iHuman Clinical Analysis Practice Exam With Answers (2 Solved Questions)

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iHuman Amka Oxendine- Pre-work & All Sections with Answer & SBAR note.19 y/o F, 5’3”, 127 lbs. Dx: Acute acetaminophen ingestionBrought vis EMS to ER with c/o abd pain with nausea. EMS reports ingestion of acetaminophen for SI. 58kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NKDA. SI precautions until psychiatristDenies ingestion of salicylates, ETOH or other substances within in 24 hr. Four hours later after waking uphad second thoughts and call EMS.58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NIKA. SI precautions until psychiatrist1.What is your primary concers for this patient and what assessments and interventions wouldbe associated with your concerns and why?My primary concern would be to assess for Airway Breathing Circulation- SOB, CP, andpalpitations. I would assess for unusual bleeding as a priority. Next I would perform aneurovascular check, noting PERRLA. I would also be aware of s/s of liver failure: anorexia, n/v,fatigue, excessive sweating and confusion.The interventions I would perform:1.Assessing time of ingestion***, Quantity/Strength, and reason.2.Consider evaluating for other co-ingestions (e.g., salicylates, tricyclic antidepressants,ethanol, ethylene glycol, methanol) especially since this is a known suicide attempt.3.Since patients with acetaminophen toxicity can develop not only liver failure, but also renalfailure, coagulopathy due to liver failure, and acid base disturbances, will monitor for thefollowing additional labs (serum creatinine, urinalysis, lactic acid level, arterial blood gas,venous blood gas). Serial labs will likely be needed to determine the clinical course of thepatient.4.Utilize oxygen therapy if pt is noted to be in respiratory distress.5.Give IV fluid and draw labs forParacetamol blood level.6.Provide antidote ofN-acetylcysteine as prescribed.7.Activated charcoal should be administered as soon as possible, usually within 1- 2 hours ofthe exposure as prescribed.2.What medications do you anticipate the health care provider would prescribe while thepatient is in the hospital and why?1. Activated charcoal to halt the absorption of acetaminophen in the stomach typicallywithin 1-2 hours of exposure. It acts by binding to the pharmaceutical drugs or poisonsi.e. organophosphates and decreasing the systemic absorption of toxic agents.

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