. Write up the paper, and then attach your matrix as an appendix. Make sure to use full sentences, and write a paper.
Based on the 1200- and 1205-hour assessments and nursing notes, use an X to identify “Indicated” (appropriate or necessary), “Contraindicated” (could be harmful), or “Nonessential” (makes no difference or not necessary) nursing interventions to manage the client’s current condition.
Suction as needed
Provide additional oxygen
Increase norepinephrine drip to 15 mcg/min
Increase fentanyl drip to 150 mcg/hr
Increase lorazepam drip to 4 mg/hr
Assess mental status
Use APA 7th edition, and use in-text-citation and the references must not be more than 5 years (from 2015 up to date). Please follow the instructions and the rubric attached.
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