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John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department...

Question

John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department...

John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but "none as bad as this." He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. John experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the emergency department for evaluation. After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented × 3, and he moves all extremities well. He is restless, constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm. Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for 1 week. The patient voids dark amber urine but denies dysuria. skin and sclera are jaundiced. Admission vital signs are blood pressure 164/100, pulse of 132 beats/min, respiration 26 breaths/min, temperature of 100° F (37.8° C), spo2 96% on 2 L of oxygen by nasal cannula. Preoperative Laboratory Test Results • WBC 11,900/mm3 • Hgb 14.3 g/dL • Hct 43% • Platelets 250,000/mm3 • ALT 200 units/L • AST 260 units/L • ALP 450 units/L • Total bilirubin 4.8 mg/dL • PT/INR 11.5 sec/1.0 • Amylase 50 units/L • Lipase 23 units/L • Urinalysis Negative . 3. Which vital signs results are abnormal, and what do they reflect?

Answers

In the vital signs of Mr. John it was clear that his temperature and blood pressure were elevated. His heat beets at a rate of 132 beats per minute it will come under tachycardia and another important finding is his respiratory rate is also 26 breaths per minute this can also consider as tachypnoea.

This was a clear indication of the patient may be undergoing through arrythmias, so it needs to be evaluated with electro cardio gram. If there are any abnormalities in the ECG it has to be reported and further management should be initiated, this will be considered as a priority of nursing management. The temperature of the patient is 100 degree F it comes under mild hyper pyrexia and should be monitored for further management. Also he had the signs of jaundice which shows that sclera was yellow in colour, and total bilirubin is also elevated, so these all will considered to be a major diagnosis for the patient upon further investigation and ward observation.


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