CRITICAL CARE NURSING

CASE PRESENTATION

RLE 3

DEMOGRAPHICS: Name: T.A. Age: 50 years old Gender: Male

PAST HEALTH HISTORY: Prior to surgery, he routinely took

medications for gastritis (+) 10 year history of type 2 diabetes

mellitus Was required to have insulin for the past

6 months to control glucose levels

PRESENT MEDICAL HISTORY: Admitted at the ICU, s/p abdominal

aortic aneurysm repair (8 cm in diameter)

Post surgery: (+) weakness of the lower extremities and decreasing urine output

PATHOPHYSIOLOGY

CASE STUDY QUESTIONS:1.) T.A has questions about his surgery. He asks you, “I was fine before surgery. I’d still be fine now if I hadn’t been operated on, wouldn’t I? Based on your knowledge of AAA, what will your response be?

2. Why are you so concerned about the weakness in T.A’s legs?

3. You are performing your initial assessment of T.A’s legs. What findings should you record?

4. Four hours after admission to your floor, you noted that T.A has had a urinary output of 75 ml of dark amber urine. Why are you so concerned?

5. You need to examine the catheter and tubing for obstructions and there are none. What other assessments do you need to gather?

CASE STUDY PROGRESSES… You notify the physician of the decrease

in urine output. The physician orders STAT electrolyte panel and asks you to call him with the results. SERUM TEST RESULTS NORMAL RANGE

Potassium 5.3 mEq/L

Sodium 132 mEq/L

BUN 48 mg/dL

Creatinine 2.4 mg/dL

INTERPRETATION OF LAB RESULTS

CASE STUDY PROGRESSES… The physician determines that T.A is in

the beginning phases of acute renal failure. T.A is sent to radiology for placement of dialysis catheter. Upon T.A’s return, the physician updates T.A’s medical orders.

7. Indicate the expected outcome for T.A that is associated with each of the following medications he is receiving.

MEDICATIONS Lantus (Insulin glargine) 30 units subcu daily NovoLog (Insulin aspart) subcu per sliding scale

ac/hs Imipenem – Cilastatin sodium (Primaxin) 1g IVPB

q8h Dopamine – IV infusion at 2 mcg/kg/hr Furosemide (Lasix) – 20 mg IV push q8 Sevelamer hydrocholoride (RenaGel) 800 mg PO

with meals Sodium polystyrene sulfonate (kayexelate) 1 g PO

bid

8. The dialysis catheter is inserted into T.A’s left subclavian vein. You are preparing to administer the IV antibiotic and find that his only other IV access, a peripheral line, is the site of the dopamine infusion., What will you do?

9. T.A is placed on fluid restriction and a renal diet. T.A asks what he is going to be able to eat and drink on this diet. What is your reply?

10. As you plan care of T.A for the remainder of the shift, identify which aspect of his care you can delegate to the assistive personnel (NAP). Select all that apply.