Year Female With Assignment Help: How to Answer This Question

This type of question evaluates analytical and critical thinking skills.

What This Question Is About

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How to Approach This Question

Use appropriate theories and support your answer with clear reasoning.

Key Explanation

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Original Question

80 Year-old female with complex medical history who presented with altered mental status of unclear etiology. The patient in this case is unable to give a history. There are no reliable sources who witnessed the events leading to her presentation making it more difficult to ascertain the etiology of her condition. The author hopes to elicit a discussion of her case among peers in critical care nursing. Background / Social History Ms. Smith is a 80-year-old female who lives independently in a first-floor apartment in the city. She has no close relatives but has neighbors who know her very well and check in on her from time to time. She hires a cleaning lady that does her house cleaning and laundry every week. Her nearest relative is a niece who lives in the same state but is 8 hours away by car. Past History Her medical history includes anxiety disorder, hypertension, hyperlipidemia, COPD, and mild kidney insufficiency. She has a 40 pack/year history of smoking. She has no known allergies. Medications Paroxetine 20 mg daily Lorazepam 1 mg daily as needed for anxiety Losartan 100 mg daily Amlodipine 10 mg daily Simvastatin 40 mg daily Tiotropium 18 mcg inhaled daily Albuterol MDI 2 puffs 4 times a day as needed Present History: On the day of her ED admission, her niece had been calling her phone and had been unable to get hold of her. Her niece called a neighbor who stated that she has not seen her in 4 days. Concerned about her condition, the neighbor knocked on her door and heard no response. Luckily she was able to open the door as it was unlocked. Upon entering the living room, the neighbor found the patient lying unconscious on the floor. She had frothy secretions from her mouth and had urinated on herself. She immediately called 911. She was intubated at the scene by EMS responders for airway protection due to her altered mental status. Vital Signs BP 180/100 HR 110 RR 32 T 38.5 C O2sat 88% on RA prior to intubation Diagnostic Studies In the ED, RS pertinent labs showed a WBC of 15,000 mm3, a lactate of 2.5 mmol/L, and CPK of 20,000 U/L. Neurologic exam was significant for agitation and inability to follow commands with sedation wean. She was hyperreflexia with increased muscle tone. She is moving all her extremities equally and has no abnormal pupillary response. She is sedated on Propofol. CV exam reveals sinus tachycardia with BP of 110/50, her skin is warm to touch. Respiratory exam reveals rhonchi in upper lung fields with moderate white secretions via ET tube ABG: 7.36, 38, 82, 19, -3, 100% on ACVC: 16X400, FiO2 of 0.5 PEEP of 5. CXR reveals mild cardiomegaly, a hyperinflated lung silhouette and mild RLL opacity. Non-contrast CT Scan of her brain showed focal vasogenic edema in the basal ganglia. The remainder of the exam revealed normal findings. Transferred to ICU without further testing in the ED. Because of her complex medical condition, she was transferred to the MICU (medical intensive care unit) under your care as her primary RN. Answer the questions below and respond to one peer. What thoughts run in your head that could possibly explain what caused the patient’s presentation? What further testing would you anticipate? How would you care for this patient as her nurse?

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