DAVID, JOVERT ANDREI BSN4B5

CRITICAL THINKING DISCUSSIONS

Instructions: Briefly answer the question. At a minimum, you must cite the journal, textbook,

article, and other reading materials. Make sure to cite any references you use. Use APA style (7th

edition) for proper citation format for your references. (see rubrics for scoring).

1. A hospitalized Mr. Santol with a diagnosis of abdominal aortic aneurysm suddenly

complains of severe back pain and shortness of breath. What should Nurse Jaysone do?

 The nurse should suspect rupture (a surgical emergency) and should notify the healthcare
practitioner right away if the patient with an abdominal aortic aneurysm suddenly complains of
acute back pain and shortness of breath (HCP). The nurse should also ask the patient about their
back discomfort, stay with them as they wait for the HCP, keep an eye on their vital signs and
neurological condition, and support them. Together with extreme discomfort or fullness in the
abdomen, soreness around the umbilicus, and the abrupt appearance of discolouration in the
extremities are other indications of rupture.

2. Nurse Buana notes that a client taking warfarin sodium (Coumadin) has an international

normalized ratio (INR) of 2.8. What should Nurse Buana do?

 Warfarin helps prevent blood clots. To do this, it slows the amount of time it takes for your
blood to clot. This raises your INR level. The INR goal for people who take warfarin is usually
from 2 to 3.5. A value higher than 3.5 increases the risk of bleeding problems. Many things can
affect the way warfarin works. Some natural health products and other medicines can make
warfarin work too well. That can raise the risk of bleeding. If you drink a lot of alcohol, that may
raise your INR. And severe diarrhea or vomiting can also raise your INR. Vitamin K can be given
by mouth or as an injection. Vitamin K slowly lowers the INR, so this is a good option if the
bleeding isn’t serious. Or it may be used along with some of the other treatments. Fresh frozen
plasma is a part of blood that people have donated. It replaces important clotting proteins to
help stop the bleeding. You may get this if you need your INR level lowered quickly. Prothrombin
complex concentrate (PCC) also provides special proteins that help the blood to clot. PCC can
rapidly lower the INR to normal. This is typically used when the bleeding is life-threatening.

3. Nurse Enoy suspects that a client with pheochromocytoma is developing hypertensive

crisis. What should Nurse Enoy do?

 Hypertensive crisis is a feared and potentially fatal complication of pheochromocytoma, which

may be precipitated by tumor manipulation, certain medications, and noxious stimuli. Emergent
 surgery should not be considered appropriate first-line treatment for a hypertensive crisis, as it
may result in dangerous complications. The key to prevention and treatment of a crisis is
diagnosis and adherence to consensus guidelines for preoperative alpha-receptor blockade,
primarily phenoxybenzamine or doxazosin, for 10–14 days prior to surgery. Careful
intraoperative monitoring of blood pressure and volume status is required. The laparoscopic,
including robotic-assisted laparoscopic, adrenalectomy has evolved as the mainstay of surgical
treatment. Meticulous surgical technique, with minimal tumor manipulation and early ligation of
the adrenal vein, should be employed. Management of a hypertensive crisis requires rapid
administration and careful titration of quick-acting vasodilators, including sodium nitroprusside
and nitroglycerin. Attention should be given to alternative agents, including magnesium,
clevidipine, and vasopressin.

4. Montemayor, a victim of a gunshot wound to the chest sustained a penetrating injury. The

EMR team applied a nonporous dressing over the victim’s sucking chest wound at the site

of the accident. On arrival at the emergency department, Montemayor is cyanotic, and

Nurse Marimar notes subcutaneous emphysema (crepitus) and tracheal deviation away

from the affected side. What should Nurse Marimar do?

 The nurse should remove the chest wound bandage right away and call the medical
professional. This is a medical emergency needing maybe chest tube insertion with a chest
drainage system, followed by needle decompression.When there is an increase in intrathoracic
pressure in the pleural space and air cannot leave, a tension pneumothorax can happen. The
covering of an open chest wound is one of the causes. Cyanosis, air-hunger cravings,
excitement, tracheal deviation away from the affected side, subcutaneous emphysema, neck
vein enlargement, and hyperresonance to percussion are some symptoms.

5. Nurse Herby notes that Mr. Ralf who experienced a stroke is sitting in a chair and is leaning

to the left with the arm caught in the side of the chair seat. Nurse Herby suspects unilateral

body neglect syndrome. What should Nurse Herby do?

 A right cerebral hemispheric stroke is more likely to result in unilateral body neglect syndrome
than other types of strokes. With this syndrome, the patient ignores or is ignorant of their left
side, which may be paralyzed. If a nurse notices this, she or he should check the patient right
away for any indications of harm and ensure the patient's safety. The client with the syndrome
frequently says that everything is great and that he or she is sitting up straight when being
evaluated. Teaching the client to use both sides of the body and focus on the injured side first is
important. The customer is instructed to move their head side to side to expand their viewing
area if they are having visual difficulties.
6. Nurse Joycee notes that a client with scleroderma (systemic sclerosis) is having difficulty

swallowing. What should Nurse Joycee do?

 Eating smaller and more frequent meals can help with gastric emptying problems. Not eating or
drinking for several hours before bed can decrease the volume of stomach contents when the
patient is asleep. This decreases the risk of gastroesophageal reflux and aspiration at night. We
put these patients on a low fat and low fiber diet. Fatty/fried foods slow gastric emptying and
relax the LES. High fiber foods are more difficult for the stomach to empty

7. On assessment, Nurse Kikey notes that Mr. Te with glomerulonephritis has developed fine

crackles in the lung bases bilaterally. What should Nurse Kikey do?

 Interventions for acute glomerulonephritis may include promoting rest, restricting salt and fluid
intake, and restricting protein depending on the severity of the disease process. Drug therapy
includes the administration of antihypertensives, diuretics, or antibiotics. In most cases,
recovery from acute glomerulonephritis is complete, however, progressive involvement can lead
to chronic conditions or the development of end stage kidney disease.

8. The laboratory reports that Mr. Leo’s platelet count is 19,000 cells/mm3. What should the

Nurse Mean do?

 Leukemia is a malignant increase in the number of leukocytes in the bone marrow that are
typically at an immature stage; it affects the bone marrow, causing decreased erythrocytes,
infection from neutropenia, and bleeding from decreased platelet production; if the platelet
count is less than 20,000 than bleeding precautions need to be taken.
References

Brain aneurysm - Symptoms and causes - Mayo Clinic. (2023, March 7). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483

Prothrombin time test - Mayo Clinic. (2022, November 30). https://www.mayoclinic.org/tests-

procedures/prothrombin-time/about/pac-20384661

Tabak, B. M. (2019, January 1). Hypertensive Crisis Due to Pheochromocytoma.

https://doi.org/10.1007/978-3-030-12823-4_32

White Blood Cell Count - Health Encyclopedia - University of Rochester Medical Center. (n.d.).
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=167&contentid=white_cell_count

Picmonic. (2021, October 12). Picmonic.

https://www.picmonic.com/pathways/nursing/courses/standard/medical-surgical-nursing-
pathophysiology-296/renal-disorders-1428/acute-glomerulonephritis-interventions_1936

Scleroderma - Esophageal Health | UCLA Health. (n.d.). UCLA Health.

https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/scleroderma