Develop a plan of care based on Apply clinical reasoning and critical thinking: Lorenzo Russo Case Study

Scenario:

Lorenzo Russo, a 68 year old male of Italian heritage, has was admitted to your ward at 1445 hours yesterday with a 2 day history of vomiting and diarrhea related to food poisoning. He has a past history of Type 2 Diabetes Mellitus, is a current smoker, increased BMI, and hypertension. In your morning handover it is revealed that his IVC tissued (phlebitis) overnight and the staff have been unable to resite it as his veins were difficult to cannulate and the Registered Medical Officer (RMO) has been busy with a deteriorating patient. He has not received IV hydration since 0100 hours. His last urine output, at 2345 hours, was 70mls and it was concentrated/dark in colour. A bladder scan at 0500 hours showed no residual urine. His last episode of vomiting and diarrhea was at 0515 hours. He has dry mucous membranes, poor skin turgor and cool peripheries indicating dehydration. The morning RMO orders UECr blood tests and is preparing to recannulate for a stat IV bolus of Normal Saline (0.9% NaCl). It is now 0735 hours.

His recent vital signs at 0730 hours are:

• BP 90/60 mmHg
• HR 115 bpm
• RR 18 breaths per minute
• SpO2 94% Room Air via finger probe and his SpO2 has consistently been 94-96% since admission
• T 36.6

Utilizing best practice research, contemporary evidence, and the nursing standards to assist, students are encouraged to link any relevant Cultural considerations, Pathophysiology and Pharmacology to the case study patient to complement any suggested nursing care and management.

1. Based on your initial impression, other than dehydration, what do you think is NOW happening with Lorenzo? In your answer please provide relevant pathophysiology.
2. What clinical impression, together with signs and symptoms, is Lorenzo presenting with that formed your impression of the condition you believe he is now suffering from and why do these signs & symptoms occur (the underlying pathophysiology)?
3. Discuss the nursing care and management, using evidence-based literature, required for managing and maintaining Lorenzo’s potential diagnosis (what do you think is now happening), in a culturally safe manner, with rationales as to why this care is provided. Include relevant medical and pharmacological treatment options.
4. List two ACUTE potential problems that Lorenzo is at risk of due to this current condition that you think is occurring. Provide rationales as to why these are potential risks and three nursing management preventative strategies for each of these problems.

ESSAY STRUCTURE

Your case-study essay should be structured as follows:

Introduction

• Start by setting the context and providing relevant background information however keep this limited as there is no need to repeat the entire given scenario
• Summarise the main aim or points of the case-study by outlining the main ideas to be discussed, in the order they appear in the body of the essay

Body (You may type each question into the body and provide your response underneath. The questions will not be included in your word count)

Each paragraph should cover a single idea expressed in a topic sentence, followed by supporting evidence and examples from contemporary academic literature, including peer-reviewed journal articles.

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