Critical Thinking I: Scenario A patient is admitted to your unit following a colon resection. The patient is receiving 2L of O2 via N/C and IV...

 Critical Thinking I: Scenario

 A patient is admitted to your unit following a colon resection. The patient is receiving 2L of O2 via N/C and IV therapy LR infusing at 125ml/hour. He has a Foley catheter, and a PCA for pain control. The abdominal dressing is clean, dry and intact. He also has Cefotaximine 1 gram IVPB every 12 hours ordered. The patient is at risk for developing the following types of shock, explain why.

1. Hypovolemic:   

2. Anaphylactic:

3. Obstructive:

Critical Thinking II: Stage and Type of Shock

Mr. Benton, age 60 years, is in respiratory failure. You are assisting the registered nurse with his care. He is intubated and on the ventilator in the ICU. He is very agitated and is given morphine sulfate 10 mg IV push. He is still agitated and is given diazepam (Valium) 5 mg IV push, which is repeated (total of 10 mg Valium given IV push). He becomes quiet and drowsy. You take his vital signs and find that you are unable to hear his blood pressure without the Doppler stethoscope, which increases sound. Blood pressure is 80/40 mm Hg, pulse is 50 bpm, respirations are 20/minute on the ventilator, and temperature is 97.6°F (36.4°C).

Identify the following-

4. Shock stage: 

5. Category of shock: (Re-read the scenario and look to the underlined words that maybe key to correct response)

6. Initial patient need: (Re-read the scenario and look to the underlined words that maybe key to correct response)

Critical Thinking III Shock Scenario

Mrs. Stevens has had gastrointestinal surgery after having a ruptured bowel. Her wound begins to bleed heavily and she is lying in a pool of blood. One area of the wound is gushing blood.  She is alert and responsive but signs of shock are present.

7. What action should the nurse take first? (2 points) Testing TIP: (What is the key word in the question? Now re-read the question before answering)

8.Identify other actions the nurse should take.

9. The physician arrives and begins giving orders. What IV solution should the nurse anticipate will be ordered?  Testing Tip: (What tonicity or fluid types are used in emergency situations?)

10.What type of shock is Mrs. Stevens experiencing?

11. Epinephrine drug therapy is used to treat shock. What if the action of this drug?

a.   Increases heart rate and contractility

b.   Affects the respiratory rate only

c.   Decreases cardiac output and blood pressure

d.   Decreases heart rate and contractility

12. The focus of collaborative management of septic shock is aimed at

e.   Limiting fluids to minimize heart failure risk

f.    Finding and treating the cause of the infection

g.   Discontinuing all IV lines as a possible cause of sepsis

h.   Administer a vasodilator drug to increase blood flow to vital organs

13.  Your patient is brought to your clinic after being stung by a bee. He is wheezing and has a swollen tongue. What medications should you anticipate administering to the client? (2pt.)