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Original Question
Hello. Could I please request some assistance regrading the question down below. “Take Actions/ Interventions”. The question is the third pasted picture. I have already highlighted the abnormal cues in green extrapolated from the case study of Meg Wright, processed the information from the abnormal cues, and then have identified three critical problems from those cues which now need 2 time critical interventions for each identified critical problem. I have pasted five sections which include; collect cues, process information, the case study of Meg Wright, question 5. Take actions/Interventions, and the three critical problems. Image transcription text 2. Collect Cues DETECT ASSESSMENT A-E Cues collected at 22:40 pm Normal ranges A-Airways Patent Patent B-Brea… Show more Process Information Airway: Patent Breathing: RR 24 (the patient is hyperventilating as a compensatory mechanism due to the presence of metabolic acidosis) PvCO2 (this is also a compensatory mechanism of the respiratory system because of the presence of metabolic acidosis) Circulation: HR 125, tachycardia (this is a compensatory mechanism of the heart because the patient is having decreased perfusion in the body or hypovolemic shock as evidence by the weak pulse, BP 85/55, delayed capillary refill (Normal: 1-2s), cool clammy skin, and shivering to touch) Ph = 7.27, HCO3 = 20 mmo/L – this is a metabolic acidosis partially compensated (partially compensated since the PVCO2 of the patient is towards alkalosis side, meaning the respiratory is trying to compensate from the metabolic acidosis, it will be only “fully compensated” if the patient went back to normal) Lactate= 3 (this means lactic acidosis probably due to dehydration of the body and again patient experience metabolic acidosis) Disability: Fluctuating LOC & Confused to place (probably due to acidosis or hypovolemic shock – there is poor oxygenation in the brain) Pain score at 0/10 Distended Abdomen Decreased bowel sound (this is a sign of peritonitis due to septic shock) Exposure: Temp: 39. 5 (indication of fever) Decreased turgor (due to dehydration of the body) Image transcription text In ED – Triage At 10:30 PM – Meg Wright, 83-year-old female, was sent in from a nursing home to the ED with a 1… Show more Image transcription text 5. TAKE ACTIONS/INTERVENTIONS You can score up to 6 marks for presenting two time-critical interventions for ea… Show more Identify Critical Problems 1. Critical Nursing Problem Ineffective tissue perfusion related to metabolic acidosis secondary to lactic acidosis as evidenced by hyperventilation, tachycardia, hypotension and altered LOC (confused to place). 2. Critical Nursing Problem Ineffective breathing pattern related to altered tissue perfusion (metabolic acidosis) as evidenced by increase respiratory rate and compensation of PvCO2. 3. Critical Nursing Problem Hyperthermia related to sepsis as evidenced by distended abdomen (peritonitis) and decrease bowel sound. Ineffective tissue perfusion nursing diagnosis signifies a presence of failure in the circulatory mechanism in which oxygen as well as energy consumption of tissue at capillary level is compromised that can result mild to serious medical complications. In lactic acidosis it can cause reduction of cardiac contractility as well as some vascular deficiencies. Ineffective breathing pattern is considered the state in which the rate, depth, timing, rhythm, or pattern of breathing is altered resulting to inadequate oxygenation. Metabolic acidosis can cause breathing to be rapid and shallow and can worsen if acidosis aggravates. Hyperthermia is defined as elevated body temperature due to a break in thermoregulation. It can be due to localized inflammatory response and can also become systemic. Sepsis is the body’s extreme response to infection that includes manifestation of high grade fever (38’C above), confusion/disorientation, cold clammy skin, shortness of breath and can trigger a chain of reaction throughout the body. Common Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract.
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