NRS-460 Case Study: John Doe – Emergency Department
Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.
The purpose of this assignment is to evaluate and synthesize patient data to propose interventions for an individualized plan of care prioritizing health problems and health concerns.
PART I:
Health History and Medical Information
Evaluate the health history and medical information for John Doe, presented below.
John Doe, a 35-year-old male, was riding his motorcycle under the influence and experienced a motor vehicle accident resulting in multiple fractures and a traumatic brain injury (TBI).
On scene, John Doe was alert but exhibiting restlessness and agitation with hands-on care. En route to the hospital, he displayed changes in level of consciousness (LOC), mood and behavior, nausea and vomiting (N/V), and dilated pupils. Upon arrival to the emergency department, John was unconscious with a Glasgow Coma Scale (GCS) score of 6, indicating a severe TBI. Prior to losing consciousness, he was exhibiting signs of extreme pain on the left side.
Objective Data – completed by ambulance personnel:
1. 84/60 BP, HR 136, RR 28 irregular, SpO2 92%
2. 5′ 11″ height, 180 lbs. weight
3. GCS Score: 6
a. No response in eyes: 1
b. No verbal response: 1
c. Flexion withdrawal from pain: 4
4. Change in LOC
5. Possible fractures to left leg and left ribs
6. Intubated in route to ED
Objective Data and Laboratory/Test Results – on arrival to the emergency department (initial results)
1. Complete blood count (CBC) –
a. White blood cells: 11.3
b. Hemoglobin: 15.6
c. Hematocrit: 41.5
d. Platelets: 316,000
2. Comprehensive Metabolic Panel (CMP) –
a. Alanine Aminotransferase (ALT): 32 U/L
b. Albumin: 4.8 g/dL
c. Alkaline Phosphatase (ALP): 122 U/L
d. Aspartate Aminotransferase (AST): 52 U/L
e. Blood Urea Nitrogen (BUN): 16mg/dL
f. Bilirubin: 1.4mg/dL
g. Calcium: 9.8mg/dL
h. Creatinine: 1.1mg/dL
i. Glucose: 112mg/dL
j. Potassium: 3.9 mEq/L
k. Sodium: 138 mEq/L
3. Prothrombin time (PT) – 12 seconds
4. Partial Thromboplastin time (PTT) – 37 seconds
5. Panscan CT (Polytrauma Whole Body Imaging): Results –
a. Closed left femur fracture
b. Hairline fracture of 3 left ribs
c. TBI consisting of frontal-temporal skull fracture
6. Urinalysis (UA) – positive for red blood cells in urine
7. Drug panel – positive for cannabinoids
8. Consent to treat options
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Assessment Findings Evaluate Mr. Doe’s health history and other pertinent medical information presented above to answer the questions that follow. | |
Based on your evaluation, synthesize normal and abnormal findings. Create a list prioritizing three to five problems and health concerns present for the patient. Your response should be a minimum of 300 words. | |
Provide rationale justifying your proposed list. Use at least one evidence-based resource to support your rationale. Your response should be a minimum of 200 words. | |
Discuss how each team member can contribute to the formation and improvement of diagnosis for this patient. Your response should be a minimum of 200 words. | |
Interventions Mr. Doe requires numerous interventions upon arrival to the hospital. | |
Based on your assessment, describe the interventions that are required upon Mr. Doe’s arrival to the hospital to mitigate the risk of further complications. Your response should be a minimum of 300 words. | |
Diagnostic Tests Review the diagnostic tests that were ordered. | |
Choose two diagnostic tests and explain how these tests relate to the patient’s condition. Your response should be a minimum of 200 words. | |
Surgical Intervention Review your assessment of Mr. Doe’s physical injuries to answer the questions below. | |
Discuss the possible surgical interventions necessary to address Mr. Doe’s multiple fractures. Your response should be a minimum of 200 words. | |
If surgery is not necessary, what steps are needed to ensure proper healing of the bones? Your response should be a minimum of 200 words. | |
Panscan Results The panscan results indicate a positive TBI. | |
Based on these results, what interventions do you foresee as necessary when treating the patient? Your response should be a minimum of 300 words. | |
Psychosocial and Spiritual Considerations Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs. | |
Given the patient’s current situation, discuss ways in which the nurse can take into account and address the patient’s psychosocial and spiritual needs. Your response should be a minimum of 150 words. | |
References (Please include working hyperlinks.) |
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