Case Study: Glasgow Coma Scale

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DISABILITY:
Kelly’s GSC score is 15/15, no brain injury reported. Her cognitive function is normal. Her anxiety and restlessness is due to lack of enough blood supply to the brain.

Monitoring patient cognitive function regularly by using a simple nursing assessment scale such Glasgow Coma Scale (GCS) used to describe the level of consciousness and to assess any brain problem or cognitive impairment.
Patient with heart attack can suddenly changes their cognitive function due to insufficiency of oxygen supply and sudden changes of heart’s rhythms due to myocardial damage (Feldman, Hart, Lindsell, & McMullan, 2014). This is high priority nursing intervention.

EXPOSURE:
Her APTT and PT are both within the normal ranges. No indication of injury
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2. ARTERIAL BLOOD GAS (ABG)
It measures the acidity and the levels of oxygen and carbon dioxide in the blood from an artery. This analysis is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

Mrs Kelly is hypoxaemic with a slightly low PaO2 and SaO2 on 93% O2.
Her pH is less than 7.35 and therefore she is acidotic. PaCO2 is within normal limits, which indicates that respiration is not the primary problem.
The HCO3- is depleted at 19mmol/L and this is reflected by a base deficit of -9, this cause a metabolic acidosis. The pH is not normal; therefore, there is no compensation (Hasan, 2013).

Mrs Kelly has an uncompensated metabolic acidosis. This is most likely because of a low cardiac output arising from the cardiac insult. Low blood pressure leads to poor tissue perfusion and therefore poor oxygenation. Lactic acid would build up as a result of aerobic metabolism and cause an excess metabolic acid
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These receptors are found in the cardiac muscle and their stimulation has a positive inotropic effect (increases the contractility of the heart). It does so without significantly increasing heart rate or affecting peripheral vascular resistance (as it does not activate alpha adrenergic receptors of blood vessels). The result is increased cardiac output via increased stroke volume (Tariq & Aronow, 2015).
In the case of Mrs Kelly the cardiac muscles are stunned by ischemia and have decreased contractility, leading to cardiogenic shock (insufficient cardiac output). Dobutamine counters this and therefore maintains systemic perfusion, reduces pulmonary venous pressure (alleviates pulmonary oedema) and also maintains coronary artery perfusion (prevents further ischemic injury of the heart) (Lehne, Moore, Croby, & Hamilton, 2012).
Explain to Mrs Kelly the rationale for giving the medication and the need for frequent monitoring. Advise her to inform nurse immediately if she feel headache, SOB, chest pain; palpitation, nausea and vomiting.
Instruct her to notify nurse immediately of pain or discomfort at the site of administration (McFadden,

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