Problem: What are the potential causes for the deterioration of this patient?
What are the immediate nursing interventions you would recommend to manage this patient? List at least three key actions. Need Assignment Help?
Which parameters should be monitored closely in a patient in this situation? How often?
Provide a detailed verbal ISOBAR (Identify-Situation-Observation-Background-Agreed Plan-Read back) report to communicate to the physician? (no need to provide R, as there is no response from a physician in this case, so just focus on the ISOBA of the above).
Which potential underlying causes of Mrs. Gomez' deterioration may have contributed to this situation?
Case Study
Patient Background:
Name: Maria Gomez
Age: 62
Sex: Female
Ethnicity: Hispanic
Occupation: Retired schoolteacher
Medical History: Type 2 Diabetes Mellitus, Hypertension, Osteoarthritis
Surgical History: Total knee replacement (left) 3 weeks ago
Scenario Overview:
Maria presents to the Emergency Department with complaints of fever, chills, confusion, shortness of breath, and increasing pain and swelling in her left knee. Her daughter reports that Maria has been increasingly lethargic over the last 24 hours.
On Admission:
At the start of your shift, you are assigned to care for Maria. During the bedside assessment, you note the following:
Vital Signs:
Temperature: 39.4°C
Heart Rate: 118 bpm, regular
Respiratory Rate: 26 breaths/min
Blood Pressure: 88/54 mmHg
Oxygen Saturation: 90% on room air
Patient appears restless, diaphoretic, and is using accessory muscles to breathe.
Peripheral perfusion is poor, with delayed capillary refill (>3 seconds) and cool, clammy extremities.
Urine output has Maria appears acutely ill, confused and disoriented to time and place
Left knee: Red, swollen, tender, with limited range of motion
decreased over the past 6 hours to 15 mL/hour (indwelling urinary catheter in situ)
Peripheral intravenous catheter (PIVC 18G) in situ
Pathology results
WBC: 18,700 /L
Hemoglobin: 12 g/dL
Hematocrit: 43 %
Lactate: 3.8 mmol/L
CRP: 15 mg/L
Serum Creatinine: 2.1 mg/dl
Glucose: 15 mmol/L
End case study
I need a note for presentation