just took my test (school test), and there was a question that I kept going back and forth and could not make up my mind which one to pick as an answer. The question was asking about. which patient does the RN need to see first after receiving the change of shift report. I eliminated 2 asnwers, and 2 were left: 1.) ESRD patient who started experiencing a new frequent oncet of early ventricular contractions, 2.) ARF patient who was Kussmauling with the rate of 26 breaths/ min, HR 100. They both are important, first one I thought was leading towards V-Fib? and the second one was in met. acidosis? So, which one you would assess 1st, correct me if I'm wrong and if someone could explain the rationals would really appreciate. Thank you guys!!!
Apr 1, '12
Definitely the Kussmaul patient. The one with PVCs likely recently returned from dialysis so he just had a big drop in his K+ and is experiencing relative hypokalemia. He can handle the PVCs (for now) but an ACUTE renal failure patient is already showing signs of decompensating and needs intervention ASAP.
edit: We're not just talking about DKA here, we're talking about an emergent sign of coma or death.
Last edit by Vespertinas on Apr 1, '12
: Reason: addition
Quote from Chisca
About the only thing that we can all agree on is this is a crummy question..
The question is so crummy it's awesome.
And come to think of it, acidosis can
cause hypercalcemia which isn't necessarily heart-friendly...so you've got a point there...
Wheeeee! Isn't it fun?
Last edit by Guttercat on Apr 1, '12