Scenario 3000 words of Episode of care
Mrs Anna is admitted to the ward with the hot water bottle used for low back pain at home, bag burst and caused a burn around 3 am. Lower back pain to lumbosacral region longstanding. Mrs Anna feels her breathing has deteriorated over the past weeks; Mrs Anna exercise tolerance previously was walking to the bathroom from her bedroom on the same floor. Now she finds this too complicated. Anna once declines a package of care. 2nd-degree burn, on 2l of oxygen
Long time condition: COPD, Diabetes
Past Medical History >>. Community DNAR instu
Surgical and psychiatric: History AF
COPD/OHS/OSA
Breast CA
Before admission :::
she lives in a flat with her sister
Mobility : minimal, mobilised 1m with 4ww to the commode, required 5 min rest and then rallied back to bed independently
Sister assist with ADLs
A recent referral was completed for DNs to ax bladder and bowel continence as the patient-reported some urinary incontinence with the RR therapist. The patient had an air- mattress , but had it sent back and wanted a foam mattress instead.
Problem list:
1.Accidental burn
2.Chronic T2RF
3.Mildly elevated inflammatory markers? reactive to burn
4.Slightly off baseline mobility
Management plan:
1.Burns advice from another hospital
2.Start review
3. Slow IV fluids
4.urine M&CS
5. Stop Adcal D3
Allergies to penicillin
Plan 1
1 Chasevancomycin level and prescribed accordingly
2 Physio team investigate CPAP mask air leak
3 Blood today
4 If progressive Hypoxia or resp requirements in the absence of chest signs/chest exam would require CTPA but not necessary at this moment
5 Pressure relief strategy needed from TVN
6 IVF needed -1L/24hrs
7 Bloods Monday
Plan:
1.if discharged outreach nurse may be able to go and see her
2. if Anna stays, then she will be given an appointment within 48hrs
1. Check tetanus status-if not up to date, provide booster revaxis
2. Await bleep from CW with plan
3.Update CW when start to review complete re-plan
-if discharged outreach nurse may be able to go and see her
-if Anna stays, then she will be given an appointment within 48hrs
Covid swab taken
Required in the two days
Meds on admission:
Azithromycin 250mg 3 times a week
Bethistine 16mg tds
Bisoprolol 7.5mg od
bumetanide 2mg and 2mg midday
Senna 15mg
1 What are the main issues in the scenario?
2 What pathophysiology needs to be discussed for this scenario?
3 How will you assess the patient in the scenario?
4 What are the specific nursing problems in this scenario?
5 What pharmacology knowledge is relevant to this scenario?
6 What sources of evidence will you utilise?
Formulate a plan of care for Anna prioritising one nursing problem/diagnosis, stating a goal (this can be short term & long term)
Outline the nursing interventions to address the nursing and also think of the rationale for each intervention.