Esther Jackson is a 56-year-old black female who is 1-day post-op following a le

Question

Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient's room for report. Approximately 1 hour later, you return to Ms. Jackson's room with her morning pills and find her slumped over the bedside stand in tears. The patient states, "I don't know what is wrong, I don't feel right. My back hurts and I'm just so tired. What is wrong with me?" The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach. Just then the nursing assistant comes into the patient's room to record Ms. Jackson's vital signs, you take this opportunity to quickly research the patient's medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn't get the patient's pulse because "it is all over the place." Please address the following questions related to the scenario. What do you suspect is the cause of the patient's symptoms? Describe the course of action that you will take to confirm this suspicion and prevent further decline. What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so. While you are caring for this patient, how will you ensure that the needs of your other patients are being met?

Explanation / Answer

Ms.Jackson is a 56 years old female with post operative left radical mastectomy. She had severe pain and it was relieved for approximately 3 hours with an analgesics.Again developed pain, but there was no other symptoms.

Naturally patient will think that the pain originating from surgical site or stomach. As the nursing assistant report all vitals normal except pulse, it feels in all over the body.

If pulse feels all over the body, it could be a sign of atrial fibrillation.

The nurse should immediately inform to the duty doctor and take 12 lead ecg even without order of doctor to ensure the abnormalities of heart. If a doctor diagnosed with atrial fibrillation then must provide ini.Amiodarone 150 mg iv for stat and start 1 gm infusion for 24 hours, as per doctors order. Nurse can take repeat ecg and analyse of progressive treatment. If possible patient can shifted to a cardiac icu to get connected to a cardiac monitor and for further treatment.

In. Amiodarone is a website medicine, so before starting it is better to give in a central intra venous catheter.

If doctor prescribes, nurse can do some lab tests like Trip I, Trip T, cardiac profile etc , in a particular perod.

When a nurse is taking care of a single patient with long time, ask the nursing assistant to take care of them, for there call and other basic needs.

Thanks.

Expecting your valuable feedback.

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