Case Study/ Final Simulation PN 255 Form C

Ms. Meyer is a 82 year old female. She is admitted to Gwinnett Rehab after being hospitalized for two
weeks with pneumonia and developed a urinary tract infection during her stay. She was treated with
multiple antibiotics and supportive measures. She has a significant past medical history of chronic kidney
disease, congestive heart failure, atrial fibrillation, and hypertension. She is obtunded upon initial
assessment. In order to get her to respond you must sternal rub her, and she only moans and grimaces.
She is a fall risk and the doctor has taken her off her coumadin last month due to this.

You take her vital signs- HR: 90, RR: 16, BP: 178/94, Temp: 98.5, O2 sat: 95% on Room Air

1) Which vital signs are abnormal and why?

2) Why do you think that this patient has developed this obtunded state? What are you concerned
about regarding this new development?

3) What lab values would you anticipate being abnormal with chronic kidney disease and explain
why? Would the values be high or low?
4) What rhythm is this EKG strip?

5) What nursing interventions can we provide for this patient? What test would you anticipate
being ordered for this patient?

6) What education would be beneficial for the nurse to provide this patient and their family?