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Original Question

Roberto Galgano, a 67 year old male of Italian heritage, has was admitted on your ward at 1430 hours yesterday with a 2 day history of vomiting and diarrhea related to food poisoning. He has a past history of Type 2 Diabetes Mellitus, is a current smoker, increased BMI, and hypertension. In your morning handover it is revealed that his IVC tissued (phlebitis) overnight and the staff have been unable to resite it as his veins were difficult to cannulate and the Registered Medical Officer (RMO) has been busy with a deteriorating patient. He has not received IV hydration since 0130 hours. His last urine output, at 2300 hours, was 50mls and it was concentrated/dark in colour. A bladder scan at 0400 hours showed no residual urine. His last episode of vomiting and diarrhea was at 0515 hours. He has dry mucous membranes, poor skin turgor and cool peripheries. The morning RMO orders UECr blood tests and is preparing to recannulate for a stat IV bolus of Normal Saline (0.9% NaCl). It is now 0735 hours. His recent vital signs at 0730 hours are: BP 95/65 mmHg HR 110 bpm RR 20 breaths per minute SpO2 94% Room Air via finger probe and his SpO2 has consistently been 94-96% since admission T 37.1 Utilising best practice research, contemporary evidence and the nursing standards to assist, students are encouraged to link any relevant Cultural considerations, Pathophysiology and Pharmacology to the case study patient to compliment any suggested nursing care and management. Based on your initial impression what do you think is now wrong with Roberto? In your answer please provide relevant pathophysiology. What clinical impression, together with signs and symptoms, is Roberto presenting with that formed your impression of the condition you believe he is now suffering from and why do these signs & symptoms occur (underlying pathophysiology)? Discuss the nursing care and management, using evidence-based literature, required for managing and maintaining Roberto’s potential diagnosis (what you think is now happening), in a culturally safe manner, with rationales as to why this care is provided. Include relevant medical and pharmacological treatment options. List two ACUTE potential problems that Roberto is at risk of due to this current condition that you think is occurring. Provide rationales as to why this is a potential risk and three nursing management preventative strategies for each of these problems.

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