Management of a Patient with Neurologic Dysfunction

Medical-Surgical Case Studies Case Study #1

Management of a Patient with Neurologic Dysfunction J.M., a 22-year-old male patient who weighs 150 pounds, presents to the emergency department (ED) after being thrown from his horse and passing out for a few minutes, after which he regained consciousness. A friend with whom he was riding witnessed the fall and called for help. Upon initial assessment, J.M. was found to have a GCS of 15 with a normal neuro exam.

The ED physician wrote orders for a CT scan without contrast of the head, a CBC, renal and metabolic profile, PT, PTT, and an INR. The nurse sent the labs and had the IV of Normal Saline at a keep-open rate per the ED protocol. The nurse was awaiting radiology to call for the patient to go for the CT when the patient had an “epileptic cry,” became unconscious, stiffened his entire body, and then had violent muscle contractions.

J.M.’s respirations became very shallow, and his lips and nail beds became blue. Furthermore, he lost control of his bowel and bladder functions. Blood was oozing from his mouth due to J.M. Having bitten down on his tongue. The radiology department has called to say they are ready for J.M. to come for the CT scan.

1. List in the correct order of priority the actions that should be taken by the nurse while the patient is actively seizing. 2. Explain What type of seizure is occurring and describe the three phases of seizure activity? Describe specific nursing care for each stage.

3. The ED physician orders the following: Valium (diazepam) 10 mg every 10 to 15 minutes prn for seizures (to a maximum dose of 30 mg). Once seizures stop, administer Dilantin (phenytoin) 10 mg/kg IVPB [The RN will be administering this IV medication], continuous ECG monitoring, VS, GCS, and neuro checks at least every 30 minutes. Explain the rationale for all of the physician’s orders.

Case Study #2

Management of Patients with Multiple Sensory Deficits You have received a report on the new admission to your short-term rehabilitation unit. Mrs. Ida Henson is an 81-year-old female with left hemiplegia, left-side neglect, and left visual field deficit (homonymous hemianopsia) due to a stroke. She has a history of hypertension and insulin-dependent diabetes Mellitus (IDDM) and she wears bilateral hearing aids.

Prior to this event, she was an extremely active octogenarian, working daily as a volunteer at a local nursery, driving, helping family members, and socializing several times a week with friends. After several weeks of therapy, the physical therapy assistant cannot tell if Mrs. Henson is experiencing fatigue or if she doesn’t seem to be hearing instructions even though her hearing aids are in both ears.

1. Identify three initial nursing diagnoses for Mrs. Henson and list the defining characteristics that would support each of your identified nursing diagnoses. 2. What assessments would the nurse perform to assess Mrs. Henson’s hearing ability? 3. Upon further assessment, it is determined that Mrs. Henson has impacted cerumen. You receive an order for carbamide peroxide (Debrox) two drops each ear twice daily for 3 days to be followed by otic irrigation on day four.

What steps should be taken by the nurse to perform the otic irrigation? How will the nurse evaluate if the otic irrigation was successful? 4. What general overall strategies can the facility staff implement to optimize communication with Mrs. Henson in view of her hearing impairment and present health status?

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