student2008

Anybody have any suggestions for this case study?? The patient was in a car accident. While in the ICU, the patient continues to be hypotensive, ands is restless on the ventilator. Vitals and ABG’s are as follows: BP 60/40 mm Hg HR 160 bpm Temperature 38.° C pH 7.3 Pco2 46 mm Hg Po2 104 mm Hg Hco3 22 mmol/L Settings on the ventilator were changed as follows: FiO2 90 %, SIMV Rate 6, Tidal Volume 800 mL The client was given a bolus 500 ml bolus of NS. His fraction of inspired oxygen (FiO2) increased from 90% to 100%, tidal volume (Vt) was 800 ml, and SIMV rate was 6 with total respirations of 16 breaths/min. At this time, a positive end-expiratory pressure (PEEP) of 5 cm H2O was added, and he continued to receive pressure support of 7 cm H20. He was given several boluses of NS and continued to receive dopamine. The ventilator settings just outlined were continued. The following arterial blood gas values were obtained 2 hours after the ventilator settings were changed: pH 7.42, PCo2 46 mm Hg, Po2 75.2 mm Hg, HCO3 28.9 mmol/L. After 5 days post-op, PEEP was increased to 10 cm H2O, and Vt was increased to 1000 ml. BP 130/60 mmHg, HR 120 bpm, Temp 38.3C, pH 7.43, PCo2 46.2 mm Hg, Po2 86.8 mm Hg, HCO3 30.5 mmol/L After these changes, the patient gradually stabilizes and he was weaned from the ventilator. You are the charge nurse on the step down unit. You currently have a census of 23, with 8 total care patients and 2 ventilators. You have 4 seasoned nurses, 1 nurse who has been on the floor for 6 months and 1 nurse on orientation. You must make the decision of which nurse to assign this patient to. Each of the seasoned nurses has a ventilator and/or 1-2 patients who are total care. Which nurse do you assign this patient to? The nurse you have assigned the patient to becomes very upset and does not want to care for anymore patients. How will you manage this situation?

I'm working on my delegation paper and was wondering if anyone had any good websites where I can fine some more information about delegation. I need to be able to integrate within my paper the 4 principles of delegation. I also need to give detailed examples of the steps of delegation. Any help would be greatly appreciated!:typing

I looked it up in my drug book, but the problem is, I don't know if it's a child or an adult...Mmmm I may have just answered my own question! LOL

got a question. I have a casy study question that says.....you are working a very busy med-surg unit and note an order for Benadryl 50 mg IV to be given before blood transfuion. the pharmacy sends up a bottle of childrens benadryl with the label stating give 50 mg IV prior to blood. What is your initial action? Would you not call Pharmacy to clarify.:imbar

Wow! Yeah...sometimes I think they like to see us squirm. She had an devilish look when she handed to the test out, you could tell that she was enjoying seeing us trying to figure it out. I don't mind them trying to teach us what to be looking for, but this is going way beyond that. I'm so frustrated right now. This is my last semster of nursing school, and they seem to be making it as confusing as possible.

I was just looking that up too, I didn't see it anywhere! I think she just want to see if we know what to do in this situation. The whole order is messed up! do you think that the 5/mg/hr is fictitious too? I've never seen it written out like this.

one of my classmates had emailed her about it, and she replied back and said it was right. ?? I have never seen it written that way.

ok...i get the part about the dilution and not to hang the med, but what about where it says....if the md order stated to start the infusion at 5/mg/hr. at what rate would this be? does this mean that the order would be increased by 5 mg increments per hour? for example, my drug book says that the dosage starts out at 0.25mg/kg; may repeat in 15 min with a dose of 0.35mg/kg? i'm so sorry to keep asking these questions over and over, but i really want to understand what she is asking. i understand if she had put 5mg/hr, but by her putting 5/mg/hr kind of changes the problem.

just had another thought about this question. I don't think the order is complete. therefore, you would call the doctor to clarify the order. the order that the teacher has given us doesnt have a range to go by. Could this be correct? this would also be true for the 2nd question two, right? This is one of those crazy problems that causes you not to sleep at night because you lay in bed at night trying to figure the problem out! Thanks again

I'm totally confused....our question had that the pharmacy sends you a 50mL bag of 0.25 NS with 250 mg of Cardizem added. I feel like they are trying to trick us, which is nothing unusal. What really bothers me is that we haven't been taught this, so it's really hard to know what to do with the problem. I've looked in the drug books and in our text books and they say to start the infusion at 0.25mg/kg; may repeat in 15 min with a dose of 0.35 mg/kg. may follow with continuous infusion at 10mg/hr (range 5-15mg/hr) for up to 24hrs. I didn't understand why she put in the problem 5/mg/hr. most of the time you would see it as 5mg/hr, but this just seems different to me. could it mean that it would be increased in increments of 5 mg??? so would I take the 0.25mg/kg = 25mg divide by 250 x 50mL = 5mL/hr??? I so sorry to keep bothering you with this crazy problem, but it will drive me crazy until I either figure it out or someone can explain it to me how it should be done. Thanks!!

I didn't put that in, thanks. They would also have to repeat the PT, PTT and the INR, right?

I have a question about Coumadin. If you had an elderly Patient who is hospitialized due to several episodes of her ICD discharging and she admits that she cannot remember to take her Amiodarone 200 mg per day. even though she is on amiodarone, she begins to have atrial fibrillation. Her weight is 45kg. she is on a heparin drip with therapeutic PT/INR levels. the physician ordered the client to get Coumadin 10 mg po yesterday. Today's labs reveal a PT of 120/ INR of 15, PTT 150 seconds. as the nurse, what is your initial action? Wouldn't you stop the medication and call the doctor? I know that with elderly clients, they may have a greater than expected PT/ INR. But these labs are through the roof! as the nurse, what assessments do you want to perform on this client? for one, LOC. assess for bleeding and hemorrhage (bleeding gums, nose bleed, unusal brusing, tarry stools, hematuria, fallin BP or hematocrite. what medication do you anticipate the MD to order? vitamin K (Phytonadione, Aquamephyton) What blood products might the MD order for this client and why? whole blood or plasma may be required in severe bleeding because of the delayed onset of vitamin K. it also increases hematocrit and hemoglboin levels. whole blood is used to replace large volumes of blood loss because it increases volume and improves the oxygen carrying capacity of the blood. Can anyone tell me if I'm on the right track?

I didn't put this in the math problem, but on the first question it ask...your order states to start the infusion (Cardizem) at 0.5mg/kg/min. Which is way too much medication to start out with because the recommended doseage shouldn't exceed 15mg/hr. then the next question had ask.....if the MD order stated to start the infusion at 5/mg/hr. at what rate would this be? 5mg/Hr x 50mL = 1 mL/hr 250mg is this correct? and if so, they way the question is written with 5/mg/hr, does that mean it should be increased each time (5mg/hr) not to exceed 15mg/hr?

yes, I'm taking critical care right now and in about 6 more weeks I will be taking mental health. This is my last semester of nursing school. It's been kind of crazy! I do thank you for all you have done to help me. I will be starting my preceptorship this week, so any advice is welcome. I will be in CCU. (yea...I'm scared to death). Thanks again, you have help me so much and I want you to know how much I appreciate it.

Thank you so much. I was hoping I was doing it right! I just wasn't sure.