Patient Care
Chamberlain University
NR 341 Complex Adult Health
March 2018
Running Head: INTERDISCIPLINARY CARE
2
Background Information
Mrs. J.E. is a 62-year-old African American female. She has a significant other with two children.
She was admitted on 03/10/2018 at the emergency room. She is a full code. No allergy to medications.
She smokes a pack of cigarettes daily, she drinks about four to five glasses of wine daily and she does
combination of heroin and pain killers medications. The main reason why the patient was admitted was
due to shortness of breath and opiate overdose.
Past medical history for Mrs. J.E. are asthma, hypertension, urinary incontinence, UTI and
diabetes mellitus Type II. Patient had knee replacement on the right knee about five years ago, had a
cyst removal on the right breast, but the biopsy came back benign.
The patient present diagnosis is bilateral pulmonary infiltrate suspect opiate overdose.
According to Lilley L, (2017)., Act as agonists–drugs that stimulate receptors in the body. They are
central nervous system depressants, risk for respiratory depression and dependency associated with
opiate use. opiates and opioids do create a slowing of your respiration, your breathing, and if it slows
too much it creates severe respiratory depression.
Significant assessment findings during the day of care includes vital signs which include blood
pressure is 98/58mm hg on the right arm laying supine, oral temperature 98.9F, respiratory 8 breaths
per minute, weight of 146 pounds, radial pulse recorded is 40 beats per minute pulse and oximetry
recording of 88% on room air. Focused assessments include odor of alcohol on breath, odor of smoke
on clothing. Intoxicated behavior during examination. Patient had Slurred speech, inflamed nasal
mucosa, Gingival ulceration notice, skin color warm to touch, laceration and bruises all over the
abdomen, legs and arms. Patient was alert and oriented to person.
PERRLA was present, pupils were not equal, react to light and accommodative. Breathing was labored,
evidence of shortness of breath indicated, shallow reparations, dyspnea indicated.
Wheezing indicated with auscultations, Respiratory depression indicated.
Laboratory and Diagnostic Tests
The significant laboratory values performed are as follow.
Test
7.20/7.39
Result
Reference Range pH
7.35 -7.45
Pco2
60/37
35-45
Po2
50/135
80-100
Running Head: INTERDISCIPLINARY CARE
Bicarbonate
18/22
22-26
Sodium
135-145
145
3
Potassium
3.2
3.5-5.0
Urea Nitrogen
29
10-20
Creatinine
1.2
0.7-1.5
RBC Count
3.9
4.7-6.1
WBC count
9.5
5-11
Hemoglobin
12.0
12-16
Hematocrit
37
40-48
Platelet Count
120
150,000-400,000
Urinalysis
Opiate positive
The diagnostic test or procedure performed EKG, Chest X-ray. EKG showed sinus bradycardia,
prolonged PR and QTc intervals. Chest X-ray showed a hazy infiltrate lower lobe. The treatment that
was done which was not successful because she did not respond naloxone, due to that, intubation
was done and between two to three hours after the arrival in the emergency room, she was
transferred to ICU.
Medication
According Vallerand, A. H., (2015). These are the lists and summary of relevant,
significant medication, and the information’s given.
Drug Name
Classification
Therapeutic Use
Adverse Effect
Nursing
Implication
Metformin
combined with
Trade:
sulfonylureas,
Fortamet, Glumetza,
taste. symptoms of
Antidiabetic
vomiting, unpleasant
Maintenance of
Abdominal bloating,
blood glucose
diarrhea, nausea,
observe for signs and Glucophage, Riomet
When
oral
metallic
h
ypoglycemic reactions. Monitor renal function before initiating at least annually during therapy.
Hydrochlorothiazide
Antihypertensives,
Lowering of blood
Hypokalemia, Monitor BP,
intake,
Trade:
diuretics
pressure in
dizziness, drowsiness,
output, and daily weight
Microzide, Oretic,
hypertensive
lethargy, weakness,
and
assess feet for
Urozide
patients and
edema daily.
diuretic with
Monitor BP before and
mobilization of periodically during edema.
therapy.
Assess patient for
The dosage and route of administration are Metformin 500mg twice a
day orally, Hydrochlorothiazide 25mg daily orally, Enoxaparin 40mg
subcutaneously, Oxybutynin 5mg three times daily. Albuterol 2mg orally twice
daily, Salicylates 81mg orally and Morphine 2mg, IV push every 4 hours PRN.
Nursing Diagnosis
Ineffective airway clearance related to sedating or paralytic effects of
drugs evidence by non-responsiveness and using Narcan to revive the patient. The
nursing outcome for the patient will be, patient will improve a patent airway, and
keeping the patient calm and comfortable. Patient will maintain a patent airway
at the end of the shift. A long-term care will be patient will demonstrate an
effective coughing and clear breath sounds by the end of the day. The nursing
interventions will be monitoring of blood gas values and pulse saturation levels.
Normal ABGs values of PO2 are 80-100mm Hg and a PCO2 of 35-45mm Hg. An
oxygen saturation of less than 90% indicates problems with oxygenation.
Hypoxemia can result from ventilation perfusion.
Ineffective health maintenance related to inability to make deliberate
and thoughtful judgement evidence by drug overdose. The nursing outcome for
the patient will be improving health promoting behavior and health seeking
behavior. The nursing interventions will be referring the patient to community
agencies for appropriate follow up care. It is known that social support has been
related to decrease mortality rate. Making sure that a follow up appointment is
schedule before her discharge, by discussing with the patient to make sure that
the appointment is kept.
Risk for suicide related to substance abuse evidence by Statements of
helplessness, despair.Nursing outcome will be patient will remain safe while in the
hospital, with the aid of nursing intervention and support. The nurse intervention will be
encouraging the client to speak freely about feeling and help plan alternative ways of
handling disappointment, anger and frustration. The rationale will be giving the client the
power to learn ways of dealing with strong emotions and gaining a sense of control.
Interventions- Routine Nursing Management
Due to the patient condition, the nursing management will be staying
with an unresponsive patient and not be distracted by anything other than
performing resuscitation. Vital signs were taken such as heart rate, blood
pressure, oxygen saturation and temperature were carefully monitored.
Naloxone the antidote was used to reverse the opiate effects.12- lead ECG test
was done to initiate continuous ECG monitoring.
Maintaining a patent airway was the priority. The patient was position in
high fowler position. Mechanical ventilation was using to move air in and out of
the lungs. Indwelling catheter was placed instantly. Monitoring for any changes
or improvement. IV access was established immediately and initiated fluid
placement. Obtaining information about the type of substance abuse, the route
it was used, when taken, the amount taken or any combination of substance
abuse.
Drug levels or comprehensive toxicity screen was obtained. Obtained
health history and any allergies from the patient. Monitor level of consciousness
and oxygen saturation. The patient was monitored closely because naloxone has a
shorter duration of action and been aware that the patient may have had mixed
drug ingestion that does not respond to opioid antagonists.
Safety precaution was constantly use by the health providers, constantly asking the
patient and checking the name band for the name and date of birth before any
treatment was done, hand hygiene was done. Patient was monitored continuously for
neurologic status, including level of consciousness, monitoring respiratory function and
cardiovascular function was very critical to make sure that the patient was stable.
Collaborative Management – Interdisciplinary Care
The interdisciplinary team members that came together to take care of Mrs. J.
E. were respiratory therapist, nurse, emergency medical doctor, ECG technician,
Lab/diagnostic tests personnel, assistive personnel.
The respiratory therapist administers respiratory care treatment involve
managing life support mechanical system. The respiratory therapist analyzed
blood sample of Mrs. J.E. to determine levels of oxygen and other gases. Assessed
lungs capacity to determined impairment. Managing artificial airways and
ventilators. Consulted with the physicians and members of medical team to
recommend a change in therapy.
The next interdisciplinary care will be nurse, the nurse provides hand on
care to the patient, by monitoring and observing patient conditions,
communicating with the doctors and maintaining records. The nurse also
administers medications, managing intravenous lines. The nurses also relied on to
give directions and supervisions to nurse aides. The nurse is always the first
person and the last health care provider a patient will see. They provide
emotional support to patient and patient’s family members.
The emergency medical doctors are responsible for several series by
assessing the condition of the patient and providing treatment. The emergency
medical doctors order tests such as CT Scan, MRI and chest X-ray and providing
medication. They help to stabilize a critical patient.
The ECG technician attaches electrodes to the patient and constantly
monitoring the patient cardiac activities. Records the activities of the heart and
print out the data recorded for further treatment of the patient.
The Lab/diagnostic tests personnel roles collect specimens from patient
and properly labels them for testing. Basically, the technicians perform tests and
procedures that physician orders. Assistive personnel assist the nurse in taking
vital signs, they are supervised, and delegations are given to them by the nurse.
Therapeutic Modalities
Therapeutic modalities provide a non-surgical medication free
treatment for a wide range of condition. Therapeutic Modalities helps to
provide pain relief physically and emotionally. Helps to provide better quality of
life and functioning. One of the therapeutic modalities care that was used for
Mrs. J.E. was psychosocial assessment, which involve sitting by the patient
bedside, taking to the patient, which in turns relaxes and calm the patient. As
you gain the trust of your patient.
The nurse provides a lot of therapeutic modalities care by just taking
time to communicate, engaging the patient with treatment, explaining treatment
for the patient understanding. Demonstrating respect and non-judgmental.
Promote equality and attempt to promote independence where it is possible.
Just by actively listening and been attentive to patient provides a therapeutic
modality care.
The nurse does a continuous assessment on the patient, which is a form of
therapeutic modality care, by touching the patient, getting the attention of the
patient and just been there for the patient or answer some question.
Nursing Role Reflection
My clinical day was quiet at first at the emergency room until Mrs. J.E
came to the ER by the ambulance. I was assigned to follow the Patient nurse by
the charge nurse. I remembered going to the patient room assisting with ECG
placement, taking vital signs like blood pressure, respiration, heart rate.
Respiratory therapist came, lab technician and emergency doctor arrived. One
nurse was getting the patient history, while another nurse was establishing IV
line. All hands were on deck, helping the patient to maintain patency. I was told
to step out for a few minutes because the room was crowded. I waited by the
door for about 15-20 minutes just in case they will need me to get something for
them. I remembered having an anxiety and at the same time excited to
experience an overdose case.
The doctor told me to come in after a while, the doctor ordered for
mechanical ventilation which was done on the patient, labs were taken, indwelling
catheter was placed. The patient kept trying to pull out the indwelling Foley
catheter, she was not aware of what she was doing. The emergency doctor ordered
for a restraint. It was beautiful to see how everyone came together to save a life.
The patient was finally stable and was transferred to ICU.
In conclusion watching the nurses taking care of the patient, makes me
know that I made the right choice. I learned a lot from my instructor and the
nurse I was place that I was placed with. She was calm and moving quickly and
making sure things were done appropriately.
References
Carpenito, L. J. (2017). Nursing diagnosis: Application to clinical practice.
Philadelphia, PA: Wolters Kluwer.
For All Your Nursing Needs. (n.d.). Retrieved March 30, 2018, from
https://nurseslabs.com/
Lewis, S. L., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing:
Assessment and management of clinical problems (9th ed.). Elsevier Mosby.
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2017). Pharmacology and the nursing process.
St. ALouis, MO: Elsevier.
Vallerand, A. H., (2015). Davis's Drug Guide for Nurses (14th ed.). Philadelphia, PA: F.A Davis
Company.