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Section 1 Clinical question. Your patient who was admitted withmelaenaand is currently only taking fluids has returned from the bathroom feeling dizzy and short of breath. What will your actions be?...

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Section 1 Clinical question.

Your patient who was admitted withmelaenaand is currently only taking fluids has returned from the bathroom feeling dizzy and short of breath. What will your actions be?

Explain your answer in detail including your assessment, hypotheses and rationales for actions.​​​​​​​​​​​500 words


Section 2 Prioritization

After morning handover of your 4 patients you have reviewed the charts and have entered the room to greet your patients. It is 0730 and breakfast is usually delivered at 0740. Before you can introduce yourself, the following demands on your time occur concurrently:

Patient 1 Mr South has his wife coming at 0800 to take him home. They have a long drive back to their home in the country. He needs his discharge paper work, medications and IVC removed.

Patient 2Mr Bolt is receiving a heparin infusion forthe diagnosis of a PE. He is due for an APTT blood test at 0800 hours. There are no phlebotomist’s available to take this blood

Patient 3Mrs Jones has an oxycodone PCAinsitu. Overnight her SpO2 dropped so the night staff applied 2L O2/min and left the SpO2 probeinsitu. The SpO2 machine is alarming.

Patient 4MrsRubenfeldisscheduled for a chestxrayat 8am and requires nurse escortas she has IVTinsitu

The ANUM ison the phone to pharmacy regarding Mr South’sdischarge medication for you.

In what order would you address these requests? Describe your rationale for each decision.

​​​​​​​​​​​500 words


Section 3 Professional

You are collecting a patient from the theatre. Your patient tells you she has pain 6 out of 10. She has been given Morphine 2.5mg IV 20 minutes previously. The recovery RN asks you to sort out the pain relief on the ward as they are too busy and need the space. The drug chart has Panadol andPanadeinefor pain relief. You suggest that the patient should not leave recovery with uncontrolled pain and the recovery RN says “I’ve already handed over to you I can’t do anything about that now”. How will you manage this situation?

Describe in detail your response to thisscenario drawing upon your knowledge and research of professional regulations and requirements, professional behaviour, conflict resolution techniques, education and provision of feedback.

​​​​​​​​​​​​700 words

Answered Same Day Jul 22, 2021 Victoria University


Swati answered on Jul 24 2021
116 Votes
Section 1
Clinical question
Patient who was admitted with Melaena is on fluids only cu
ently and when came out of bathroom, he is feeling very dizzy and short of
eathe. This must have happened because of iron deficiency caused in his body due to blood loss. As in Melaena, there are much gastrointestinal bleeding causing black ta
y stools. Melena occurs usually due to bleeding in upper gastrointestinal tract; underlying cause behind this may be peptic ulcer disease, gastric cancer or the liver disease. This blood loss causes anemic condition leading to shortness of
eath and dizziness.
· First and foremost, I will assist the patient to sit on bed in comfortable positioning which is very important. Breathing can be eased up by making him sit up and lean forward with hands on knees. Also, I will make him sit near window followed by teaching relaxation techniques to calm him down. I will try to be friendly while empathizing his condition and will make him aware about the condition and reason behind this.
· Afterwards, I will start his oxygen supplement equipment; will advise to have nothing by mouth. Avoid NIPPV due to the risk of aspiration with ongoing vomiting.
· IV fluid will be started with normal saline or Lactated Ringer’s solution for Resuscitation.
· Will start diagnostic studies and lab tests to know the risks, extent of disease and bleeding areas. And diagnosis.
· Blood units may be transfused in case of low hemoglobin count based on the reports.
The reason behind the dizziness and shortness of
eath is anemia like condition caused by heavy blood loss by gastrointestinal bleeding. Thus, to manage it, patient must be calm and comfortable followed by assistance via oxygen supplement.
Another reason behind this symptom may be anxiety about the disease or not able to cope up with the stress in air of hospital.
To overcome the condition of short
eathless, the first step is to be done is setting up oxygen level in body by starting the oxygen by nasal tube. But in cases, where nasal tube is not helping to soothe or calm the
eathing pattern or in case oxygen saturation is really low, incubation may be required.
Oral intake is to be stopped for while even for fluids as it interferes with the oxygen intake, to cope up this, IV resuscitation is much required side by side. Also, there is need to make patient comfortable and calm which can be done by being friendly, calm and supportive as and when required.
After first line of action to cu
the dizziness and short
eath, there is need to ca
y out the diagnosis of real reasons behind it. The lab tests and other diagnostics must be done at earliest to know the extent and spread of disease along with the actual underlying cause of this melena whether it is peptic ulcer, gastric cancer or liver disease. If required, blood transfusion may also be added to line of treatment.
Section 2
First of all I will consider request of Patient 3 Mrs Jones who has an oxycodone PCA in situ. Overnight her SpO2 dropped so the night staff applied 2L O2/min and left the SpO2 probe in situ. The SpO2 machine is alarming. She needs attention and nursing care at priority reason being there are chances of Respiratory distress, tachypnoea or slow respirations. Impaired oxygenation or cyanosis chances are higher in case of delay. Patient may suffer from hypotension, agitation or confusion if not checked...

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