Health Care: The Problem with the Highest Priority

Case Scenario
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Case Scenario
Question 1: The Problem with the Highest Priority when Planning for Mr. Brown’s Care
Of the listed problems, the highest priority would be given to the decreased levels of consciousness. The major reason for this is that the other problems such as altered serum potassium, dehydration, altered blood glucose level and paresthesia and paralysis can be managed once the patient is fully conscious and aware of the things that are going on around him. From the objective data, it is seen that the patient had been drowsy, implying that the operation procedure must have made the situation worse, leading to decreased levels of consciousness.
According to Puggina et al (2012), nursing care of patients with problems of decreased levels of consciousnessshould be particular and specific for various reasons such as the difficulties in diagnosis and the lack of demonstration of consciousness.It is important to keep the patient conscious for the purposes of communication. The altered states of consciousness may be inclusive of conditions that are normal and paranormal in nature.In most cases, the decreased levels of consciousness is as a result of decreased blood flow. In Mr. Brown’s case, the severe leg pain in his anterior right lower part of the leg, as a presumed result of claudication, is the most likely cause of the temporary loss of consciousness. The decreased serum potassium level may be taken care of thereafter since it was reported in the objective data. Includingthe management of the decreased levels of serum potassium, as a subsequent priority in the patient report sheet, will line it up for attention from the doctor.
The other reason for prioritizing the decreased levels of consciousness is based on the patient’s past medical history. As reported, Mr. Brown had previously suffered from Hyperosmolar Hyperglycemic Nonketotic Syndrome. This is a medical emergency, resulting as a complication of type 2 diabetes that is most frequently seen in adults of Mr. Brown’s age who have diabetes. As reported after the operation procedure, Mr. Brown became dehydrated. This is as a result of extremely high blood glucose levels and increased viscosity of the blood. The patient is therefore at risk of intravascular clotting, clots in the blood vessels and strokes because of the Hyperosmolar Hyperglycemic Nonketotic Syndrome. Additionally, the patient has shown some of the vital symptoms of the disease, most importantly decreased consciousness. Should he continue being in this state, he is at risk of falling into a coma.
The reason that the problem of altered serum potassium level was not prioritized over the decreased level of consciousness is that electrolyte imbalances are a common problem in elderly people. In its nature, the immediate cause of the altered serum potassium level is usually clinically apparent, that is the fluid overload or depletion. Additionally, some medicines that the patient has been taking may be attributed to the cause. The potential causes of the altered levels of serum potassium can be discussed after referral to secondary care is detailed. Further investigationof the problem isonly appropriate in case the clinical assessment and patient history do not reveal the cause of the alteration (Kyle & Jayathissa, 2011). This case can be listed high in priorities after taking care of the consciousness issue, given that Mr. Brown’s serum sodium is far below the normal 135-145 mmoI/L.
Question 2: The Best Nursing Management to Help Alleviate Mr. Brown’s Discomfort as It Is Related to His Hyperthermia
Mr. Brown’s hyperthermia is related to his past and present medical conditions as evidenced by general weakness and dehydration. Records indicate that he has been weak over the past two days, and after the operation procedure, he is showing signs of extreme fatigue, discomfort and loss of consciousness. According his friend, Mr. Brown lives alone and has children who visit (they live with the mother). The patient’s report also indicates that he has not been able to take food and water well due to nausea. Previously, the patient was lethargic, but alert enough to tell his medical history, being the main reason he came to the hospital. On assessment, it was noted that he is quite dehydrated, and this has persisted even after the operation.
In my management plan, the objective of the assessment should be to attain the normal temperature of about 37.50C and maintain the normal heartbeat. The rationale for this is that the vital signs provide an accurate indication of the core temperature and the proposed procedures help to lower the body temperature. The first nursing intervention would be constant assessment, probably at intervals of 3-4 hours. During this period, the patient’s oral temperature will be recorded and any readings greater than 390Cbe reported to the doctor. This is a short term intervention in order to ensure that the patient’s temperature comes down to about 37.50C.After this, the patient shall be put on ordered antipyretics for a temperature greater than that. After four hours of appropriate nursing intervention the patient’s vital signs are expected to return to within the normal range, with a temperature recording of bout 36.50C to 37.0C.The C-pulse rate is also supposed to be between 60-100 bpm and the respiratory rate at 12-20 cpm. Another important step to take is the oral fluid intake every two hours so that the patient can regainbody fluids and help with the dehydration too. I will also have the patient to rate his energy on a scale of 1 to 10, with 1 being the lowest energy level and 10 being the highest energy level within the first three days of hospitalization. This will help to keep tract of the patient’s progress and wellbeing. (Ackley & Ladwig, 2013) outline how to formulate nursing diagnoses and creating individualized care plans. The table below provides the nursing care plan for the patient.
NURSING CARE PLAN FOR MR. BROWN
Assessment

Nursing diagnosis

Nursing goal

Nursing intervention

Rationale

Outcome criteria

Actual evaluation

Objective
The skin is warm, recorded at a temperature of 390C.
Dry skin and warm w...