Using the A-E approach identify the nursing priorities for Sheila’s care. - Consider both her current presentation and the potential for any further deterioration and how this could be managed
SPECIAL ARRANGEMENTS Y/N - ATTACH SFORM IF APPLICABLE
Sheila is 51 and is a headmistress in a local primary academy as well as being a regional officer the Primary Heads’ Association. Sheila enjoys her job but in recent years has found it increasingly stressful. Sheila lives with her husband John and they have been married for 24 years, he is often absent on business as he is an engineer involved in many overseas projects. They have two children, Daisy is twenty and currently studying law at university in Swansea. Philip is nineteen and is studying geography in Dundee. Apart from visits to her GP for symptoms of anxiety, for which she has refused medication, Sheila has no medical history of note.
Sheila has not returned to work following the autumn half-term break. The school secretary phones her home and gets no answer, she tries to contact John but he is overseas and his phone goes straight to voicemail. Concerned she drives the short distance to Sheila’s home and sees the car in the drive, looking through the lounge window she sees Sheila sprawled on the sofa with an empty vodka bottle at her side. She dials 999. Sheila is unconscious with a GCS of 9 following an overdose of alcohol, she is taken to hospital and admitted to ICU where she is stabilised overnight
OBSERVATIONS ON ADMISSION TO A&E
Airway: Unable to maintain airway, airway adjunct inserted by paramedics.
Breathing: Irregular breaths. RR: 7bpm. High flow oxygen attached to airway.
Circulation: HR: 28bpm, shallow and irregular pulse, BP: 96/42mmHg
Disability: AVPU: Unconscious but with some response to pain, GCS assessed at 9.
Exposure: Temperature 35.3C, BM 2.8mmol/L, she has pale skin with a slight blue tinge apparent. There are traces of vomit around her mouth and on her clothes. Serum bilirubin 25µmol/l, ALT 45iu/l, Prothrombin Time 21seconds.
Using the A-E approach identify the nursing priorities for Sheila’s care.
- Consider both her current presentation and the potential for any further deterioration and how this could be managed.
- Consider Sheila as a whole person, considering everything we know about her and not just her presenting condition.
Problem 2: Provide a rationale for the care you have suggested in Problem 1
- Use the pathophysiology of liver failure and understanding of Sheila’s overall condition.
- Remember to refer to relevant pharmacology
- Refer to appropriate national guidelines
Despite being stabilised initially Shelia’s liver function continues to decline causing an ongoing deterioration in her condition that progresses to end-stage and six weeks after her admission Sheila dies because of liver failure.
Problem 3: Discuss the nursing management of Sheila during this time
- Consider the likely symptoms of end-stage lever disease and principles relating to end-of-life care generally.
- What referral options are available for managing Sheila in her final days?
- What support might be available for Sheila’s family after her death?
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