An 82-year-old elderly patient arrives at the Emergency Department by car- via a neighbor. The neighbor reported that she had been nauseous and vomiting for a week- possibly due to stress related to her husband’s admission to an LTC facility for Alzheimer’s. The Patient appears unkempt, and unable to obtain much history from the Patient; she is experiencing acute confusion. The neighbor also stated that the Patient has not been eating much and experienced bloody vomit and dizziness. The Patient smokes two- packs of cigarettes per day and has an open wound on the bottom of their right foot. The hypothesis for this mode of inquiry wound falls in line with the ethical way of inquiry: to research if the Patient has any health care surrogates, next of kin, question about advanced directives, and or living will. Will admit the patient and continue to monitor them.
The most appropriate hypothesis that aligns with the scenario is the hypothesis made from the empirical mode. The Patient presents in the ER, where the healthcare professionals’ priority is to provide necessary medical interventions to improve their condition. The Patient suffers from chronic bronchitis, as evidenced by blood in vomit, labored breathing, high blood pressure, smoking, and peripheral neuropathy apparent by the wound on the right foot. The Patient appears to be declining and needs immediate treatment and interventions. Administer Bronchodilator to reduce symptoms and increase the Patient’s O2 saturation. Apply O2- improved O2 sats- keep sats above 90. The patients’ confusion could be related to possible Bronchitis, UTI, dehydration, and hypoglycemia (type 1 diabetic). The Patient will need diagnostic tests and lab work orders, including a BMP and a urine sample. Also, a demand for PIV to start her on IV maintenance fluid- for possible dehydration needs (Donges et al., 2019). The patient’s BP is high, with the possibility of noncompliance with the medication regime for a few days by now- the Patient cannot let us know the last time taken. It could contribute to her elevated blood pressure readings. The Patient did have a Lopressor bottle brought in by a neighbor, and the bottle was empty.
Accu checks to assess blood glucose levels, treat them appropriately, and continue to monitor them. Debridement of a large wound on the bottom of the right foot, then dressed follow-up with WOC in am for more in-depth orders – possible decreased circulation due to type 1 diabetes and smoking.
To evaluate these hypotheses’ outcomes, the nurse would reassess the Patient’s respiratory status, check for the inflammation level, and administer bronchodilators. Monitor effectiveness by using a bronchoscope and pulse oximeter; the level of oxygen saturation should improve following a bronchodilator. The care provider will also check for the level of blood glucose and then administer insulin. Blood glucose and cognitive status will monitor the effectiveness of insulin. Peripheral neuropathy: – evaluating the presence of sensation in the lower part of the right and left leg. In this, the care provider will ask the patient to move her left/right leg/foot and pinch some parts to check for the presence/loss of sensation. To evaluate the efficacy of wound management interventions, observe the wound for signs of healing/infection. Monitor status, recheck all vitals, and pay close attention to
outcomes. Document improved vitals and ones that continue to decline. The provider will immediately modify the care plan if the signs of infection are present in the wound (Donges et al., 2019). BP needs to be brought down and controlled. The Patient has a self-care deficit apparent by their current physical state; follow up with a social worker tomorrow to address socioeconomic needs as the chart states only Medicaid for insurance, which indicates low economic status and need for assistance. Overall plan- The patient needs to be admitted with continuous monitoring and update the care plan following doctor evaluation at the bedside. The goal is to get her back to baseline mentation, raise O2 sats, lower BP, and continue wound care and healing. Evaluation of the patient’s ability to go home or go to a transitional care unit to assist with a self-care deficit (Donges et al., 2019).
Doane, G.H., Varcoe, C. (2014) How to Nurse: Relational Inquiry with Individuals and Families in Shifting Contexts. [Bookshelf Ambassadored]. https://ambassadored.vitalsource.com/#/books/9781469872209/
Doenges, M.
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