NUR 259: Medical Surgical Nursing III<\/p>\n
CASE STUDY #5: NEUROLOGY <\/p>\n
(25 points possible)<\/p>\n
Student Name: _________________________________________________________________________________<\/p>\n
Read the following case study and its evolving components to answer the questions below. You may use your Medical-Surgical textbook, Saunders & drug book and other reliable resources to answer these questions. <\/p>\n
SCENARIO<\/p>\n
Meryl Streep is a 67-year-old widow who is brought to the emergency department via ambulance after she was found by a neighbor lying on the bedroom floor complaining of pain in her left hip. Meryl lives alone but she and her older neighbor check on each other daily because they both have grown children who live out of state. Meryl reports that she fell this morning as she was getting dressed and was not able to move due to the severe pain in her left hip. She did not lose consciousness.<\/p>\n
When asked about medications she takes at home, she indicates taking Sinemet for her Parkinson\u2019s Disease– diagnosed 10 years ago\u2014but explains that her symptoms are worse lately. She also takes Verapamil and Fosamax for her hypertension and osteoporosis. <\/p>\n
As Meryl tries to sign the admission form, the nurse notes that Meryl\u2019s hands are tremulous.<\/p>\n
Triage assessment: Upon examination, the nurse finds Meryl\u2019s left hip has a 6-inch diameter hematoma, is shortened and externally rotated. 2+ pitting edema noted on the left hip and upper thigh. Pedal and dorsalis pedis pulses are palpable. Capillary refill is \u2264 3 seconds in her feet and hands. Ecchymosis and moderate tenderness are present on the left shoulder. Meryl complains of moderate and constant numbness and tingling in her left leg.<\/p>\n
Meryl verbalizes an 8\/10 constant aching pain on her left hip and a 5\/10 constant dull pain on left shoulder. Clear lung sounds are present throughout her lung fields. Bowel sounds are active through all four quadrants. No complaints of urine incontinence. EMS services placed a peripheral IV line in her right forearm. IV site is patent and without S\/S of infection. No NKDA. Full code status. Alert and oriented x 2. Vital signs: BP 92\/60 mm Hg, HR 98, RR 22, tympanic temperature 97.2\u00b0 F, and SpO2 89% on room air. <\/p>\n
Review Meryl\u2019s assessment findings presented in the scenario above and identify 5 abnormal assessment findings the nurse would prioritize and focus on. (2 points)<\/p>\n
Case Study Progression: The nurse receives the following orders from the ER health care provider. <\/p>\n
Administer warm D5 \u00bd NS at 100 mL\/hr. <\/p>\n
STAT portable anterior and lateral view X-ray of left hip and shoulder. <\/p>\n
Morphine Sulfate 4 mg IVP q1h prn pain.<\/p>\n
Obtain CBC & CMP labs.<\/p>\n
Titrate O2 per nasal cannula to keep SpO2 >94%. <\/p>\n
Provide the rationale behind each of the ER provider\u2019s orders below. (2.5 points, 0.5 point per each)<\/p>\n
Administer warm D5 \u00bd NS at 100 mL\/hr. <\/p>\n
STAT portable anterior and lateral view X-ray of left hip and shoulder. <\/p>\n
Morphine Sulfate 4 mg IVP q1h prn pain.<\/p>\n
Obtain CBC & CMP labs.<\/p>\n
Titrate O2 per nasal cannula to keep SpO2 >94%. <\/p>\n
Case Study Progression: The portable x-ray confirms the diagnosis of complete fracture of the left hip, and an orthopedic consult is requested per the ER provider. The orthopedic surgeon assesses Meryl and orders a transfer to the orthopedic unit from the ER; vital signs every 4 hours; neurovascular assessments every 4 hours; Morphine sulfate 2 \u2013 4 mg IVP every hour prn pain; Keep NPO; and placement of Buck\u2019s traction with a 5 lb weight to keep her comfortable until an operating room becomes available early next morning.<\/p>\n
Multiple Choice Question:<\/p>\n
The orthopedic surgeon orders a Buck’s traction with a 5 lb weight to be placed in Meryl\u2019s left lower extremity. The nurse recognizes that the purpose of the traction is to: (2 points)<\/p>\n
control the dementia caused by her Parkinson\u2019s disease before surgery. <\/p>\n
immobilize the leg until healing is complete. <\/p>\n
prevent non-union of the fractured bone.<\/p>\n
reduce pain and muscle spasms before surgery.<\/p>\n
Select All that Apply Question:<\/p>\n
The orthopedic nurse assesses Meryl’s left leg for neurovascular impairments every 4 hours as ordered. Which of the following are part of the neurovascular assessment? <\/p>\n
Select all that apply. (2 points)<\/p>\n
Assess for peripheral edema and rate severity. <\/p>\n
Assess pulses distal to the injury area(s), bilaterally.<\/p>\n
Assess capillary refill in all extremities.<\/p>\n
Assess the extremity\u2019s color and temperature bilaterally.<\/p>\n
Complete thorough pain assessment hourly.<\/p>\n
Complete assessment of all cranial nerves. <\/p>\n
Evaluate presence of paresthesia in all extremities.<\/p>\n
Evaluate sensation and motor function in all extremities. <\/p>\n
Evaluate swallowing ability.<\/p>\n
Case Study Progression: Meryl undergoes a total left hip arthroplasty\u2014 posterior approach at 0600 hours. She returns to the orthopedic unit with Lactated Ringers IVF at 125 mL\/hr, and a hemovac drain in the left hip with a small amount of serosanguineous drainage. A large ABD pad dressing covers the incision site which appears to be clean and dry. Her SpO2 level is at 94% at 2 L\/min per nasal cannula.<\/p>\n
Given the information above, the orthopedic nurse would initiate the following postoperative nursing interventions during the first 24 hours. Place an \u201cX\u201d by the correct answers. (3.5 points, 0.5 point per each)<\/p>\n
Assess vital signs every 4 hours. <\/p>\n
Assess neurovascular status of operative leg every hour. <\/p>\n
Empty and measure Hemovac drainage every 4 hours or as needed. <\/p>\n
Encourage use of incentive spirometer every 2 hours. <\/p>\n
Monitor intake and output (I & O) every 4 hours.<\/p>\n
Provide full range of motion (ROM) leg exercises to both legs three times daily. <\/p>\n
Position the operative leg in abduction and internal rotation with an abductor pillow.<\/p>\n
Turn to back and unaffected side every 2 hours.<\/p>\n
Turn, cough, and deep breath every 2 hours. <\/p>\n
The <\/p>\n
nurse reviews hip precautions with Meryl to prevent dislocation of the newly placed prosthesis on her left hip. Place an \u201cX\u201d by the \u201cDO\u201d or \u201cDO NOT\u201d sections to indicate which activities would be followed as part of hip precautions. (4 points, 0.5 point per each)<\/p>\n
Activities<\/p>\n
DO<\/p>\n
DO NOT<\/p>\n
Bend over to pick something off the floor.<\/p>\n
Cross legs at knees.<\/p>\n
Keep hip in neutral, straight position.<\/p>\n
Put on own shoes and socks without assistive device.<\/p>\n
Sit on chairs without arms.<\/p>\n
Sit on a chair in shower when bathing.<\/p>\n
Use pillow between legs when lying on “good” side or back.<\/p>\n
Use a toilet seat riser.<\/p>\n
Case Study Progression: While reviewing the client\u2019s home medications, the orthopedic nurse notes that Meryl takes Sinemet and Fosamax daily to help manage her Parkinson\u2019s disease and osteoporosis, but these have not been reordered. A prompt call to the orthopedic surgeon is made and new orders are received to restart Meryl\u2019s Sinemet 10\/100 mg PO daily and Fosamax 35 mg PO daily<\/p>\n
Select All that Apply Question:<\/p>\n
While procuring the Sinemet medication, the orthopedic nurse remembers that during report the night nurse stated that Meryl\u2019s Parkinson\u2019s symptoms were becoming worse. The nurse decides to further assess Meryl\u2019s symptoms prior to the administration of the Sinemet. Which of the following signs and symptoms are consistent with Parkinson\u2019s disease? Select all that apply by placing an \u201cX\u201d by the correct answers. (2 points)<\/p>\n
Cogwheel rigidity<\/p>\n
Festination <\/p>\n
Spontaneous involuntary movements<\/p>\n
Manic episodes<\/p>\n
Stooped posture<\/p>\n
Tremors<\/p>\n
Case Study Progression: The nurse decides to hold the Sinemet for now and calls the orthopedic surgeon again. The nurse updates the HCP and shares her concerns about the client\u2019s Parkinson\u2019s symptoms being worse. Orders are received to change the medication order to Sinemet 10\/100 mg PO twice daily.<\/p>\n
Fill in the blank Question:<\/p>\n
The nurse informs Meryl that her Sinemet dosage has increased and educates her on signs and symptoms of Sinemet toxicity. Meryl would demonstrate understanding of the medication education when she states the need to report the following signs or symptoms to her provider: (1 point)<\/p>\n
Multiple Choice Question:<\/p>\n
The nurse is assigned to mentor a nursing student while caring for Meryl. The nurse updates the student on the client\u2019s new orders and the interventions she has completed thus far. When the nurse asks the student what side effect would be anticipated as a result of taking the Sinemet? The student correctly responds by stating that (2 points)<\/p>\n
\u201cThe Sinemet may cause esophageal perforation if not given with meals.\u201d <\/p>\n
\u201cThe Sinemet may cause Stevens-Johnson Syndrome.\u201d<\/p>\n
\u201cThe Sinemet may cause orthostatic hypotension.\u201d <\/p>\n
\u201cThe Sinemet causes an initial euphoria followed by depression.\u201d<\/p>\n
To further determine the student nurse\u2019s pharmacology knowledge, the nurse asks the student, \u201cHow does Sinemet work in Parkinson\u2019s disease? The student correctly responds by stating (2 points)<\/p>\n
\u201cThe supplementation of Levodopa enables the brain to improve myelination of neurons.\u201d<\/p>\n
\u201cMore Levodopa is made available for transport to the brain and for conversion to Dopamine in the brain.\u201d<\/p>\n
\u201cOnce Sinemet reaches therapeutic levels, it increases acetylcholine production.\u201d<\/p>\n
\u201cSinemet allows for the supplementation of Levodopa and Carbidopa which causes regeneration of injured thalamic cells.\u201d<\/p>\n
Case Study Progression: Meryl\u2019s physical therapist appropriately tailors her exercise plan so Meryl can continue to make progress while in the hospital and get her ready to be discharged home with her daughter who is now at her bedside and plans to care for her mother for a month.<\/p>\n
Fill in the Blank Question<\/p>\n
The physical therapist works with Meryl in strengthening and stretching specific muscles to prevent futures falls which will increase in risk due to her progressive Parkinson\u2019s disease. What instructions would be applicable for Meryl to follow to prevent falls? List a minimum of 3 applicable instructions. (2 points)<\/p>\n
4<\/p>\n","protected":false},"excerpt":{"rendered":"
NUR 259: Medical Surgical Nursing III CASE STUDY #5: NEUROLOGY (25 points possible) Student Name: _________________________________________________________________________________ Read the following case study and its evolving components to answer the questions below. You may use your Medical-Surgical textbook, Saunders & drug book and other reliable resources to answer these questions. SCENARIO Meryl Streep is a 67-year-old widow […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[10],"class_list":["post-78805","post","type-post","status-publish","format-standard","hentry","category-research-paper-writing","tag-writing"],"_links":{"self":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/78805","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/comments?post=78805"}],"version-history":[{"count":0,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/78805\/revisions"}],"wp:attachment":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/media?parent=78805"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/categories?post=78805"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/tags?post=78805"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}