Dr. Kathy

The NP and PhD is the way to go! This is a powerful combination, and highly sought after. Dr. Kathy, PhD, RN, CCNS

This patient sounds like they are septic or on the road to MODS. In these patients, aggressive volume infusion to optimize perfusion and cellular uptake of 02 is essential. You said the lungs are "cruddy." Is that ARDS, pneumonia or fluid volume overload? One way to monitor these folks is to watch their serum lactates, and base deficits as well as their urine output. Lactates will normalize, as will base deficits as perfusion is restored. This patient would also be a good candidate for the monitoring of intrabdominal hypertension. Most cutting edge folks now use vasopressors ONLY after volume therapy fails. Although it is not about trauma, per se, google "Early Goal Directed Sepsis Therapy" or "EGDT" and you will find some of the rationales for these actions. Good luck--this can be a great patient to learn from. Dr. Kathy, RN, PhD, CCNS

I teach pathophysiology at both the graduate and undergraduate level. McCance and Heuther is a great book. I frequently recommend the Prentice-Hall book, Pathophysiology, Reviews and Rationales (Hogan, 2004) to my students. It is an excellent supplemental study aid. Each unit, organized in an outline, bullet format includes a pre and post test with rationales. Content likely to be included on the NCLEX is flagged as well. Students seem to find it helpful. (I teach in a University, and have no relationship with the author, publisher, etc!) :wink2: