Reference no: EM133864069
Assignment:
B.K. is a 63-year-old woman who is admitted to the step-down unit from the ED with N/V and epigastric and LUQ abdominal pain that is severe, sharp, and boring and radiates through to her mid back. The pain started 24 hours ago and awoke her in the middle of the night. B.K. is a divorced, retired sales manager who smokes a half-pack of cigarettes daily. The ED nurse reports that B.K. is anxious and demanding. B.K. denies using alcohol. Her vital signs are as follows: 100/70, 97, 30, 100.2° F (37.9° C) (tympanic), SpO2 88% on room air and 92% on 2 L of oxygen by nasal cannula (NC). She is in normal sinus rhythm. She has no primary care provider and has not seen a physician "in years." The ED nurse giving you the report states that the admitting diagnosis is acute pancreatitis of unknown etiology. An abdominal ultrasound showed "no cholelithiasis, gallbladder wall thickening, or choledocholithiasis.
The pancreas was not well visualized due to overlying bowel gas." An abdominal CT is scheduled for the morning. Admission labs have been drawn; a clean-catch urine specimen was sent to the lab, and the urine was dark in color. You complete an admission assessment and note the following: B.K. is restless and alert, lying on her right side in a semi-fetal position. Skin is cool, diaphoretic, and pale with poor skin turgor; mucous membranes are dry. ECG shows sinus tachycardia, rate 106, heart sounds without murmurs or rubs. Peripheral pulses are palpable at 1+ in four extremities. Respiration rate 24, but unlabored on 2 L O2/NC with Spo2 90%.
Breath sounds are diminished in lower left lobe (LLL) posteriorly. She complains of nausea and is having dry heaves. Bowel sounds are hypoactive throughout. Abdomen is distended, firm, and tender in a diffuse fashion to light palpation, with guarding noted. The admission chest x-ray report reads, "moderate pleural effusion in the left lower lobe." B.K. eventually falls asleep and seems to be sleeping peacefully. Several hours later, you hear an alarm on her pulse oximeter and enter her room to investigate. You find B.K. moaning softly; her oximeter reads 87%.
1. Several hours later, you hear an alarm on her pulse oximeter. You find B.K. moaning softly; her oximeter reads 87%. What will you do next? Identify at least 5 interventions.
2. The provider orders a stat chest x-ray, which shows a significant LLL pleural. A thoracentesis was performed. Seventy-two hours later, B.K.'s laboratory test results show improvement. The provider writes an order to advance B.K.'s diet from clear to full liquids.18. How would you know if B.K. is not tolerating the advancement in her diet? Identify at least 3 manifestations.
3. What will you include in your discharge teaching with B.K.? Identify at least 4 discharge teaching.