Question

FUNDAMENTAL Reasoning: STUDENT Cirrhosis I. Developing Nurse Thinking by Identifying Clinical Relevance/Significance History of Present Problem: John Richards is a 45-year-old male who presents to the emergency department (ED) with abdominal pain, and increasing nausea and vomiting the past 3 days that has not resolved. He is also feeling more fatigued and has had a poor appetite. He denies any ETOH intake the past week, but admits to episodic binge drinking on most weekends. John weighs 150 pounds and is 6 '0" (BMI 17.6) Personal/Social History: John is single, has never married and lives alone in his own apartment. He has struggled with heroin uselabuse in the past, but has not aused in the past 2 years. John is currently unemployed and has no health insurance. What data from the histories is im portant&RELEVANT: therefore it has clinical siguiflcance to the nurse? RELEVANT Dat fromPresentP oblem:ーClinical Significance: RELEVANT Data from Social History: Clinical Significance Lab/diagnostic Results: Basic Metabolic Panel (BMP):ーー1 Current:ー」HighLowwNL? Sodium (135-145 mEq/L 151 3.5 Glucose (70-110 mgdL) Creatinine (0.6-1.2 mg/dL Liver Function Test (LFT:) Albumin (3.5-5.5 g/dL Current:High/Low/WNL 2.5 Total Bilirubin (0.1-1.0 mg/dL) Alkaline Phosphatase male: 38-126 UM female: 70-230 U 42 285 ALT (8-20 U/L) AST (8-20 LVL) 128 124 What lab results are RELEVANT that must be recognized as clinically significant to the nurse? RELEVANT Lab(s): Clinical Significance: 2014 Keith Rischer/www.KeithRN.com

Answer 1

Q. No. I. Answer :

Developing nurse thinking by identifying clinical relevance or significance :

* relevant data from present problem is patient is having abdominal pain, nausea and vomiting, loss of appetite ect.

Clinical significance due to that the patient is having fatigue and loss of appetite, due to he is taking ETOH and binge drinking more at weekends.

* relevant data from social history he was unmarried, unemployment and no insurance.

Clinical significance is heroin abuse past but not now, he is alone.

Labdiagnostic results :

* sodium 151 mEq per liter it is high hypernatremia.

* potassium 3.5 mEq per liter it is boarder line hypokalemia.

* glucose 68 mg per dl it is low hypoglycemia.

* creatinine 1.3 mg per dl it is high.

* Albumine 2.5 gm per dl, it is low hypoalbuminemia.

* Total bilirubine 4.2 mg per dl it is high, indicates hyper bilirubinemia.

* Alkaline pasphotase 285 units per liter, it is high.

* Alt 128 u/ lit, it is also high.

* Ast 124 u / lit, it is also high.

* Ammonia 40 McGee / dl, it indicates normal.

# all LFT values are relevance to the client problem that is liver cirrhosis.

V. Answer. 4. Developing nurse thinking by identifying client priority

* first we need to check for arthostatic blood pressure, because we should know whether it is hypotension, mild, moderate and severe.

* next keep intravenous line to administer fluids.

* give intravenous fluids 1000 ml normal saline, to maintain normal blood pressure that means increases blood pressure by giving bolus intravenous fluids.

* next administer compazine 10 mg iv push. Because to reduce anxiety.