Assessment of the Neurological System
NR305 Week 3 Discussion Latest 2017 November
Week 3: Assessment of the Neurological System
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Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist.
Based on the above please discuss the following.
1. Pathophysiology of concussive injuries and treatment
2. Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)
3. Current best practices associated with post-traumatic stress disorder (PTSD)
4. Nursing interventions you would include in this patient’s plan of care
NR305 Week 4 Discussion Latest 2017 November
Week 4: Assessment of Cardiac Status
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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.
1. What do you suspect is the cause of the patient’s symptoms?
2. Describe the course of action that you will take to confirm this suspicion and prevent further decline.
3. 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.
4. While you are caring for this patient, how will you ensure that the needs of your other patients are being met?
NR305 Week 5 Discussion Latest 2017 November
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