[Verified Answer]: Ms

Ms. B is admitted through the emergency department (ED) after being hit in the abdomen by an automobile. An 18 gauge IV catheter is started in the left forearm and normal saline is started at 100 mL/hr. The UAP reports that her blood pressure dropped to 92/58 mm Hg and she is reporting weakness, fatigue, and abdominal pain. When you assess Ms. B, you discover that she is nauseated and just vomited 560 mL. Laboratory values from the ED are as follows: Aldosterone level 3 ng/dL (low) Cortisol level 2 mcg/dL (low) Potassium level 3.7 mEq/L Sodium level 136 mEq/L 1. What is your first action? Explain. 2. Ms. B blood pressure is now 84/50. Place the healthcare provider orders in the order you would complete them. Explain. Do you question any of these orders? If so, why? 3. Infuse normal saline at 250 mL/hr 4. Type and cross match for 2 units of packed red blood cells 5. Insert a large bore IV catheter 6. Administer prednisone 10mg orally 7. Which actions will you delegate to the UAP in providing care for Ms. B? Exaplain. 8. Encourage the patient to take in adequate fluids 9. Measuring vital signs every 15 mins 10. Recording intake and output accurately every hour 11. Getting a baseline weight to guide therapy 12. Administering oral antinausea medication 13. Ms. B develops diaphoresis, increase heart rate (124 bpm), and tremors. She also reports an increasing headache. Place these actions in order of how you would complete them. Explain. Are there any that you would not complete? Explain. 14. Check fingerstick glucose 15. Check serum potassium level 16. Place the patient on a cardiac monitor 17. Decrease the IV fluids to 100 mL/hr You are also taking care of Mrs. H, she was admitted to the med/surg unit for a workup for Cushing Disease. Upon your admission assessment Mrs. H report the following: cessation of mensuration at 33, increase craving for salty foods, weight loss of 25 lbs, nausea, diarrhea, and loss of appetite. During your physical assessment you find the following abnormal findings: truncal obesity, weight loss, bruising, hypertension, thickened skin, dependent edema. 1. Which further questions do you have for Mrs. H and of which factor reported by Mrs. H supports the diagnosis of Cushing Disease? Explain. 2. Which of your abnormal assessment findings will you teach the student nurse to expect if a patient has Cushing Disease? Explain. 3. Which vital sign reported to you by the UAP causes concern for a patient with Cushing Disease (hypercortisolism)? Explain. 4. Heart rate of 102 bpm 5. Respiratory rate of 26 breaths per min. 6. Blood pressure of 156/88 mm Hg 7. Oral temp of 101.8 F Cushing Disease is diagnosed in Mrs. H because of increased secretion of adrenocorticotropic hormone (ACTH), and she is scheduled for an adrenalectomy. 4. Which of the following actions should you delegate to the LPN? Explain 5. Assessing the patient’s cardiac rhythm 6. Reviewing the patient’s laboratory results 7. Checking the patient’s fingerstick glucose results 8. Administering insulin on a sliding scale as needed 9. Discussing goals and outcomes of care with the patient 10. After Mrs. H’s surgery she will have a risk for infection related to immunosuppression and decreased primary defenses. What education should you provide to Mrs. H?