You are an LPN working on a medical-surgical floor in a team that consists of an RN and a medical assistant. Read through some of the chart entries over a 48-hour period and answer the questions at the end. Please make sure you cite any sources using APA format. You will find when there is a major clue.
0130: Admission nurses note (RN): Client arrived via EMS from long-term-care for evaluation of â€œlow blood sugar.â€ Pt. arrived confused (alert and oriented X 1) and is a known diabetic. Finger stick was 45. Orange juice and crackers, given repeat finger stick 104. Pt now alert and oriented X 4. Report from the charge nurse at the long-term-care facility indicates that the client has been having frequent bouts of hypoglycemia.
0530: (RN) Foley catheter inserted for incontinence–pt. â€œtoo weakâ€ to get up to the bathroom and is experiencing bouts of incontinence.
600 mL clear yellow urine noted. The nurse indicates that the ER is â€œvery busyâ€ and â€œshort-staffed.â€ 0545 (Admitting Physician) See history and physical. Pt. admitted to the medical-surgical service for evaluation of recurrent hypoglycemia.
View the ER chart before the pt. is transferred to the floor:
0730: (RN) Report is given to RN on 3 North.
Emergency Department Chart
Client: Mabel Simpson
Admission Date 8/16/2019
Medical Diagnosis: recurrent hypoglycemia
Vitals/ Data Collection: Temp.- 97.3 PO
History: Diabetes (insulin dependent)
Medications: Insulin R titrated to finger sticks
Vitals/ Data Collection: Pulse- 68
Medications: Furosemide 20 MG twice per day
Vitals/ Data Collection: Respirations- 18
History: Atrial Fibrillation
Medications: Warfarin 5 Mg Mon, Wed, Fri 2 Mg Tues, Thurs
Vitals/ Data Collection: Blood Pressure- 122/86
History: Rheumatoid Arthritis
Medications: Enalapril 5 Mg once per day
Vitals/ Data Collection: No C/O pain
History: Mild Heart Failure (class 1)
Medications: Proventil inhaler as needed for wheezing
Vitals/ Data Collection: Alert and oriented X 4
History: Former Smoker- smoked 1 pack per day X 40 years- last smoked 10 years ago
Medications: Methotrexate 2.5 Mg per day
Vitals/ Data Collection: Lungs: No adventitious sounds
History: Appendectomy as a child
Medications: Tylenol 650 Mg as needed for pain or fever
Vitals/ Data Collection: + Bowel sounds
History: Mobility (baseline): able to ambulate slowly with minimal assist
Clear yellow urine draining from Foley catheter in adequate amts.
Vitals/ Data Collection: Clear yellow urine draining from Foley catheter in adequate amts.
10:00: (RN) Pt received on 3 North. Alert and oriented X 4. Fingerstick 81. Eating breakfast. Offering no complaints.
8/17/2019 (Medical Assistant)
0130: Sleeping Soundly
0700: (LPN) alert and oriented Finger stick 124. Offering no complaints. Medications given as ordered. Foley catheter draining cloudy yellow urine- RN notified.
1100: (Case Manager note): Pt. alert and oriented. Blood sugar stable. Will speak to the physician about discharge tomorrow morning.
1300: (Physical Therapy): Ambulated to the hallway 200 feet. Ambulates slowly- baseline as per long-term-care facility charge nurse. Recommend physical therapy after discharge, however, ambulated well enough for discharge.
1600: (LPN) Pt found to be confused (alert and oriented X 1). RN notified. Fingerstick 130. Vitals 97.5 (axillary), 110, 24, 98/64
1800: (Medical assistant) 400 ccâ€™s emptied from catheter bag.
0100: (RN) Pt confused and combative. Attempting to pull out her IV and repeatedly removing her gown. Ptâ€™s physician was paged- ordered Lorazepam 1 MG IM. Medicated as ordered and slept the remainder of the night with no incident.
0700: (RN) Pt awake and alert but combative. Finger stick-124. Vitals: 98.9 (axillary), 116, 28, 90/55
1730: (LPN) Unable to administer medication. Pt appears extremely confused. RN notified.
1200: (LPN) Ptâ€™s daughter at bedside. Daughter indicates that her mother is not normally confused and is concerned that she may have had a stroke and notes that her mom feels â€œvery warm.â€ RN notified. Foley catheter draining cloudy urine.
1230: (Medical Assistant) Vital signs: T 103.6 (rectal), P=130, BP=84/43, resp rate=28
1300: (RN) Rapid response called (because of the change in condition) and client transferred to the ICU.
Update: The client spent 3 days in the ICU but unfortunately did not recover.
Please answer the following questions:
- Why did this client become confused and combative? (5-10 sentences)
- What pivotal decision made in the ER directly caused this clientâ€™s worsening condition? (1-2 sentences)
- What type of incontinence did this client have? Explain your answer. (5-10 sentences)
- What factors in the clientâ€™s medical history contributed to the clientâ€™s change in condition? (5-10 sentences)
- How did communication (or lack thereof) contribute to the poor outcome for this client? (5-10 sentences)