Nursing critical thinking

Well??? Are you going to attempt to answer these questions or are you expecting us to give you the answers?

We will help guide you to the answers, but we will not give you the answers without you attempting to answer the questions.

This is my first semester and we never done anything like this in class. I'll take any help I can get.Thank you!

For scenario one he has poor skin turgor which means he is dehydrated and he also has low blood pressure. Maybe the IV is not placed properly if it is hurting. He could be dehydrated because the IV stopped or ran out of fluids. I should assess the IV and how long it takes his skin to go back or if it tents. I should report this information to the physician. Dehydration would be my diagnosis. Is any of this correct?

1st patient I would assess the IV site for infiltration due to the patient stating it hurt. Also if the skin turgor is poor and hypotensive this would lead me to a diagnosis of dehydration. What would I do? Remove the IV catheter and again reassess site. D5RL fluids can cause necrosis from previous mentioned infiltration and also be causing the symptoms of pain, hypotension and poor skin turgor. My nursing diagnosis would be Dehydration and IV infiltration.

2nd patient I would check the foley and confirm placement if it's causing pain and producing little to no urine in bag. Remove foley and if possible re-cath.

3rd patient I would diagnose with CHF. Although Emphysema is more likely because of the cigarette smoking the symptoms do not match. Typically in Emphysema there are little symptoms and sputum is not produced. Take vitals, listen to lung sounds and consider O2 supportive care if necessary.

I really appreciate your help!

Critical Thinking Questions

1. S.G. is a 70 year old male who has just had abdominal surgery. He is NPO and has an IV of D5RL infusing at 100 cc/hr. You enter the room and notice the IV has stopped running. The patient has poor skin turgor and is hypotensive. The patient tells you the IV is hurting him. Answer the following questions.
   

1. What could be the problem?
   
2. What should you assess?
   
3. What should you do?
   
4. What would be a nursing diagnosis for this patient?
   

Yes, skin turgor is an indication of dehydration. This patient is also hypotensive. What could be a bigger issue here? The IV is not running (presumably it is still hooked up) and the site hurts. What can be going on? Also, what type of fluid is D5LR and what is its affect on fluid status? Think about abdominal surgery..what is the colon full of?

1. J.D. is a 48 year old female 2 days post-op abdominal surgery. She has a foley to gravity drainage. While assessing J.D.'s vital signs at 12 noon, you note that there is no urine in the tubing and there is only a little in the bag.
   

The patient tells you "I am in pain and I feel like I need to urinate." Answer the following questions.

1. What could be the problem?
   
2. What should you assess?
   
3. What should you do?
   
4. What could be a nursing diagnosis for this patient?
   

There are multiple issues that may be in play. There is a foley present. What is a foley catheter a risk factor for? Why do we want to get foleys out stat, especially after surgery? What could the pain be from? Also, there is just a little drainage in the catheter. How is the patient's fluid status? Is there an obstruction somewhere? What does the bladder scan show?

1. A patient is admitted with complaint of shortness of breath, chronic cough with small amounts of sputum, loss of appetite and fatigue. He states that these symptoms have become worse within the last 2 months. He is 40 years old and smokes cigarettes. Answer the following questions?
   

1. What could be the problem?
   
2. What should you assess?
   
3. What should you do?
   
4. What could be a nursing diagnosis for this patient?
   

Smokers are at increased risk for many conditions including chronic respiratory conditions and cardiac conditions. Remember to stick to nursing diagnoses and not be tempted to use a medical diagnosis.

Thank you!