While Getting John Explained for Students (Easy Guide)
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Original Question
While you are getting John Doe settled, you continue your assessment. Neurologic findings: PERRL (Pupils Equal, Round, Reactive to Light), moves all extremities, but patient is sluggish, pulling away during assessment, and follows commands sporadically. Cerebrovascular findings: Pulse is regular but tachycardic without adventitious sounds. All peripheral pulses are palpable, with 3+ bilateral and 3+ pitting edema in lower extremities. Respiratory assessment: Breath sounds decreased to all lobes, no adventitious sounds audible, patient not cooperating with cough and deep breathing, and Sao2 at 90% on room air. GI assessment: Tongue and gums are beefy red and swollen, abdomen is enlarged and protuberant, girth is 141 cm, and abdominal skin is taut and slightly tender to palpation. His Salem Sump NGT is patent, connected to LCS with small to moderate greenish drainage; bowel sounds positive with NGT clamped. Genitourinary (GU) assessment: Foley to gravity drainage, with 75 mL dark amber urine since admission (2 hours). Skin: Pale on torso and lower extremities; heavily sunburned on upper extremities and head. Skin appears thin and dry. Numerous spider angiomas are found on the upper abdomen with several dilated veins across abdomen. Vital signs: 120/60, 104, 32, 99.1° F (37.3° C). 5. What is the significance of the spider angiomas, dilated abdominal veins, peripheral edema, and distended abdomen? 6. How would you further assess the distended abdomen, and what is the clinical name for your findings? 7. What is your concern about John Doe’s nutritional status? What are your objective findings? 8. If his protein levels are so low, why isn’t John Doe on a high-protein diet? 9. How might you respond to fellow staff nurses’ remarks, “Why are we wasting time with this ‘wino’? He isn’t worth the time or money. Why don’t they let him die?” 10. A nursing problem relative to John Doe’s care is the possibility of injury. Ensuring safety is a priority when caring for a person who might be withdrawing from alcohol. Identify two areas of injury risk and specify actions you will take to ensure his safety. 11. You monitor John Doe for signs and symptoms of alcohol withdrawal and delirium tremens (DTs). So far, he is restless, has tremors, and has a low-grade fever. Which of the symptoms listed are symptoms of the more severe DTs? (Select all that apply.) a. GI bleeding b. Hallucinations c. Hypotension d. Somnolence e. Extreme diaphoresis f. Tachycardia g. Vomiting 12. Falls are particularly dangerous for someone in this patient’s situation. Why? CASE STUDY PROGRESS During John Doe’s hospitalization, a staff psychiatrist evaluates him for mental decline associated with alcohol abuse and dependence, including alcoholic dementia, or Korsakoff’s psychosis. 13. What are alcoholic dementia and Korsakoff’s psychosis?
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