A nursing home resident, Mrs. Johnson a
A nursing home resident, Mrs. Johnson a 79 year old female, arrived to the Emergency Room where caregivers reported confusion, weakness, and altered mental status that began that morning. 2 large bore peripheral IVs are inserted for a chemistry and complete blood count, ordered by the Provider who is concerned she may be having a stroke. What initial nursing assessments should be performed? What diagnostic testing do you anticipate for Mrs. Johnson? Mrs. Johnson vitals are as follows: HR 128 RR 24 BP 94/56 SpO2 91% Temp 103.8°F Mrs. Johnson’s CT scan is negative for cranial bleed, NIHSS score is 2, and the neurologist rules out stroke. The caregivers called the Nurse into the room as the patient had an episode of incontinence. The nurse smells a sour, foul odor to the urine. Mrs. Johnson’s blood pressure is now 87/53. The nurse notifies the Provider. 3. What orders do you anticipate from the provider? 4. What may be going on with Mrs. Johnson physiologically? The provider places orders for the following: Keep SpO2 > 92% Blood Cultures x 2 Urinalysis Urine Culture 500 mL NS IV bolus STAT 100 mL/hr NS IV continuous infusion Vancomycin 1,000 mg IV x 1 dose NOW. 5. Which order should be implemented first? Why? The nurse obtains 2 sets of blood cultures and a sterile urine sample. The Nursing Assistant reports foul-smelling, cloudy urine. The nurse initiates the IV fluid bolus and requests the Vancomycin from the Pharmacy. Mrs. Johnson’s caregiver is concerned about her confusion. 6. Why is Mrs. Johnson presenting with Altered Mental Status? After 3 days of treatment with IV antibiotics, Mrs. Johnson is awake and oriented x 2-3 (she has dementia at baseline). She is calm, able to ambulate with assistance, and conversing with staff, She will be discharged with PO antibiotics the next day. 7. What discharge teaching should be provided to Mrs. Johnson and to the caregivers?
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