Critical Thinking Snapshot for Nurses&Students - page 4

by betts 4,848 Views | 33 Comments

Patient: Mr. Jones Mr. Jones, a 38-year-old white male with no known previous chronic illness, was admitted six hours ago after being involved in a single motor vehicle accident. He was the unbelted driver of a vehicle that... Read More


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    patient: mr. jones
    mr. jones, a 38-year-old white male with no known previous chronic illness, was admitted six hours ago after being involved in a single motor vehicle accident. he was the unbelted driver of a vehicle that skidded off the road and hit a tree at approximately 45mph. he reported losing consciousness at the scene. mr. jones was admitted in stable condition with a diagnosis of myocardial contusion and fractured ribs (4,5, & 6) on the left thorax.
    patient: mrs. smith
    mrs. smith, a 64-year-old female with known coronary artery disease, was admitted for coronary artery bypass surgery. her risk factors for arteriosclerosis include a strong family history, smoking, and hypertension. she has been admitted to the ccu several times with angina. cardiac catheterization demonstrated a high grade (>90%) stenosis of the left anterior descending (lad) artery. surgery was performed 3 days ago with a left internal mammary artery (lima) graft.
    mrs. smith stayed in the cardiovascular surgical intensive care unit (cvsicu) for two days. on the second day, her swan-ganz catheter was removed, iv medications tapered off, and her foley catheter removed. on this, the third day, mrs. smith was transferred to the step-down unit with a heparin lock iv in place.
    the "trigger" for me on this one is comparing the 2 patients, granted mrs. smith could possibly be reinfarcting, however when you consider that mr. smith was admitted only 6hrs ago from a mva, unbelted and 3 rib fx's you have to consider a tension pneumo here which can quickly progress into severe complications. i'd go check on mr. smith 1st listen for diminished breath sounds on the left. meanwhile mrs. smith was transferred back as stable.

    beyond that i'd delegate to other staff to check on mrs. smith and her cp, possibly get here a nitro tab see if that helps and slap some 02 on her. mr. smith on the other hand has a much shorter timespan, if it was a tension pneumo he'd need a ct fast. if i had checked on mrs. smith 1st, mr. smith could have expired in that time, and it would be too late to save him. hence litigation.
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    Originally posted by maxthecat
    And the point of all this was????

    Most of the nurses who post here seem to me to be professionals who are perfectly capable of using critical thinking in their daily dealings with patients/families. They are not children who need remedial case studies. Personally, I found the tone of this exercise condescending, and my guess as to why you received so few responses is that many other nurses felt the same way and didn't waste their time replying.
    AMEN> -- I'm a hemodialysis nurse these days....such situations are EXACTLY why I got out of the hospital. You can't know the entire situation that quickly (especially with it on paper and the patient is sight unseen) and I didn't have the benefit of v/s and assessment data in the original scenario....also, my experience is in coronary care much more than in trauma care. We always shipped those out to the trauma centers.

    But I still say if you can talk, you can breathe.

    And I STILL say that leaving the whole thing unanswered in a freakin' bulletin board doesn't say anything at ALL about those who chose to read and not respond. We all have that right.
    Last edit by babs_rn on May 28, '03
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    Originally posted by sandgroper


    And the number of staff for this unit is very dangerous to start with. If you allowed yourself to be in this position, only one person will be responsible for any adverse outcome.
    That's how it is in the real world.
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    Wow can we get more of this betts?


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