Critical thinking exercise

OKay I will bite..the VERY first thing I would do is make sure that the foley is patent by checking to see that the tubing is not kinked, since many times when pts are in bed they can lay on the tubing etc.

I would be checking vs along with the foley tubing. BMP and Mg. It sounds like the pt may be dry. What was the last dig. level? Lung sounds? Any edema?

Noney

See if the tubing to the foley is kinked.

I'm with Erin - the VERY first thing I would do would be to check the tubing.

The key to the question is "the first thing I would do". Yes, check for kinks and placement of the foley catheter.

You say she was sleeping?? Well, the first thing I would do would be to make sure she was just sleeping, and not unconscious. Then, I would check to see if there was a kink, all the while checking for edema,Kussmaul respirations, color of skin, etc...

Originally posted by mjlrn97

And if no problems are found with any of the above........ask the aide if s/he just emptied the bag!

I mention this only because I made that very mistake in my 'rookie' year as a nurse:imbar

:roll :roll :roll :roll

scream at the top of my lungs

oh my god there is no urine

lol first thing wake her and ask her if she feels the urge to relieve her bladder and then palpate her bladder, then check for kinks and then see when her bag was emptied.

originally posted by ccu nrs

scream at the top of my lungs

oh my god there is no urine

omg! :roll roflol you sooooooooooooo crack me up!

check for kinks..................if there has truly been no urine for 2 hours I would call doc for orders.......................

Most of you got the answer I wanted from my students. Of course, check the foley for kinks. None of the students thought of doing this. Most wanted to assess the patient, check labs, then call the doc, which of course would be the right thing to do if there was no urine. One wanted to call the doc immediately, and one young man wanted to put a PA line in to check her fluid status.

This is only my second semester as a teacher, after 20 years in a hospital setting, so maybe I am doing things wrong, but I don't know why everything has to be so complicated. Of course I want my students to know that patients with CHF are at a higher risk for kidney failure, and that lasix can cause kidney damage. But I also want them to know that sometimes the simplest answer is the correct answer. This is their last semester, and some of them seem so unsure and frightened. I just want to give them some confidence and let them know that it isn't always going to be a struggle.

So now, here's another one.

Mr. J was admitted two days ago with COPD and pneumonia to a monitored bed. He has been getting IV ATB and IV steroids. His sat has been 93% on 4 liters of O2. He had a respiratory treatment a few minutes ago, and now his monitor is alarming with a sat of 84%, and he is having a few PVCs. You assume he took his O2 off again since he has a tendency to remove it. So you go into his room to put it back on, but the cannula is in place. What do you do next?