General Medsurge discussion questions

Published Oct 14, 2008

11 Posts

x is a 28-year-old male who presents to the Emergency Department with severe fatigue and dehydration secondary to a four-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he "ate something bad." Upon admission his vital signs are a temperature of 102.7, pulse of 116, respirations 18, and blood pressure of 86/54. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas.

The following results are returned from the laboratory:

Sodium (Na+) 150

Potassium (K+) 5.5

Chloride (Cl-) 110

BUN 42

Creatinine 0.8

Glucose 86

pH 7.32

PaCO2 35

HCO3- 20

PaO2 90

O2 Sat 98%

1. What is your interpretation of this arterial blood gas sample?

2. Explain the high potassium in this patient.

3. What are your priority nursing diagnoses for this patient? (Name 3)

4. Name three nursing interventions based on one of your nursing diagnoses.

y- has undergone treatment for renal stones three times in the last year. Today he calls this primary healthcare provider with complaints of acute, excruciating, colicky, pain that radiates down the thigh toward the genitalia. The pain started last night, and has become progressively more severe. He also complains of the urge to void but has little urine output, and it is blood tinged. Due to the pain, he has not taken any fluids or food in 24 hours. Mr. Lyons has the following orders:

Morphine sulfate 2 mg IVP every 2 hours as needed for severe pain

Ibuprofen 600 mg every 6 hours

Normal saline at 200 cc/hr

5. What are the rationales for the above orders?

6. Mr. Lyons' symptoms are most indicative of stones in what area of the renal

system?

7. What potential complications can you see in Mr. Lyon's condition?

8. Describe nursing collaborative functions that may help determine the type of

stone Mr. Lyons has.

9. Name 3 priority nursing interventions for Mr. Lyons.

10. Describe priority nursing interventions for the priority nursing diagnosis.

The nurse working in the Cardiac Procedures area receives a patient who has undergone a cardiac catheterization via the right femoral artery for evaluation of unstable angina. Prior to the procedure, the patient was NPO for 12 hours, and received a sedative. An IV catheter was placed for administration of the contract agents and to have access in case of an emergency situation.

37.What is the rationale for assessing distal pulses immediately after the catheterization?

38. What other assessments should the nurse perform to check for arterial insufficiency?

39. The patient asks why he needs to stay in bed with the leg extended for 2 - 6 hours. How should the nurse respond?

40. After the procedure, why is it important to assess the patient's BUN and creatinine, and fluid volume status?

41. List the 3 common waveforms found on the ECG. Explain what each waveform of the ECG indicates in NSR.

42.Describe the relevance of the following abnormal waveforms

a) P-waveform in atrial fibrillation.

b) QRS waveform in ventricular fibrillation

c) T waveform -that has been identified a "peaked" T wave

d) U wave

Alfred Jamison, age 74, is admitted to the neurology medical unit for a possible stroke. His daughter says he has been living independently and has no problems with memory or taking care of himself. She also says he has a "heart problem" and takes a blood thinner. He is very confused, has right-sided weakness, and fluent speech.

43.What are risk factors for stroke? Name at least 5.

44.What questions do you have for Alfred's daughter? List at least 6 priority questions.

45.What are the possible explanations for the change in mental status?

46.The stroke is determined to be hemorrhagic. Would thrombolytic therapy be an appropriate consideration? Why or Why not. Please be detailed in your explanation.