Critical patient scenarios

Nurses General Nursing

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I took a quiz yesterday in which our instructor was just assessing our overall 'critical thinking'. She said she wasn't concerned with us knowing specifically which interventions to use for these patients, just how we would go about it. So I really felt like I knew they were bad situations, but didn't know what I was supposed to do, and was just looking for a little bit of help :)

1) You receive a patient who had a recent bowel resection and is complaining of pain at 8/10 even though just having received pain meds. The patient's systolic pressure rose from 70 to 130. What would you do?

2) You receive a patient who is post surgery, and has a chest tube. 800 mL of dark red discharge have gone into the chamber in the last hour, and the current vitals are 170/100, pulse 130. What do you do?

3) You receive a patient who is 2 hours post stent placement. They complain of a sharp chest pain at 5/10, and current vital signs are 160/84. What would you be doing for this patient?

Thank you! My inexperienced intuition was just assess and call the doctor. Lol.

I took a quiz yesterday in which our instructor was just assessing our overall 'critical thinking'. She said she wasn't concerned with us knowing specifically which interventions to use for these patients, just how we would go about it. So I really felt like I knew they were bad situations, but didn't know what I was supposed to do, and was just looking for a little bit of help :)

1) You receive a patient who had a recent bowel resection and is complaining of pain at 8/10 even though just having received pain meds. The patient's systolic pressure rose from 70 to 130. What would you do?

2) You receive a patient who is post surgery, and has a chest tube. 800 mL of dark red discharge have gone into the chamber in the last hour, and the current vitals are 170/100, pulse 130. What do you do?

3) You receive a patient who is 2 hours post stent placement. They complain of a sharp chest pain at 5/10, and current vital signs are 160/84. What would you be doing for this patient?

Thank you! My inexperienced intuition was just assess and call the doctor. Lol.

1. Why did you accept a pt. with a systolic pressure of 70? But OK, his BP is ok, and the meds have not had a chance to work. Give it 10 minutes, reassess and give something if you have an order, or call the doctor for more.

2. Call the Crisis team immediately, and call the doctor next. Your pt. is bleeding out, and needs to go back to OR stat. The The heart rate is compensatory for the lessened preload, and the elevated BP is probably due to mediastinal shift.

3. Chest pain is chest pain. Treat according to algorithms ,call the doc, get some enzymes and go from there.

Thank you to all of you who replied to my post! It was really helpful to see that I did have a lot of this all written down.. and then the things I didn't know off hand were just a result of my inexperience. :)

A heart rate of 130 in this situation would never be treated with a beta blocker....this heart rate is most likely compensatory and NEEDED. If the patient is truly bleeding his blood pressure will come down all on its own....and it won't be pretty. Again, you would never beta block a fresh post-op patient that you suspect is bleeding.

Agreed. Consider volume and let the team know to see this patient. Stat ECHO could show tamponade or if theres not time for that a quick trip to the OR for exploration

Specializes in Cath Lab/ ICU.
A heart rate of 130 in this situation would never be treated with a beta blocker....this heart rate is most likely compensatory and NEEDED. If the patient is truly bleeding his blood pressure will come down all on its own....and it won't be pretty. Again, you would never beta block a fresh post-op patient that you suspect is bleeding.

Jenni isn't a working nurse. Herin lies the problem on message boards-anyone can give you advice with the implication that they are nurses. Even terrible advice like giving metoprolol to a compensating tachycardia.

The the OP, please reasearch. It's good to get advice, and there has been good advice given here, but also take it with a grain of salt. Anybody can be anybody here...

Jenni isn't a working nurse. Herin lies the problem on message boards-anyone can give you advice with the implication that they are nurses. Even terrible advice like giving metoprolol to a compensating tachycardia.

The the OP, please reasearch. It's good to get advice, and there has been good advice given here, but also take it with a grain of salt. Anybody can be anybody here...

CCL......I think these types of discussions are great. Hopefully there are enough experienced nurses on the forum to counter-act the inaccurate advice. So now a whole bunch of readers are clear on the fact that when a patient has a compensatory heart rate a beta blocker should never be given......and guess what I have seen doctors order it! So I think these discussions are huge....and I am not sorry that Jenni threw it out there....it gave us a chance to correct her thinking.

Specializes in Cath Lab/ ICU.
CCL......I think these types of discussions are great. Hopefully there are enough experienced nurses on the forum to counter-act the inaccurate advice. So now a whole bunch of readers are clear on the fact that when a patient has a compensatory heart rate a beta blocker should never be given......and guess what I have seen doctors order it! So I think these discussions are huge....and I am not sorry that Jenni threw it out there....it gave us a chance to correct her thinking.

That's a great point!

Specializes in CICU.

Was just thinking in scenario #1 - I would also assess the incision / dressing

#2 call RRT

#3 MONA, ekg, trops/cardiac enzymes, call doc, verify that ordered meds given appropriately (plavix)

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