Questions:
Task
Debbie aged 43 has been suffering mild epigastric pain for the last few months until it became severe pain. On presentation to the emergency department she rated as 10/10 with associated nausea and diaphoresis. Debbie was sent to the operating theatre for an emergency laparotomy.
Debbie is admitted to the surgical ward where you are working following an emergency cholecystectomy and peritoneal lavage for a gangrenous gall bladder.
Past medical history and subjective data.
Debbie was diagnosed with Multiple Sclerosis 3 years ago and now leads a sedentary lifestyle due to impaired mobility as a result of muscle spasticity.
Familial hyperlipidaemia treated with Atorvastatin for 8 years Debbie’s maternal aunt has Multiple Sclerosis.
Debbie used to smoke up to 25 cigarettes a day before being diagnosed with MS
Objective data Weight 92 kg Height 168cm
|
Last set of observations in recovery |
First set Observations at return to ward |
|
|
Blood Pressure |
126/ 58 mmhg |
108/ 52 mmhg |
|
Heart Rate |
72 regular |
84 regular |
|
Temperature |
37.1 o c |
37.1 o c |
|
Resp Rate |
14 / minute |
15 / minute |
|
SpO2 |
97% on O2 3 l/min nasal prongs |
96% on O2 3 l/min nasal prongs |
|
Level Of Consciousness |
Alert |
Alert |
|
Pain |
3/10 |
4/10 |
Indwelling catheter insitu to straight drainage.
IVI Compound Sodium Lactate (Hartmann’s) at 80 mLs / hr T Tube to straight drainage
Patient Controlled Intravenous Analgesia (PCIA) 500microg / 50mL 0.9% Na Chloride with 20microg bolus and lockout time of 10 minutes
Current Medications Teriflunomide 14 mg daily Baclofen 10mg three times a day Atorvastatin 20mg daily
Fentanyl PCIA
Metoclopramide 10 mg IV 6 hourly PRN
Question 1
Discuss the aetiology (including identification of any risk factors Debbie may have), pathophysiology and diagnosis of Multiple Sclerosis.
Question 2
Discuss how the medications Debbie is currently prescribed pre admission help manage her Multiple Sclerosis. Include in your answer mechanisms of action, normal dosage, ADR’s and any specific nursing and poly pharmacy considerations. (DO NOT USE TABLES)
Question 3
Debbie is at risk of developing septic shock due to the ruptured gall bladder. Using a body system approach discuss what clinical manifestations would be present and what specific nursing interventions you would need to implement to alert you to changes in her condition that would indicate sepsis and progression to septic shock.
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