Kent Clark Admitted Explained for Students (Easy Guide)
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Original Question
Kent Clark, age 29, was admitted 24 hours ago for observation related to a suspected closed head injury following the motor vehicle accident (MVA). Mr. Clark, baseline vital signs are stable. He has a cervical collar and is scheduled to undergo MRI to determine if he has cervical spine injury. The primary care provider has asked you to reduce his activity until cervical spinal injuries are ruled out. Currently, Mr. Clark is awake, alert and oriented (person, place and time); his pupils are equally round and reactive to light and accommodation (PERRLA). He moves all four extremities bilaterally. His head is elevated 30 degrees to minimize increased intracranial pressure (ICP) and edema. A peripheral IV in his right arm is infusing D5 ½ NS at 20 ml/hr. Just before you are scheduled to take him to Special Procedures, Mr. Clark becomes restless and anxious. During the neuro check you notice that his right pupil is sluggish. Although he denies pain, he says ” I don’t care what the doctor says. I am not going to stay in this bed any longer!”. When you call the primary care provider, he orders lorazepam 0.5 mg IV push. However, as you give IV push medication to Mr. Clark, you notice a cloudy substance forming in the IV line and he reports a slight burning at his IV insertion site. 1) What clinical symptoms alert you that Mr. Clark’s condition is changing, and what additional assessment will you do? 2) Describe special positioning and transfer technique to be followed for Mr. Clark. 3) How will you handle Mr. Clark’s anger and prevent him from getting out of bed? 4) Identify the source of the pain at the IV insertion site and the cloudy substance in the IV tubing. 5) What could you have done to prevent these complications, and how will you intervene now?
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