UCCBRN

Thanks. It pays to ask questions. You are a great help, and I truly appreciate it!

hi, everyone; i would like input from experienced icu or ccu nurses on a case study i am researching. please advise as to what you would do if this were your patient. as a novice about to graduate, i want to look at it from an experiential view as opposed to taking it from a book. any advice would be greatly appreciated. here is the case study in question: patient was admitted to the intensive care unit following a thoracotomy with segmental resection of the left lung for carcinoma of the left lung. as the nurse responsible for his care you are concerned about your most recent assessment findings. neurological perla @ 4mm handgrips moderate and equal moderate and equal leg strength orientated to time, place and person "seems agitated" what are the possible sources of mr. brown's agitation? respiratory respiratory rate 28-32 oxygen per high humidity @ 40% oxygen saturation of 89% chest coorifice with decreased air entry to the left side chest tubes * 2 # 28 argyle connected via y-connector to atrium dry suction system with -20 cm of wall suction. chest tubes tidaling with respirations and bubbling noted in water seal chamber. large amount of bloody drainage noted in collection chamber. large amount of serous sanguineous drainage noted on chest tube dressing. operative dressing appears dry and intact except for small amount of shadowing appearing through outer layer of dressing are any of the above findings of concern to you? why or why not? address each finding separately. cardiovascular heart rate 120 - 130's blood pressure 80's systolic temperature 39 degrees celsius. monitor sinus tachycardia pedal pulses palpable (dorsalis pedis and posterior tibial) color pale skin diaphoretic peripheral iv d/5/w with .45 saline at 100 cc/hr are any of the above findings of concern to you? why or why not? address each finding separately gastrointestinal abdomen flat with no audible bowel sounds genitourinary # 14 2-way foley catheter draining approximately 30-45mls per hour for the last three hours. most recent blood work wbc 29, 000 hemoglobin 79 platelets 165,000 bun 4.7 creatinine 112 sodium 145 potassium 3.2 chloride 110 arterial blood gases ph 7.375 po2 88 pco2 40 hco3 22 base excess -1.5 chest x-ray reveals a left pleural effusion after reviewing patient'sblood work with the physician, an order is received to transfuse mr. brown with 2 units of packed cells. he has never received blood before. what are you going to do? should you be concerned that he has not received blood before? patient will also receive a serum potassium bolus to correct his hypokalemia. as a beginning practitioner you are wondering what the hype is anyway about giving potassium iv bolus. you have been told that "potassium is dangerous if given incorrectly" is this correct? why or why not? what does the evidence say? what is the correct way to administer potassium iv? what else is of concern to you regarding mr. brown's blood work? should you be concerned about the reveals of the chest-xray? explain how your assessment findings correlate with a diagnosis of a pleural effusion?