Mary Jo returns to work on the medical ward in a general hospital after having some days off. At handover she hears that Mr Johns, a 70-year-old male admitted for cardiac investigations because of bradycardia and shortness of breath, required restraint overnight because of his unpredictable behaviour and aggression towards staff. Overnight Mr Johns had been confused, calling out and attempting to wander. He was also incontinent, and had urinated onto a chair. He had interfered with his telemetry and staff were unable to get his cooperation to do his cardiac enzymes. He benefited from oxygen via nasal specs but again interfered with the equipment. The night registrar had approved sedation and restraint and the treating doctor is to review him today.
This surprises Mary Jo as she had admitted him four days ago and had found him and his wife, Betty, who is his carer, to be very amiable and cooperative. The staff are judgmental about Betty Johns and describe her as interfering and behaving yesterday as if ‘she was losing the plot too’. Mr Johns had scratched the night nurse on the face and she is still upset by this and says, ‘I didn’t get Mrs Johns to come in even though she said she would come if we needed her. I didn’t want to put up with her having a go at me too!’.
Mr Johns was allocated to Mary Jo and the second-year student on placement. The student was not very pleased about this as she did not want to be attacked as the night nurse had been, and she thought there were ‘more interesting cases’ on the ward.
Mary Jo’s nursing admission and assessment recorded the following:
Mr Johns is a retired accountant (past 7 years) living in his own home with the support of his wife.
Referral: Dr Marks; cardiac insufficiency for investigation.
Past medical history: early dementia – Alzheimer’s type – diagnosed 12 months ago. Nil other significant.
Medications: anticholinesetrase inhibitor, occasional aperients, and paracetamol for joint pain. Takes multi-vitamin supplement daily.
Self-care: ADLs achieved with direction from wife.
Elimination: routinely continent; however, may need prompting to toilet himself if he does not self-initiate within three hours of last urination. Bowels usually open twice daily; last observed yesterday.
Skin integrity: intact.
Falls risk rating: 8.
ATOD use: no current use; last smoked at age 40. Occasional drinker (2–3 times per week, max. 4 standard drinks) throughout adult life up to five years ago.
Interests: jazz music and horse racing.
Observations on admission: BP 130/86; pulse 64; resps 18; temp 36.8; weight 65 kg; height 163 cm.
Mary Jo reviews his notes, the medications he has been given and the restraint documentation. She notes that in the past 48 hours he has had 2X nocte dose of 15 mg of oxazepam, plus PRN doses of lorazepam 1 mg and haloperidol 10 mg.
At present Mr Johns is sleeping, having fallen asleep because of the effect of the 1 mg of lorazepam and 10 mg of haloperidol he was given at 0400. Mr Johns has also been given oxazepam 15 mg nocte each night since admission to ensure that he sleeps overnight. The soft cuff hand restraints are still in place and he is lying on his back.
His resps are 10, he is making guttural noises and is not woken by the taking of observations. Pulse 50; BP 110/70; and afebrile pupils equal and reacting. His mouth is dry and his lips crusty.
For custom-written answers, place your order now!
What We Offer
• On-time delivery guarantee
• PhD-level professionals
• Automatic plagiarism check
• 100% Privacy and Confidentiality
• High Quality custom-written papers
