NGN Case Study: Immunity Patient 1 & 2

NGN Case Study: Immunity Patient 1 & 2 Patient 1 info: Client is a 22-year-old woman brought into the emergency department (ED) by a friend. Client reports of facial swelling and pain especially in the mouth area, making it difficult to talk and swallow. Her eyes, lips, and tongue appear extremely edematous with erythema. Client is also experiencing pruritis on trunk area and bilateral lower extremities. Hives noted on abdomen and bilateral lower legs. Client states she went to her primary doctor a couple of days ago for signs of a urinary tract infection. She was prescribed an antibiotic and has taken two doses so far. She does not remember the name of the medication. Client has a history of hypothyroidism and takes levothyroxine 100 mcg per day. Client is alert and oriented with cranial nerves I to XIII intact Drag one condition and one client finding to complete the sentence. [anaphylaxis] based on the client finding of [angioedema]. Patient 2 info: The client appears to have A 34-year-old woman with a history of bipolar disorder and an allergy to tree nuts. The client has experienced one hypersensitivity reaction as a child. However, as an adult she is careful to avoid ingestion of tree nuts and thought the sensitivity went away. She was unaware that the new dish at the restaurant had crushed cashews in the sauce. This evening patient was eating at a local restaurant. After eating several bites of a new dish, she began to experience itching and tightness in the back of her throat. Lips became red and edematous. The client described difficulty breathing and EMS notified. Emergency services arrived within 6 minutes. The client was hypoxic but awake on their arrival. The client received oxygen at 8 L per nasal cannula and 0.3 mg of epinephrine intramuscularly and a bolus of normal saline intravenously in route to the hospital. Current assessment reveals stridor with decreased breath sounds, laryngeal edema, facial swelling, and a decreased level of consciousness. Currently in sinus tachycardia with heart rate varied from 120 to 150 beats/min. Current blood pressure is 90/40 mm Hg after a normal saline fluid bolus in route to the hospital. Patient 2: Choose the most likely options for the information missing from the statements by selecting from the lists of options provided. Based on the client's history of previous hypersensitivity reaction, the nurse identifies [facial edema] and [laryngeal edema] as priority assessment findings requiring immediate follow-up. Patient 2: Which finding indicates that this client has a problem with oxygenation? Select all that apply. Oxygen saturation 86% on 15L of oxygen -Blood pressure 90/40 mm Hg -Heart rate 140 beats/min -Continuous cardiac monitoring shows tachycardia -Lip swelling -Artieral blood gas (ABG) values: pH 7.32; PaO2 71 mm Hg; HCO3 29 mEq/L; PaCO2 49 mm Hg; SpO2 92% -The client reported feeling tightness in the back of her throat -Decreased level of consciousness Patient 2: Based on the client's condition, priority needs are to prevent which 4 conditions? collapse -Neuromuscular compromise -Respiratory arrest -Acid-based imbalance Patient 2: -Airway Which action will the nurse include in the plan of care a