Answer Happy

Carl Bowden: Alcoholism Case Study Carl Bowden, a 58-year-oldmale with a history of hypertension and type 1 diabetes, wasadmitted today to the medical-surgical unit for treatment of a leftfoot wound. The patient had been binge drinking when he fell andsustained the cut to his foot one week ago. He had been treatingthe wound at home but has noticed increased swelling and redness tohis foot, and the wound is not healing. He has been drinkingheavily for the past 6 months since he lost his job. He states “Ilearned my lesson when I fell, and I am going to quit drinking.”His last drink was 3 days ago, and he is beginning to show signs ofalcohol withdrawal. Mr. Bowden is married, and his wife is verysupportive. His home medications are lisinopril, atenolol, Lantusinsulin, and Humalog insulin Phase 1 Monday 14:15 You assume carefor Mr. Bowden and receive a report from the charge nurse who hasstarted the admissions process. She mentions the labs tests weredrawn, and radiology has been notified to transport Mr. Bowden whenthey are ready to perform the MRI. The nurse tells you she isconcerned that the admitting provider might be unaware of thepatient's withdrawal symptoms. You enter Mr. Bowden's room toperform a head-to-toe assessment. You find an obese, unkempt,unshaven man. You verify his identification with doubleidentifiers. Mr. Bowden is alert but repeatedly asks where he isand what time it is. He appears slightly agitated and answers yourquestions curtly. He complains that the unit is "very loud andirritating" and asks whether you could turn off the lights as theyare "really bright." ...Vital Signs... Temperature: 99.0 degreesFahrenheit (37.2 degrees Celsius), tympanic... Heart rate: 100,radial Blood pressure 140/72 mmHg, right arm, sitting…Respirations: 20… Oxygen saturation: 93% via room air per fingerprobe… Height: 6 ft 1 in... Weight: 268 lbs, patient statement...You hear S1S2 in a regular rhythm with no murmur. Peripheral pulsesin the femoral, popliteal, right anterior tibial, right dorsalispedis, brachial, and radial areas are normal. Left anterior tibialand left dorsalis pedis are nonpalpable. His extremities aregenerally cool and pale. Capillary refill is normal in upperextremities and right foot but greater than 3 seconds in the leftfoot. Mucous membranes are pink and moist. Left foot with 4-pluspitting edema and reddened. No cardiac problems are found. Mr.Bowden's breathing pattern is even and unlabored, and lung fieldsare clear bilaterally in all fields but slightly diminished in thelower posterior fields. You note the presence of a dry,nonproductive cough that the patient describes as a "smoker’scough" during examination. Muscle strength and movement is normalin all extremities but you notice some small tremors in both upperand lower extremities during the assessment. Mr. Bowden states "Idon't shake!" Neurological examination of cranial nerves II-XII isnormal. The patient's gait is steady and his cerebellar function isalso normal. Reflexes are hyperreflexive and symmetricalbilaterally in all extremities. His pupils are equal, 2 mm, withbrisk reaction to light. Mr. Bowden's skin is expected color,slightly cool, and diaphoretic with good elasticity and intact withno lesions except for foot wound. Mr. Bowden's abdomen is round andhis bowel sounds are hyperactive in quality and intensity in allareas. He had a bowel movement this morning that was "normal"brown. He denies any bowel or urinary problems. His urinal at thebedside contains 250 mL cloudy amber urine. The previous nurse hasdressed Mr. Bowden's foot with a moist gauze dressing until thewound consult staff ordered specific dressing changes. She stated“I don’t want the tissue to become dry.” You note red streakingemanating from the wound, moving towards the calf. The entire rightfoot appears red and swollen, but the patient states the pain is"the same as usual," ranking it as 6 out of 10 on a numeric painscale and describing it as constant and throbbing. He grimaces whenyou touch his foot or ask him to move it, and he has had no reliefof pain. You wash your hands and leave the room. [STUDENT ACTION:Document your assessment findings.] Having completed yourassessment, you decide to check the chart for laboratory resultsbefore reporting your findings to the patient's provider. [CRITICALTHINKING: What are you concerned about with regard to the patient'scurrent assessment? What types of orders are you going to requestand why?] [STUDENT ACTION: Document your SBAR communication withthe patient's provider.] ->patient charting -> special charts-> SBAR Phase 2 Monday 14:45 As a result of your communicationwith the provider, you receive new orders. [STUDENT ACTION:Review, verify -provider’s orders click on verify box enter the neworders -> order entry -> pharmacy Now that you have placedall orders, it is time to administer the patient's medications andperform any associated nursing interventions. The patient remainsagitated and is still complaining of pain that he rates as 6 out of10 on a numerical pain scale and describes as constant andthrobbing in his feet and legs. He also reports increased nausea.You decide to administer the indicated medications and initiateappropriate patient teaching regarding medication and alcoholwithdrawal. [STUDENT ACTION: Document medication administration goto MAR, click on green circle next to medication you would like toadminister document patient teaching about medication documentpatient teaching about alcohol withdrawl Phase 3 Monday 15:10Having medicated the patient, it is time to complete yourdocumentation and create a plan of care. [CRITICAL THINKING:Consider nursing diagnoses that apply to this patient. What aresome nursing interventions that you can initiate to assist thepatient in his recovery?] [STUDENT ACTION: Develop a care plan toaddress the patient's needs and document nursing interventionsimplemented based on your care plan. Make sure to includereasonable or expected outcomes and your rationales.] AT LEAST 4interventions