Critical thinking exercise

georgia peaches · Feb 10, 2004

FIRST I would try to rouse the patient - see if she is simply napping, or if there has been a decline in consciousness (scenario says nothing about level of consciousness). SECOND I would check the foley to make sure it is clear and able to drain.

This would be a start, at least.....

John

Erin RN · Feb 10, 2004

I used this case study with my students today, and got quite a few different answers. What do you guys think?
Mrs. M was admitted four days ago with CHF. She has a long hx of the disease, and is usually admitted several times a year. She has been treated with IV lasix and dig, and has been diuresing well. When you get shift report from the daylight nurse, she tells you that Mrs. M's urine output has been dropping, and she emptied 500 ccs from her foley at 1400. You have to give a pain med to another patient, then answer phone calls from two other patient's families before you get in to see Mrs. M. When you go into her room at 1600, she is sleeping, but you notice immediately that there is no urine in her foley bag. What is the first thing that you do?

True Oliguria is less than 500 cc out in a 24 hour period of course I would need more info..like how much she has diuresed so far, but if 500cc was empited only 2 hours previous I would doubt that she would have altered LOC. Erin

CCU NRS · Feb 10, 2004

see what the med was in the resp tx and assumne it is albuterol causing this trouble

casper1 · Feb 10, 2004

undefined :rotfl:

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?

casper1 · Feb 10, 2004

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 everythingmonitor 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?

With a history of COPD it's possible that patient is a retainer. 4l is to high

a concentration I would turn down the O2 and get an order for ABG's. Monitor the patient closely, get Vital signs PVC's may be a side effect of Albuterol treatment.

Peeps Mcarthur · Feb 10, 2004

:) I would wash my hands

Peeps Mcarthur · Feb 10, 2004

:) I would wash my hands

Look at the patients breathing pattern. O2 toxicity is rare everywhere but in a patient scenario :) . The fact he just had a tx raises the possibility that he is ventillating well enough to shut down his hypoxic drive. Patients usually take exaggerated breaths while on a tx. These actions coupled with the 4L for an extended time period could lead to the fabled 02 toxicity.

Check the sat probe for placement and clean it.

gingerzoe · Feb 11, 2004

check the foley to see if it is kinked. Wake her up and check lung sounds, check for edema, check her intake/output sheet to see what she had in, then go from there

Pab_Meister · Feb 11, 2004

Hi Teacher Sue,

I'm a first semester student in his third week and I have no idea what the right answer is. I sure hope you can post more of these. I love this! What a cool way to learn.

suzy253, RN · Feb 11, 2004

I'm going with too much O2 and get ABG's as well....but what do I know..I'm just a student and we've only just started respiratory in pharmacology 2 weeks ago :)

Erin RN · Feb 11, 2004

Hi Teacher Sue,
I'm a first semester student in his third week and I have no idea what the right answer is. I sure hope you can post more of these. I love this! What a cool way to learn.[/quote
I agree with you Alexander, wish we had a board like this 14 yrs ago when i was lst yr..liken the patient to a radio..you turn it on no music, what do you do first? See if it is plugged in..what next? make sure it is on a station. Still no music THEN you do the more invasive stuff ..KISS definately applies to nursing in many ways and will make you a good nurse. You will develop mini plans of action for various scenarios and if you are consistent you won't miss anything important..good luck to you
Erin :)

Pretzlgl · Feb 11, 2004

FIRST check to make sure that the pulse ox is on the finger correctly