Blog

Sonya Murray is a 32-year-old with sickle cell disease.  She has been fairly healthy until this week, when she developed a cold that settled in her chest, resulting in congestion and a productive cough of thick green sputum.  She has no appetite and has not had much to eat or drink for a few days.  Today she is admitted with painful knees and back.  She says that it hurts so bad she can hardly move around and has come to the hospital for pain relief.  She says that she has been admitted to the hospital 5 or 6 times previously for similar painful episodes.  Her sclera are icteric, mucous membranes are dry, skin is warm, and knees are swollen, hot, and painful to touch.  She appears short of breath and oxygen is administered.  Vital signs are:  38.9 C, 112, 30, 96/48, 93% on 2 liters nasal cannula. The following laboratory values were reported:   Ms. Murray’s reticulocyte count indicates which of the following?

Jon Gibbs is a 28-year-old college student who has been reportedly healthy with the exception of recent fatigue and low energy.  School “has been stressful this year” but he says that he tries to exercise and eat as well as he can to stay healthy.   Mr. Gibbs faints in class and falls, hitting his head on a desk on the way to the floor.  911 is called and emergency personnel arrive!  Vital signs are 37.9 C, 112, 30, 200/104.  The cardiac monitor displays an irregular cardiac rhythm with premature ventricular contractions (PVCs).  A swollen, red area is noted on the back of his head from the fall.   Mr. Gibbs is subsequently admitted to the hospital.  You observe that he is alert, shaky with trembling hands, anxious, and weak.  Skin is dry and mucous membranes are moist.  He has bilateral edema of his feet and ankles.  A chest x-ray reveals myocardial hypertrophy, and a computerized tomography (CT) scan of the head is negative. Serum Electrolytes are assessed. Na 152 mEq/L                           Cl 104 mEq/L                          K 6.4 mEq/L BUN 42 mg/dl Creat. 3.4 mg/dl CO2 23 mmol/L Ca 7.2 mg/dl Mag 3.7 mEq/L Phos 5.6 mg/dl Glucose 132 mg/dl Albumin    4.4 g/dl   Lactic Acid 1.8 mEq/L   The swelling on the back of Mr. Gibbs’ head is likely caused by which of the following?

April Jernigan is a 64-year-old teacher with a 10-year history of chronic lung disease.  Despite advice from her doctor to quit smoking, Ms. Jernigan continues to smoke two packs of cigarettes a day.  She is admitted to the hospital with dyspnea, fatigue, and significant pedal edema.  She has a significant “smoker’s cough” and a specimen of sputum has been sent to the laboratory for analysis. Vital signs are 39.8C, 118, 26, 168/104. The following laboratory values are obtained:   Ms. Jernigan has been taking the anticoagulant Coumadin.  Which of the following indicates therapeutic anticoagulation on this medication?

Your patient is taking warfarin (Coumadin) for DVT treatment.  The INR level drawn this morning is 5.2 (normal range 1.0) . What is your priority action?

A 65 year old male is admitted for syndrome of inappropriate antidiuretic hormone (SIADH) resulting from a brain tumor in his frontal lobe. The serum sodium is 112 mEq/L. What is the priority of nursing care for this patient?

Mr. Collins is a 59-year-old male with a history of vomiting blood.  He has been in good health except for hypertension and “stomach problems”, including chronic indigestion and heartburn usually relieved with over-the-counter antacids.  He reports a poor appetite and recent weight loss.  Mr. Collins states that he has a very stressful job at times, and he jokes “I knew this job would give me an ulcer”.  Mr. Collins reports that last evening the heartburn was particularly bad, but he experienced relief after taking his antacids.  He awakened early today with nausea, bloody emesis, weakness, and dizziness.  He also reports black tarry stools. His wife drove him to the emergency room where he was admitted with an upper gastro-intestinal bleed. He is alert and oriented X3, breathing is quiet and unlabored.  Skin and mucous membranes are pale and dry.  There is 90 mL of dark, concentrated urine in a bedside urinal.  An endoscopy reveals esophageal metaplasia and numerous gastric and duodenal ulcers.  A chest x-ray shows normal lung fields with myocardial hypertrophy.  An electrocardiogram (ECG) shows sinus tachycardia with occasional Premature Ventricular Contractions (PVCs). Vital signs are:  36.9 C, 112, 30, 94/42, and 98% Oxygen saturation. The following laboratory values were assessed: Serum Electrolytes Na 130 mEq/L    Cl 89 mEq/L   K 6.2 mEq/L BUN 52 mg/dl   Creatinine 2.4 mg/dl   CO2 16 mmol/L Ca 7.6 mg/dL   Mag 1.5 mEq/L   Phosphorous 4.4 mg/dL Glucose 138 mg/dL   Albumin 3.0 g/dL   Lactic Acid 1.8 mEq/L   Considering Mr. Collins’ clinical status, he would benefit from administration of which of the following?

Jon Gibbs is a 28-year-old college student who has been reportedly healthy with the exception of recent fatigue and low energy.  School “has been stressful this year” but he says that he tries to exercise and eat as well as he can to stay healthy.   Mr. Gibbs faints in class and falls, hitting his head on a desk on the way to the floor.  911 is called and emergency personnel arrive!  Vital signs are 37.9 C, 112, 30, 200/104.  The cardiac monitor displays an irregular cardiac rhythm with premature ventricular contractions (PVCs).  A swollen, red area is noted on the back of his head from the fall.   Mr. Gibbs is subsequently admitted to the hospital.  You observe that he is alert, shaky with trembling hands, anxious, and weak.  Skin is dry and mucous membranes are moist.  He has bilateral edema of his feet and ankles.  A chest x-ray reveals myocardial hypertrophy, and a computerized tomography (CT) scan of the head is negative. Serum Electrolytes are assessed. Na 152 mEq/L                           Cl 104 mEq/L                          K 6.4 mEq/L BUN 42 mg/dl Creat. 3.4 mg/dl CO2 23 mmol/L Ca 7.2 mg/dl Mag 3.7 mEq/L Phos 5.6 mg/dl Glucose 132 mg/dl Albumin    4.4 g/dl   Lactic Acid 1.8 mEq/L   Mr. Gibbs’ potassium value may result in which of the following?

Sonya Murray is a 32-year-old with sickle cell disease.  She has been fairly healthy until this week, when she developed a cold that settled in her chest, resulting in congestion and a productive cough of thick green sputum.  She has no appetite and has not had much to eat or drink for a few days.  Today she is admitted with painful knees and back.  She says that it hurts so bad she can hardly move around and has come to the hospital for pain relief.  She says that she has been admitted to the hospital 5 or 6 times previously for similar painful episodes.  Her sclera are icteric, mucous membranes are dry, skin is warm, and knees are swollen, hot, and painful to touch.  She appears short of breath and oxygen is administered.  Vital signs are:  38.9 C, 112, 30, 96/48, 93% on 2 liters nasal cannula. The following laboratory values were reported:   Ms. Murray’s autonomic status will result in which of the following?

Mr. Collins is a 59-year-old male with a history of vomiting blood.  He has been in good health except for hypertension and “stomach problems”, including chronic indigestion and heartburn usually relieved with over-the-counter antacids.  He reports a poor appetite and recent weight loss.  Mr. Collins states that he has a very stressful job at times, and he jokes “I knew this job would give me an ulcer”.  Mr. Collins reports that last evening the heartburn was particularly bad, but he experienced relief after taking his antacids.  He awakened early today with nausea, bloody emesis, weakness, and dizziness.  He also reports black tarry stools. His wife drove him to the emergency room where he was admitted with an upper gastro-intestinal bleed. He is alert and oriented X3, breathing is quiet and unlabored.  Skin and mucous membranes are pale and dry.  There is 90 mL of dark, concentrated urine in a bedside urinal.  An endoscopy reveals esophageal metaplasia and numerous gastric and duodenal ulcers.  A chest x-ray shows normal lung fields with myocardial hypertrophy.  An electrocardiogram (ECG) shows sinus tachycardia with occasional Premature Ventricular Contractions (PVCs). Vital signs are:  36.9 C, 112, 30, 94/42, and 98% Oxygen saturation. The following laboratory values were assessed: Serum Electrolytes Na 130 mEq/L    Cl 89 mEq/L   K 6.2 mEq/L BUN 52 mg/dl   Creatinine 2.4 mg/dl   CO2 16 mmol/L Ca 7.6 mg/dL   Mag 1.5 mEq/L   Phosphorous 4.4 mg/dL Glucose 138 mg/dL   Albumin 3.0 g/dL   Lactic Acid 1.8 mEq/L   The sacral skin breakdown is evidence of cellular injury, most likely from which of the following?

Jon Gibbs is a 28-year-old college student who has been reportedly healthy with the exception of recent fatigue and low energy.  School “has been stressful this year” but he says that he tries to exercise and eat as well as he can to stay healthy.   Mr. Gibbs faints in class and falls, hitting his head on a desk on the way to the floor.  911 is called and emergency personnel arrive!  Vital signs are 37.9 C, 112, 30, 200/104.  The cardiac monitor displays an irregular cardiac rhythm with premature ventricular contractions (PVCs).  A swollen, red area is noted on the back of his head from the fall.   Mr. Gibbs is subsequently admitted to the hospital.  You observe that he is alert, shaky with trembling hands, anxious, and weak.  Skin is dry and mucous membranes are moist.  He has bilateral edema of his feet and ankles.  A chest x-ray reveals myocardial hypertrophy, and a computerized tomography (CT) scan of the head is negative. Serum Electrolytes are assessed. Na 152 mEq/L                           Cl 104 mEq/L                          K 6.4 mEq/L BUN 42 mg/dl Creat. 3.4 mg/dl CO2 23 mmol/L Ca 7.2 mg/dl Mag 3.7 mEq/L Phos 5.6 mg/dl Glucose 132 mg/dl Albumin    4.4 g/dl   Lactic Acid 1.8 mEq/L   Sustained hypoxia has the potential to result in which of the following?