Case study

[kenda]

I need help with this case study. Iam a LPN student. Mr. James is an 84y.o. male admitted w acute confusion. VS T-101,HR110,RESO 24 BP-90/53, Pox 91% on o2 4l NC. AxO x1, lethargic and groogy. Chronic foley? dark amber colored urine output. lives is nursing home, not ambulatory and suddenly combative. blood sugar 90. Lungs scattered, rhonci, trace edema to ble, bsx4 quad. sacrel area abraised. HR irregular. H/O DM, MIx2, BPH,HTN, Asthma,CAD,CHF,COPD. Dr. orders NS@125cc/HR x 3l, ATIVAN 0.5mg PRN @hs. UA/C+S, CXR to R/O pneumonia, blood cultsx2 orthostaic BP, Haldol 0.5mg IV stat.

1. According to admit dx What is the cause of his acute confusion?
my ans. Fluid volume deficit

2. What are ramifications of administering NS @ 125cc/hr/HR x 3l w h/o of CHF administering Haldol 0.5mg IV stat

Fluid overload

What are safety concerns? Fall risks

Part II

After 6h pt SOB, O2 cannula on bed and more confused. On assessment lungs hace rhonci w coarseness, wheezing on inspiration & expiration, little urine infoley. Pt combative and his IVF is still running at 125cc/HR What would you do?

Part III

two days have passed, he has improved and will be discharged in nxt few days. AxO x3 lungs scattered crackles, blood sugar 148 T-98.9, HR 90, Resp-22, BP-128/69 POX94% O2 2l, NC trace edema to ble ankles, sitting up watching tv.

What has happend in the last couple of days, what was going on w pt.

[JLS]

Trying To Answer Your Questions:
First Another Risk Would Be ?aspiration Pneumonia, But It Sounds Like The Patient Has Some Aspiration Pneumonia With Chf