Critical Reasoning Activities Chapters 16 and 17
Identify two strategies that the critical care nurse can use to help prevent AKI
Describe the factors in elderly patients that increase susceptibility to the development of AKI
Describe patients who are at high risk for contrast-induced nephropathy and discuss interventions that may be used to decrease their risk.
What disorders are associated with anemia in the critically ill patient?
Why is the critical care unit often a dangerous place for the immunosupressed patient?
How can therapeutic choices such as interventions and medications worsen the hematologic or immunologic comprise of critically ill patients?
What criteria are used for prioritization of nursing and medical interventions for the bleeding patient?
Critical Reasoning Activities Chapters 18 & 19
The nurse is caring for a patient who is admitted with acute abdominal pain and vomiting. His admission vital signs and laboratory values include the following:
Blood pressure 94/72 mm Hg
Heart rate 114 beats/min
Respiratory rate 32 breaths per minute
Potassium 3.0 mEq/L
Calcium 7.0 mg/dL
Arterial oxygen saturation 88%
Serum amylase 280 IU/L
Serum lipase 320 IU/L
- What is the suspected medical diagnosis?
- What are the priority nursing and medical interventions?
A 50 year old patient is admitted with hematemesis and reports having dark stools for the past 12 hours. Which of the following admission data is the best indicator of the amount of blood loss?
Blood pressure 95/60
Heart rate 125 beats/min
Respiratory rate 28 breaths per minute
A 45 year old business executive is admitted to the telemetry unit. He tells the nurse that he travels a lot for business and recently returned from a trip to Mexico. During your initial assessment, he tells you that he is not married and he relates stories about some of the women he has met and dated on his many trips. His history includes persistent abdominal pain, nausea with occasional vomiting, fatigue and decreases appetite. Initial vital signs and laboratory results include the following:
Heart rate 70 beats/min
Urine clear and dark yellow
Aspartate transaminase (AST) 20 IU/L
Alanine transaminase (ALT) 70 IU/L
Serum albumin 3.2 mg/dL
Total serum bilirubin 1.5 mg/dL
- What is the most likely diagnosis?
- What precautions should the nurse take while caring for this patient?
Insulin therapy is a critical intervention in the treatment of DKA and HHS. What crucial parameters must be monitored to ensure optimal patient outcomes?
How can the hazards of hypoglycemia be prevented?
In which patient population would the nurse expect to administer a cosyntropin stimulation test? What factors affect the interpretation of the test results?
In a patient with neurologic injury, how do lab values help to differentiate DI, SIADH and CSW?
Critical Reasoning Activities Chapters 20 & 21
A patient presents to the trauma center after a high-speed motor vehicle crash. The patient was restrained by his seat belt; however, he was driving an older car that did not have airbags. He was awake at the scene, but his level of consciousness quickly declined during transport by emergency medical services. Initial assessment revealed a 6-cm scalp laceration, a right closed femur fracture, four broken ribs and possible cardiac contusion. What additional prehospital information would be helpful in anticipating care for this patient?
Considering the mechanism and patterns of the injuries, what are the immediate nursing management priorities for this patient?
A construction worker is admitted after falling approximately 15 feet from scaffolding. What diagnostic interventions does the nurse anticipate in the care of this trauma patient?
If a patient experiences thoracic trauma, what laboratory analysis is anticipated and why? Why is cardiac monitoring and/or a 12-lead ECG prescribed?
Describe the nursing assessment and intervention priorities during the first postoperative hour once a patient is admitted during the first postoperative hour once a patient is admitted to the critical care unit. Discuss ways to incorporate patient and family centered care during the immediate postoperative phase of nursing care.
Explain why patients with burns need extensive fluid resuscitation even though they are extremely edematous.
Why is multiprofessional team care of the burn-injured patient important? Who is involved?
What interventions can be used in the critical care unit to promote early rehabilitation of a patient with a burn injury?
Describe some injury history and physical assessment findings that might lead you to suspect that a burn was caused by abuse.
What specific strategies and interventions can the critical care nurse employ to reduce the incidence of infection in burn patients?
What strategies might the critical care nurse use to meet the high caloric needs of burn patients who can take foods by mouth?
Many patients with burn injuries must be treated at institutions far from home. What approaches can be sued to meet the psychosocial needs of these patients and their families?