Urden, L., Stacy, K. & Lough, M. (2021). Critical Care Nursing: Diagnosis and management (9th ed.). Mosby. ISBN: 978-0-323-44752-2
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Patient information Patient name: Maria Gonzales Diagnosis: Severe necrotizing pancreatitis Age: 64 Ht: 5 ft 2 in Wt: 175 lbs (79.5 kg) Gender: Female Medications: - IV access - IV fluid: D5.45%NS with 20 meq/L at 100 ml/hour - IV medication: - Esomeprazole 20 mg IV - Hydromorphone 0.5 mg IVP/2 hours - Promethazine 25 mg IVP/6 hours - Sliding scale insulin - BS > 200 call PCP - BS < 60 give Dextrose 50% 50 ml IVP General orders: - Advanced directives: Full Code - Diet: NPO - Fall precautions: - Restraints: - Isolation precautions: Unit: Progressive ICU Family: Daughter Rosanna Phone: xxx xxx xxxx Immunizations: Up to date Medication from home: None Monitoring: - I & O every hour - Vital signs every 15 minutes until stable then every hour - ECG monitor - SpO2 monitor Diagnostics: - Lab: BMP, Calcium, Magnesium, CBC, Amylase, lipase - ABG - X-ray: CXR Respiratory: - Incentive spirometer every hour - O2 titrate to keep SpO2 > 92% - Cannula - Oxygen mask - Non-Rebreather mask - Bag-mask ventilator - Nebulizer Social history: - Daughter next of kin - History of smoking 20 years ago - History of ETOH moderate - Employed: Sales manager - Ethnicity: Hispanic - Religion: Catholic Maria Gonzales Simulation Learning Objectives OBJECTIVES: 1. Identifies the primary nursing diagnosis 2. Identifies relevant patient history information 3. Implements patient safety measures 4. Explains physical assessment findings and diagnostics related to patient condition, specifically pancreatitis and septic shock 5. Implements clinician's orders appropriately 6. Implements nursing interventions based on patient care needs 7. Prioritizes nursing interventions 8. Identifies indications, contraindications, and potential adverse effects of prescribed medications 9. Demonstrates correct medication administration 10. Implements a focused cardiac and respiratory assessment 11. Explains clinical findings and critical lab values relating to pancreatitis and sepsis 12. Summarizes potential complications for patients with acute pancreatitis 13. Demonstrates appropriate nursing interventions for a patient with pancreatitis and sepsis 14. Provides relevant patient/family education and teaching 15. Demonstrates therapeutic and confidential communication 16. Demonstrates direct and accurate communication with interprofessional team members 17. Demonstrates effective teamwork Groups will be divided according to clinical groups.
Sri K.
Mr J. is a 44 year-old man with no previous medical history presents to the emergency department with a chief complaint of severe abdominal pain, fever, and chills. He is subsequently admitted to the critical care unit after an open exploratory laparotomy where it was found that he had a perforated appendix and diffuse peritonitis. Intraoperatively he had an estimated blood loss of 350 mL and he received 1 Liter of crystalloid solution in the OR. He arrives at the critical care unit intubated and sedated with a right radial arterial line, a five-lumen pulmonary artery catheter, and an indwelling urinary catheter in place. CASE SCENARIO QUESTIONS: 1.The charge nurse and CCU nurse receiving the patient from the OR team had just finished getting the patient settled. The CCU nurse performs her admission assessment and documenting vital signs and pressure. Before she records his arterial, pulmonary artery pressure and right atrial pressure readings, what should she do first? Why? 2.Right after recording the PAOP, what is most important nursing action to prevent complications of an indwelling PA line? 3.The cardiologist asks the CCU nurse to obtain and give him current CVP reading for Mr. J. Which port on the PA line will the nurse need to access in order to obtain these readings? What does the CVP reading measures? 4.The RAP is reading 1 mmHg. What does this mean? What may have caused this? What nursing interventions do you expect Mr. J needs? 5.The night CCU nurse is now performing her beginning of the shift assessment. She zeroes her arterial and PA line via the transducer to phlebostatic axis. What level does the stopcock needs to be positioned in relation to the patient in order for the pressure readings to be accurate? What pressure reading on the monitor indicates successful zeroing? 6.What is important for the CCU nurse to include in the documentation of Mr. J’s pressure lines? What nursing interventions should be included during routine assessment of patient in regards to pressure lines? What are the complications of PA and arterial lines? 7.Since Mr. J is being weaned off mechanical ventilation, the cardiologist has ordered follow-up ABG to evaluate his tolerance to the weaning parameters. What line will the nurse need to access to obtain the ABG readings? 8. It is 4 hours post-op and Mr. J’s current BP is 82/53, and HR 119. The nurse noticed that his blood pressure has dropped from earlier reading of 95/65 mmHg and heart rate increased from 110 bpm. Mr. J’s urine output for past 4 hours has been approximately 20mL/hr. The intensivist orders for the nurse to administer a 1000mL NS bolus and start Dopamine drip to keep BP WNL. Which pressure line is required for patients on vasopressor drips? 9.One hour after IV NS bolus given and Dopamine drip started, Mr. J’s BP is now 105/68 mmHg and HR is 108 bpm with urine output of 30mL/hr. However, nurse noticed on reassessment that patient still requires high FiO2 concentration to keep his SaO2 >95%. The nurse documents his SvO2 which is 57% and pale skin color. Is the SvO2 reading normal and what does it measure compared to SaO2? What may be a contributing factor to this reading? What should the nurse expect the patient needs? What labs will need to be obtained? 10.After the blood transfusion, the nurse is documenting current vital signs and pressure readings. She notices the PAP suddenly dropped and performed a dynamic response test. What abnormal response could the nurse expect to observe on the monitor? What nursing interventions may be done to troubleshoot? 11.The CCU nurse found the tubing to be kinked in multiple areas along the pressure tubing. After straigtening the tubing, a dynamic response test was done and is normal. The nurse then zeroes the transducer/stopcock to phlebostatic axis. She inflated the balloon of the PA line to obtain the PAOP but was met with resistance after 1 mL of air is injected. Is this normal? What is the next nursing action? What may have caused this? .
The physician was called to the hospital floor for the medical management of a 56-year-old patient admitted one day ago with aspiration pneumonia and COPD. No chest pain at present, but still SOB and some swelling in his lower extremities. The patient was tachypneic yesterday; lungs reveal coarse crackles in both bases, right worse than left. The physician writes instructions to continue with intravenous antibiotic treatment and respiratory support with ventilator management. He reviewed chest x-ray and labs. The patient is improving, and a pulmonary consultation has been requested. What CPT® code is reported?
Rupsa S.
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