2021-Clinical Reasoning Case Study-Priority Patient Activity

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PRIORITY Patient Activity Part I: Who does the nurse see first? Part I-Patient Care Scenarios You are the RN on a busy medical-surgical/telemetry floor at Anytown General Hospital. Each nurse on y... our unit typically cares for 3-5 patients. You have just arrived for your day shift and are receiving nurse-to-nurse reports from three different night shift nurses. After you receive reports, you will have an opportunity to review the current orders for each of your patients. >>Herbie Saunders is a 62-year-old male who came in last night for a CHF exacerbation. His doctor is Dr. Davis and he’s a full code. He’s alert and oriented and can make his needs known. He’s on tele, normal sinus rhythm with occasional PVCs. His pressures are fine, heart rate is in the 70s. Lungs are clear in the uppers with crackles in the bases. He’s coughing up a small amount of white frothy secretions. He’s been on room air since he arrived, oxygen sats are in the low-mid 90s. He got 40 mg IV Lasix last night in the ED; I think you might have something scheduled during your shift but I haven’t given anything overnight. He has a 20 gauge in his right forearm. I’m not sure how he gets around since he’s been in bed since he got here.” >>>>David Mueller is 72 years old, here for a right BKA. He is Dr. Snyder’s patient. Vitals are fine, he’s not on telemetry. Lungs are clear, he’s on room air. I think he still has an 18 gauge in his left a/c but I didn’t get a chance to flush it because he was sleeping most of the night. His finger sticks have been in the high 200s and he gets a sliding scale. That’s really all I have for him. I was so busy last night with a new admission and another patient who was on the call light all night long.” >>>>Gladys Parker is a sweet little 92-year-old lady. She’s here because she had a fall at her nursing home that they think was due to dehydration and weakness. She was admitted by the night float but Dr. Howard will probably be her attending. She’s DNR/DNI. Alert to self and place, but definitely disoriented to time and situation. She’s really forgetful and doesn’t seem to want to bother anyone so she hasn’t used her call light all night. I’d guess she’s at least an assist of one for transfers. She’s on telemetry because her electrolytes were off when she arrived. EKG showed Afib with a heart rate in the 90s. Blood pressures are pretty soft, her systolic blood pressures were in the low 90s for me. Lungs are clear, she’s on room air. They put her on a mechanical soft diet. She takes her pills whole in pudding or applesauce. The nursing home said her last bowel movement was 3 days ago and that she’s incontinent of both bowel and bladder. Her urine seems really concentrated and has a strong odor. I noticed that there is still an outstanding order to collect a UA but I couldn’t get one since she was incontinent all night. Maybe you can address that with the doctor today if they still want it. She’s got a 22 gauge in her left wrist with LR running at 100 mls/hr for a total of one liter. I started that at 0200.” [Show More]

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