Nursing case study of acute dyspnea and altered mental status in elderly patient

Nursing Case Study

The first concern is that Mrs. Baker is taking a new drug that has side effects such as she is experiencing. Although the other high blood pressure medication has similar side effects (Drugs.com, 2012), she has been taking it for a long period of time and should not be experiencing as much difficulty. It seems germane to ask her how long she has been taking the hydrochlorothiazide though. One of the first thoughts is how well do the two medications work together, which is something her doctor understands, and if she can have an increase in side effects because of the increase in medication. The second question the symptoms, especially the fact that she seemed "confused and beside herself" on the phone, is to determine if there are other symptoms of stroke. Her breathing difficulties could be a symptom of the medication, and so could the confusion, but it is pertinent to look at other difficulties that she may be having.

The fact that she becomes unresponsive after answering a few questions is a grave concern. It is necessary, obviously to somehow provide more oxygen because she is obviously not able to process enough herself. She needs to have oxygen, which is readily available, and see if this mediates that symptom.

B. The tools to use during the initial part of the assessment are limited because she is in obvious physical distress and needs to be put on oxygen right away. However, it other tools need to be quickly implemented to further assist the patient. It is necessary to immediately her O2 saturation also, so it is necessary to use either the finger cuff or an another type of sensing machine. The benefit of this machine is that it will provide the staff with information about how the patent is processing oxygen.

C. The first part of data collection has to be what is immediately seen from the patient when she walks in the door. She is obviously short of breath, so this has to be the first priority. Second, she seems confused and she passes out during the assessment, so this indicates that she may be having some type of reaction to a med or some other immediate issue such as a stroke. Because of her age and the fact that she is taking blood pressure medication, it is necessary to look at all conditions that could be related to her health in that regard. Finally, the nurse needs to determine how long she has been taking the new medication, if she has had any mild symptoms after taking it before, and when she took it last.

D. Pain can be seen in the non-conversant patient, but it necessary to be cautious in this case. The patient who is awake can likely tell the nurse if there have been any reactions to a certain type of medication in the past, or if there is something that works better than other medications. The nurse can ask this patient if the drug seems to be working also. With a patient who cannot respond, it has to be done through careful observation. With any pain medication, it will probably be necessary to start slow and with a low dose, then the nurse can see how the patient reacts to the medication. In all cases the patients physician should be called to determine if there are any medications which may be better for this particular person, and which should not be used. The doctor can prescribe the correct medication and dose.

E. The safe assessment would be to give the patient acetaminophen which has far fewer side effects and can be safely administered whether the patient can respond or not. It is probably safe to assume from the standing order that it is okay to give the patient morphine, but it is not advised unless the pain reaches what seem to be a critical level. It is possible to know if the pain management is successful if the patient relaxes both bodily and in facial expression. It is difficult to assess a patient who is non-responsive because there are fewer clues as to the real problem. It is necessary to use more precise observation skills in this case.