Novel Coronavirus Disease (COVID-19) Part III: Critical Care Unfolding Reasoning - John Taylor, 68 years old, Case Study.

Novel Coronavirus Disease (COVID-19) Part III: Critical Care Unfolding Reasoning - John Taylor, 68 years old, Case Study. Novel Coronavirus Disease (COVID-19) Part III: Critical Care Unfolding Reasoning John Taylor, 68 years old Primary Concept Immunity/Gas Exchange/Perfusion Interrelated Concepts (In order of emphasis)  Clinical judgment  Communication  Acid-base balance  Patient education NCLEX Client Need Categories Covered in Case Study NCSBN Clinical Judgment Model Covered in Case Study Safe and Effective Care Environment Step 1: Recognize Cues   Management of Care  Step 2: Analyze Cues   Safety and Infection Control Step 3: Prioritize Hypotheses  Health Promotion and Maintenance  Step 4: Generate Solutions  Psychosocial Integrity  Step 5: Take Action  Physiological Integrity Step 6: Evaluate Outcomes   Basic Care and Comfort   Pharmacological and Parenteral Therapies   Reduction of Risk Potential   Physiological Adaptation  © 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Part III. Transfer to ICU Situation: Name/age: John Taylor is a 68-year-old African-American male. BRIEF summary of primary problem: He presented to the emergency department because he felt crummy; complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past two days. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom. Transferred to MedSurg four hours ago and was clinically stable until he got up to use the bathroom and went into acute respiratory distress with increasing O2 needs and decreasing O2 sat. Background: Primary problem/diagnosis: positive for COVID-19 RELEVANT past medical history: hypertension and type II diabetes Code Status: Full code Assessment: Most recent vital signs:  P: 134 (reg)  R: 32 slightly labored  BP: 102/54 MAP: 70  O2 sat: 90% non-rebreather facemask-100% RELEVANT body system nursing assessment data: Pale, diaphoretic, anxious, breath sounds diminished with scattered coarse crackles bilat. Use of accessory muscles, unable to verbalize. RELEVANT lab values: Pending lactate and ABG How have you advanced the plan of care? Initiated rapid response and increased 02 nonrebreather mask. Patient response: O2 sat has increased slightly from 85% on oxymask 6 L to 90% on NRB. Respiratory rate remains elevated at 34 and blood pressure has decreased to 102/54 Isar at the INTERPRETATION of current clinical status (stable/unstable/worsening): Dramatic decline-CRITICAL Recommendation: Suggestions to advance the plan of care: Emergent transfer to ICU John is emergently transferred to ICU due to acute respiratory failure. You receive the following SBAR report in preparation to assume care: Transfer to ICU: Five Minutes Later… Cardiac Monitor: Interpretation/Clinical Significance: Irregular. Has changed since the last strip. Signifies a change in the patient’s condition Current VS: Last VS before transfer: T: 102.6 F/39.2 C (oral) T: 102.8 F/39.3 C (oral) P: 118 (irregular) P: 124 (regular) R: 20 (regular) R: 32 (regular) BP: 98/52 MAP: 67 BP: 102/54 MAP: 70 O2 sat: 84% non-rebreather face mask 100% O2 sat: 90% non-rebreather face mask 100% 15 LPM Current Head to Toe Nursing Assessment: GENERAL SURVEY: Appears anxious, body tense. NEUROLOGICAL: Unable to assess orientation due to non-rebreather mask and labored resp. Able to follow simple commands. HEENT: Head normocephalic with symmetry of all facial features. PERRLA, sclera white bilaterally, conjunctival sac pink bilaterally. RESPIRATORY: Breath sounds coarse crackles bilat. with diminished aeration on inspiration and expiration in all lobes anteriorly, posteriorly, and laterally. Shallow respiratory effort. CARDIAC: No edema, heart sounds irregular, pulses palpable, equal with palpation at radial/pedal/posttibial landmarks, brisk cap refill. Heart tones audible and irregular, S1 and S2 noted over AP-T-M cardiac landmarks with no abnormal beats or murmurs. No JVD noted at 30-45 degrees. ABDOMEN: Abdomen round, soft, and nontender. BS active in all 4 quadrants. GU: Last void 250 mL 4 hours ago INTEGUMENTARY: Skin hot, dry, intact, normal color for ethnicity. Skin integrity intact, skin turgor elastic, no tenting present. 20 g. peripheral IV/saline lock left forearm. Site intact with no swelling.