KeithRN Case Study Part I-Priority
You are the RN on a busy medical-surgical/telemetry floor at Anytown General Hospital. Each nurse on your 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 ...
KeithRN Case Study
Part I-Patient Care Scenarios
You are the RN on a busy medical-surgical/telemetry floor at Anytown General
Hospital. Each nurse on your 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.
, Review Current Orders
NOC Nurse Report
Patient #1: Herbie Saunders
Patient Report: What Do You Notice? Clinical Significance:
The patient has occasional Patient has CHF which can
“Herbie Saunders is a 62-year-old male who came in last PVC, white frothy secretions, in turn cause pulmonary
night for a CHF exacerbation. His doctor is Dr. Davis and abnormal lung sounds and edema which is displayed by
he’s a full code. He’s alert and oriented and can make his had a CHF exacerbation. He the crackles in his lungs and
needs known. He’s on tele, normal sinus rhythm with is receiving 40 mg of IV white frothy secretions.
occasional PVCs. His pressures are fine, heart rate is in Lasix and has a 20 gauge IV Which may be worsened by
the 70s. Lungs are clear in the uppers with crackles in the in right forearm. Also, the not ambulating. Patient is
bases. nurse does not know how the receiving IV Lasix due to his
patient gets around since he’s accumulation of fluids, the
He’s coughing up a small amount of white frothy been in bed since admission. diuretic given will allow the
secretions. He’s been on room air since he arrived, patient to secrete this fluid.
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.”
Most Recent Vital Signs @ 0357 What Do You Notice? Clinical Significance:
Vitals of the patient are Overall, well maintained
T: 98.6 F (oral) normal vitals and no signs of
P: 76 distress.
R: 20
BP: 128/87 (MAP 101 mmHg)
O2 sat: 92% on room air
Pain: denies
Admission Weight: 196 lb (89.1 kg)
In one sentence, describe the ESSENCE of the patient scenario that will guide your plan of care?
What will guide my plan of care for the patient is performing focused assessments of the patient’s lungs and
heart, due to his CHF and abnormal lung sounds/secretions.
What questions do you have for the nurse?
I will ask the nurse when was the last time she/he performed these focused assessment on the patient and if the
patient has been experiencing and signs of distress throughout the shift, such low oxygen saturation or shortness
of breath. Also, I will question what orders has the doctor provided if any and if he/she has followed with the
MD.
Patient #1: Herbie Saunders
Vital Signs: Q4H with telemetry and continuous pulse oximetry
, Review Current Orders
Weight: Daily
I&O: Strict I&O Q8H
General Orders:
Supplemental oxygen to keeps sats >90%
Fingerstick blood glucose QID
Hypoglycemia protocol (includes PRN orders for glucose and dextrose)
Activity: ad lib
Diet: 2gm Na
Notify MD if temp >100.4, HR <40 or >120, RR <8 or >26, BP <90 or >180 or O2 <90%
sustained with supplemental oxygen
Medications: 080
0
insulin aspart per sliding scale subq TID with
090
0 meals aspirin 81 mg PO daily lisinopril 5 mg PO
daily metoprolol 25 mg PO BID insulin glargine
20 units subq daily furosemide 40 mg IV push
BID insulin aspart per sliding scale subq TID with
meals
120 saline flush 10 ml IV TID
0
furosemide 40 mg IV push BID
130
0
Diagnostics:
Echocardiogram, on-call
BMP + Mg, drawn but not yet resulted
Complete Blood Count (CBC) – Yesterday @1730
WBC HGB Hct PLTs
7.9 13.4 45 186
Basic Metabolic Panel (BMP) + Mg – Yesterday @ 1730
Na K Cl CO2 BUN Creat. Gluc Mg
141 3.6 103 26 16 1.1 132 2.0
Basic Metabolic Panel (BMP) + Mg – Today @ 0530
Na K Cl CO2 BUN Creat. Gluc Mg
collected collected collected collected collected collected collected collected
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