Noah is6 yearsoldbroughtin by ambulance to ED at 2100hrs following a seizure which lasted for 30 seconds. Parents state that Noah complained of a headache and stiff neck then vomited after being given...

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Noah is6 yearsoldbroughtin by ambulance to ED at 2100hrs following a seizure which lasted for 30 seconds. Parents state that Noah complained of a headache and stiff neck then vomited after being given a dose of paracetamol. He has been lethargic all day, has a fever and is turning his head inwardly to avoid the bright lights.Noah is flushed and irritable.Noah is being managed for bacterial meningitis and intravenous antibiotics (cefotaxime) have now commenced.•Past MedicalHistory: Nil significant•Nil known allergies.

Childhood vaccinations up to date.

ASSESSMENT

Airway. - Patent

Breathing. - Spontaneous, RR-12 mt, SPO2-98% RA, air-entry equal

Circulation- Pale in face, BP- 75/57 mmHg, HR- 145/mt but weak, capillary refill 3 seconds, cool and clammy to touch.

Disability - GCS-13 E3V4M6, opening eyes to speech not oriented to time, place or person, PEARL- 4mm-significantly photophobicon examination

Exposure - Febrile 39.5 degrees Celsius. Unable to flex neck and lift head. Cool extremities. Significant swelling to lips and blanching rash to left arm. IVC 22g via left cubital fossa.

Fluids - Unable to tolerate oral fluids, NBM for now. IV cefotaxime in progress. Oliguric. Loose involuntary bowel motion.

Glucose - BGL-7.8 mmol/L

INVESTIGATIONS

•Urine analysis: Nil abnormalities detected. Urine very concentrated•Bloods- WCC- 22.4, CRP- 96•Lumbar puncture- CSF analysis- opalescent fluid,15 000/cmmwith 88% neutrophils, 8% lymphocytes; glucose of 2 mg/dL and protein of 15 mg/dL. CSF Gram stain positive.•Additional information: CSF cultures –Streptococcus•Diagnosis: Anaphylactic shock associated with the management of bacterial meningitis.

A MET call was activated at 2200hrs.

The presentation should answerallthe questions below.

Q1.Explain in an oral presentationthe high priority clinical manifestationsthat have resulted in the escalation to MET call using a primary survey format (A-G).

Q2.Describethe pathophysiological linkto the identified high priority clinical manifestations and the disease conditions that the patient has.

Q3.Discuss the pathophysiological link betweenthe multiple disease conditionsthat the deteriorating patient has and the clinical presentation.

Q4.DiscussTWO diagnostic resultsand relate it to the underlying pathophysiology.Q5.ExplainTHREE high priority interventionsyou will do to improve the patient’s

clinical condition.

Q6.Discuss the pharmacological actions ofTWO drugsthat could be used in the management of this patient’s acute deterioration.

Answered 3 days AfterApr 10, 2022

Solution

Ananya answered on Apr 14 2022
12 Votes
Running Head: NURSING                                    1
NURSING                                            8
NURSING
Table of Contents
Question 1    3
Question 2    4
Question 3    5
Question 4    6
Question 5    7
Question 6    7
References    9
Question 1
A patient shows several primary symptoms and escalation of health condition when it results in an emergency. During such cases, the Medical Emergency Team (MET) comes into action, which consists of a number of trained nurses and medical staffs to handle such situation and revive the patient from the severe condition. The high priority clinical manifestations that the patient showed in the given case study are seizure, which lasted for 30 seconds followed by headache and stiffness of the neck, which resulted in vomiting after consuming paracetamol.
The patient is having been lethargic all da with fever and sensitivity towards light. The primary survey conducted showed:
Airway – Patent,
Breathing – Spontaneously without difficulty,
Respiration Rate-12 mt,
The oxygen level being 98% in the body,
Yet, it showed a pale appearance on the face with a low blood pressure of 75/57 mmHg, Heart rate being 145/mt but weak, the capillary was refilled every 3 seconds, cool and clammy to touch.
Disability - GCS-13 E3V4M6, opening eyes to speech not oriented to time, place or person, PEARL- 4mm-significantly photophobic on examination.
Exposure - Fe
ile 39.5 degrees Celsius
· Unable to flex neck and lift head
· Cool extremities
· Significant swelling to lips and blanching rash to left arm
IVC 22g via left cubital fossa. Patient was oliguric and showed involuntary loose bowel movement.
The patient was showing intolerance towards fluid and hence nothing was being provided by mouth. The glucose level of the patient dropped to 7.8 mmol/L. This primary examination showed an altered values from the normal, which indicated towards an emergency of Noah in the given case study. Such deteriorating clinical symptoms have resulted in the escalation of calling the Medical Emergency Team.
In such case, a MET must be called for help as the nurses and staffs of a MET are trained to cope up with such situation when a patient experiences the risk of losing their life. The manifestation of nausea, weakness, shortness of
eath and severe chest pain are some of the clinical manifestations, which requires a MET to take quick decisions and actions to save the life of the deteriorating patient.
Question 2
The pathophysiology shows the cause and symptoms of an outcome, which the patient suffers. Several pathological tests are done to analyse the values of the components present in the body, which must be present at a required amount. If the values are different from the normal ones, the person displays several symptoms of deterioration and they are rushed to the emergency department. In the given case study, the patient Noah was being already managed for bacterial meningitis and he started the course of intravenous antibiotic cefotaxime.
The pathophysiological reports of Noah also showed higher levels of white blood cells count of 22.4, C - reactive protein value 96, Lumbar puncture of Cere
ospinal Fluid showed an opalescent fluid, 15 000/cmm with 88% neutrophils, 8% lymphocytes. His glucose was 2 mg/dL and protein was 15 mg/dL, which indicated the presence of high infection by streptococcus manifestation in the meninges.
According to the case, all the reports indicated towards a high rate of...
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