Challenging Question

cracklingkraken, ASN, RN · Jun 9, 2016

What are your thoughts?

rn2k16 · Jun 9, 2016

Using the ABC's, breathing would be a priority over circulation; so I think it's crackles in the lungs. However, why would a patient develop crackles after an AAA, the main complication from what I understand is hemmorhage/ decreased circulation distal to site, which is indicated by the cool skin.

Esme12, ASN, BSN, RN · Jun 9, 2016

Using the ABC's, breathing would be a priority over circulation; so I think it's crackles in the lungs. However, why would a patient develop crackles after an AAA, the main complication from what I understand is hemorrhage/ decreased circulation distal to site, which is indicated by the cool skin.

Good thinking...now which do you feel is more life (limb) threatening.

rn2k16 · Jun 10, 2016

I thought a theat to your ability to breathe would be more life threatening. I guess maybe I'm reading into the question too much, it didn't indicate he was in any respiratory distress. You can still breathe with crackles.

AliNajaCat · Jun 13, 2016

I thought a theat to your ability to breathe would be more life threatening. I guess maybe I'm reading into the question too much, it didn't indicate he was in any respiratory distress. You can still breathe with crackles.

Exactly. Lots of postops will have crackles because they have been flat in bed, may have gotten a little too much fluids, and/or have heart disease too. But. In the absence of other information (SPO2, ABGs, SOB?, etc) think about what's going on here. A AAA repair involves all the circulation from the aneurysm to the toes. They had to clamp off the distal aorta to do the repair. If they have been working there and suddenly there's no circulation beyond the repair, that's really, really serious. Stat call to the surgery team.

Esme12, ASN, BSN, RN · Jun 13, 2016

I thought a theat to your ability to breathe would be more life threatening. I guess maybe I'm reading into the question too much, it didn't indicate he was in any respiratory distress. You can still breathe with crackles.

but if you look at what is going to hurt the patient the most FIRST

Lev, MSN, RN, NP · Jun 14, 2016

Good thinking!

If this guy doesn't have any blood left to circulate, his lungs won't get oxygenated.

Here.I.Stand, BSN, RN · Jun 14, 2016

Psst...it's CAB now. But in any case, that's not a cookie cutter formula. What will do the mist damage the fastest? I think you're on the right track now -- the crackles should be addressed, but cold legs could mean no perfusion.

Now if the pt was at the time choking on his dry turkey sandwich........ :cheeky:

suzw · Jun 27, 2016

Best real-world answer would be legs. Crackles without respiratory distress are not terribly serious, and fairly common after surgery. Yes, it needs to be addressed but as someone said, the patient can still breathe.

Not it sure if this is the best "test answer" though.

Mia415 · Jul 10, 2016

A new finding of legs cold to the touch and losing circulation is an emergency and if this question had the option to choose "call the surgeon!" You need to inform the doctor stat of this finding as yes patient could lose his legs. This has only happened to me once. Once hand totally and completely cold to the touch (patient reported this complaint to me and I assessed) and the other hand warm and normal. Yikes! I called the doc!

And yes yes crackles are really common after any surgery, should be monitored closely and use incentive spirometry, but not life threatening finding.