Would Love To See A Forum With Scenerios For Icu

meandragonbrett · Jun 22, 2007

Google "Critical Care Case Studies" or something of the nature.

ceecel.dee, MSN, RN · Jun 22, 2007

You can do a search on this site for titles like "I had an awful shift" or "has this ever happened to you" or "and that's when the shift when to ****" or similar.

starcandy · Jun 22, 2007

I would love to see a forum like this. This is the main reason I come to the site is looking for ways to strenghthen my critical thinking skills. I think med surg scenarios would also be good. I am just trying to be a better nurse.

RNDude · Jun 22, 2007

Maybe you could start a thread and post the first one in the Critical Care Forum on Allnurses?

smk1, LPN · Jun 22, 2007

I would love to see more case studies and see the input from everyone from students to experienced nurses. Respectful debate over priorities, drug therapies, assessment findings makes us all stronger. After all if we are ever brought into court there will be a nurse judging are actions to see if a prudent nurse in similar circumstances would have acted in the same way. What better way to pick each others brains now and see how similar are plan of care and thought processes are?

Christie RN2006 · Jun 22, 2007

If you post this in one of the ICU forums, you will probably get more replies from ICU people.

Here is one for you... you are working in the ICU and find out you are going to be tripled. You can give one patient to your LPN, which one do you give her...

Patient #1 was just extubated a few hours ago who is restrained and has a CVP monitor. They are also on Neosynepherine for blood pressure, and you are having to titrate it often. They need 2 units of blood and the first unit was just hung. They also need potassium and magnesium boluses along with a lot of IV meds to be given through a central line.

Patient #2 is vented and restrained and on diprivan that you are titrating for sedation. Their IV meds are also going through a central line. This patient is currently going through detox and his heart rate is very unstable.

Patient #3 is a fresh post-op and all you know about them is that they had surgery for a incarcerated hernia and small bowel obstruction. Rumor is the person is going to be vented, but you have not heard drips, vent, etc for sure. You have heard that this person was very confused and kept trying to get out of bed, pull out lines, etc. before the surgery.

Who do you give to your LPN?

smk1, LPN · Jun 22, 2007

None are really appropriate but I would say patient number 3 because at this point without further information he is the least critical. No central lines, vents or drips. An LPN can give PO meds and depending on the state peripheral IV meds which the post op patient will need for pain. As a student this is what I would do. What am I missing? (we haven't really been told a lot about LPN scope of practice issues yet, I am assuming it will be covered in our last quarter in our ethics and leadership course).

Freshman RN · Jun 22, 2007

I am pretty sure that in Wyoming an LPN would not be able to take any patients except for the 3rd. However that said, they cannot push iv meds so a person post op I am sure would come back without p.o. meds right away.

The rumor mill is a hot one, Who says that this person you will even recieve as a patient. Maybe he was "You have heard that this person was very confused and kept trying to get out of bed, pull out lines, etc. before the surgery." A little major surgery sure "fix" this problem. Where did he come from?M/S? ICU? what was his age. Does he have any co morbidities.

What is the answer?

Lisa

Christie RN2006 · Jun 23, 2007

I am pretty sure that in Wyoming an LPN would not be able to take any patients except for the 3rd. However that said, they cannot push iv meds so a person post op I am sure would come back without p.o. meds right away.
The rumor mill is a hot one, Who says that this person you will even recieve as a patient. Maybe he was "You have heard that this person was very confused and kept trying to get out of bed, pull out lines, etc. before the surgery." A little major surgery sure "fix" this problem. Where did he come from?M/S? ICU? what was his age. Does he have any co morbidities.
What is the answer?
Lisa

If charge tells you that you are getting a patient, that means you are getting them. The age of this person is 92, and they have multiple risk factors including age, cardiac, etc. The RN that had this person previously is the one that gives you report telling you what this person was like before surgery, but who knows what they will be like after surgery.

But the answer to this one is the third patient. The RN would have to give all the IV pain meds and any other IVP meds. This particular scenario did happen to me and that patient had to be "babysat". She came back from OR and was honestly going crazy! I was trying really hard not to restrain her because I thought that would cause more harm than good, so I gave her to my LPN so that they could sit in there and keep her from pulling out everything and keep her from falling/getting out of bed. At one point I was in there trying to calm her down and she looked me straight in the eyes and said "God is never going to forgive you for what you are doing to me." Lets just say that this was a long and frustrating night...

Freshman RN · Jun 23, 2007

Why exactly was this pt in the ICU except that the pt "wanted everything done". That would be a an extremely stressful night. What kind of hospital are you at?

Tell us more about pt 1 & 2

Patient #1 was just extubated a few hours ago who is restrained and has a CVP monitor. They are also on Neosynepherine for blood pressure, and you are having to titrate it often. They need 2 units of blood and the first unit was just hung. They also need potassium and magnesium boluses along with a lot of IV meds to be given through a central line.

Tubed for what? how long? age? BP and med? Blood? Outcome? Sounds very sick.

Patient #2 is vented and restrained and on diprivan that you are titrating for sedation. Their IV meds are also going through a central line. This patient is currently going through detox and his heart rate is very unstable.

Vented cause of etoh? age? etc..

Christie RN2006 · Jun 24, 2007

Why exactly was this pt in the ICU except that the pt "wanted everything done". That would be a an extremely stressful night. What kind of hospital are you at?
Tell us more about pt 1 & 2
Patient #1 was just extubated a few hours ago who is restrained and has a CVP monitor. They are also on Neosynepherine for blood pressure, and you are having to titrate it often. They need 2 units of blood and the first unit was just hung. They also need potassium and magnesium boluses along with a lot of IV meds to be given through a central line.
Tubed for what? how long? age? BP and med? Blood? Outcome? Sounds very sick.
Patient #2 is vented and restrained and on diprivan that you are titrating for sedation. Their IV meds are also going through a central line. This patient is currently going through detox and his heart rate is very unstable.
Vented cause of etoh? age? etc..

Pt #1 is now a DNR CCA He was tubed because he was breathing in the 40s, sounded like crap and he almost coded on me... his HR was 175 and SBP 68 (This was well over a week before this night) He also has lung, bladder, and brain CA

Pt #2 was vented due to resp failure... possible lung CA he is still currently vented and his HR is back to NSR