NRNP 6566: Advanced Care of Adults in Acute Settings Paper

NRNP 6566: Advanced Care of Adults in Acute Settings Paper

NRNP 6566: Advanced Care of Adults in Acute Settings Paper

Admission Orders
The case study depicts an 84-year-old woman brought to the hospital by her family with complaints of increased confusion and lethargy. The patient’s son mentions that her confusion has increased and she sleeps a lot at home. The patient reports feeling generalized body pain. Her vital signs are: BP-105/64, HR-115, RR-24, Temp-96.0, and SPO2-92% (room air). On physical exam, the patient is alert and oriented to person but disoriented to time. The purpose of this assignment is to outline the patient’s admission orders.
Primary Diagnosis: Delirium

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Status/Condition (Critical, Guarded, Stable, etc.): Guarded

Code Status: DNR

Allergies: None

Admit to Unit: Medical Unit

Activity Level: Ambulate as tolerated

Diet: Balanced diet.

IV Fluids: 0.9% NS 2L in 24 hours to hydrate the patient.

• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.): No critical drips ordered yet.

Respiratory: Humidified oxygen 4L/minute via a face mask to increase SPO2 to >95%.

Medications: Low-dose haloperidol 0.5 IV once, then repeated every 4 hours. Haloperidol is considered the most preferred medication for managing delirium (Grover & Avasthi, 2018).
Nursing Orders:
• Vital signs monitoring every 2 hours.
• Administer medications as prescribed.
• Supportive care- IV fluids to correct dehydration and replace electrolytes (Grover & Avasthi, 2018).
• No use of physical restraints (Lauretani et al., 2020).
• Turn the patient four-hourly to prevent pressure sores.

Follow-Up Lab Tests:
• Diagnostic testing: Serum electrolytes
Blood glucose levels
Arterial blood gas (ABG) analysis
Full Hemogram
Liver Function Tests
Electrocardiogram
Consults:
Psychiatric consultation for management of behavioral problems like agitation or aggressive behavior.
Consult a psychotherapist for supportive psychotherapeutic interventions to help the patient manage the distress that occurs with the recollection of delirium experiences (Iglseder et al., 2022).

Patient Education and Health Promotion: Patient education on self-management interventions to control hypertension and diabetes.
The patient will be educated on diet and physical exercise strategies that help to maintain optimal BP and glycemic control.
The patient and caregiver will be educated on the importance of having sleep, good nutrition, and hydration to prevent relapse of delirium after discharge (Iglseder et al., 2022).
Before discharge, the family will be educated about any further management issues and the required monitoring of the patient (Lauretani et al., 2020).

Discharge Planning and Required Follow-Up Care: The patient will be discharged when the delirium resolves. Patients with delirium are at a high risk of developing dementia, thus the patient’s cognitive functions will be monitored from time to time (Wilson et al., 2020).
Conclusion
Delirium is the clinical impression for this patient based on symptoms of increasing confusion and lethargy. The patient will be administered Haloperidol to manage delirium and will be discharged when the delirium has resolved. A psychiatric consultation will be needed to help the patient manage distress and address agitation. Patient education will focus on preventing relapse of delirium and managing then patient’s hypertension and diabetes.

References
Grover, S., & Avasthi, A. (2018). Clinical Practice Guidelines for Management of Delirium in Elderly. Indian Journal of psychiatry, 60(Suppl 3), S329–S340. https://doi.org/10.4103/0019-5545.224473
Iglseder, B., Frühwald, T., & Jagsch, C. (2022). Delirium in geriatric patients. Wiener Medizinische Wochenschrift, 172(5-6), 114-121. https://doi.org/10.1007/s10354-021-00904-z
Lauretani, F., Bellelli, G., Pelà, G., Morganti, S., Tagliaferri, S., & Maggio, M. (2020). Treatment of Delirium in Older Persons: What We Should Not Do! International journal of molecular sciences, 21(7), 2397. https://doi.org/10.3390/ijms21072397
Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature reviews. Disease primers, 6(1), 90. https://doi.org/10.1038/s41572-020-00223-4

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please include introduction and conclusion ***

Using the required admission orders template found under the Learning Resources: Required Reading.

Develop a set of orders as the admitting provider.

Be sure to address each aspect of the order template

Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.

Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.

Make sure the order is complete and applicable to the patient.

Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.

Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.

A minimum of three current (within the last 5 years), evidenced based references are required.