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Case Scenario

 

82 year-old male that presented with a clinical history of CVA with right hemiparesis and aphasia, chronic atrial fibrillation, and currently on anticoagulants. 

Patient’s had developed abdominal, constipation, wheezing, and shortness of breath 1-week PTA. The patient was diagnosed with a 1.5 cm ureteral stone, pulmonary congestion, and bilateral pleural effusions.

 

Labs:

WBC 15.0. 

Hgb 5.8

MEWS: 2

Interventions:

1 Unit PRBC

VS:

Pre- Transfusion: BP 120/75, Temp 97.5, HR 80 bpm, RR- 20 on 2 lpm at 97% Saturation

During Transfusion: BP 180/95, Temp 98.2, HR 124, and RR 18 on 2 lpm at 96% Saturation

Post Transfusion: BP 150/85, Temp 99.2, HR 120, RR 25 on Venti Mask 50% Fi02 at 95% Saturation

Transferred to ICU at 04:00

Questions:

1.                 What is the process for Blood Transfusion?

2.                 What are the signs and Symptoms of Blood Transfusion Reaction?

3.                 Are there any abnormal findings? If yes, what would you do?

 

Case Progression

Patient was admitted to ICU at 04:05. Patient in critical condition due to multiple acute medical conditions upon arrival to the ICU and continued to decline, you immediately placed a call with Intensivist to inform of the patient condition, but the physician never return your call.

VS: BP 90/85, Temp 99.2, HR 130, RR 25 on Venti Mask 50% Fi02 at 88% Saturation.

Labs: Stat ABG: PH 7.1, SPO2 78, CO2 45, Bicarb 23; lactic acid 6

MEWS: 6

 

Questions:

Chain of Command

1.                 What is the process for Chain of Command?

2.                 What action will be taken if chain of command was used but the patient condition is deteriorating?

 

Case Progression

After following the chain of command, you are able to speak with the doctor and received the following orders.

1.                 Immediate intubation

2.                 Insert central venous catheter and arterial line for IV access and hemodynamic monitoring

3.                 Additional units of FFP and PRBC ordered

4.                 Labs: CBC, CMP, ABG, CXR, Lactic Acid, Pan- culture

5.                 Antibiotics, Sedation

 

Your shift is finally over,

 

Questions:

1.     What communication tool should you utilize to provide thorough report to oncoming nurse?

SCIENCE
HEALTH SCIENCE
NURSING

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