NUR 200 Week 7 Practice Case Study

The nurse is working as the charge nurse in the emergency department when a 60-year-old who has had vomiting
and diarrhea for the last 2 days arrives. The patient’s vital signs are: 101.8° F (38.8° C), 112, 24, 88/60, 97% room air,
pain 7/10. The nurse immediately applies the cardiac monitor and the telemetry strip reads sinus tachycardia with
no dysthymias. The nurse notes that the patient’s mouth is dry, eyes sunken, tenting skin turgor. The nurse starts
the patient’s admission history from the patient, spouse and medical record. Past medical history: appendectomy,
tonsillectomy, adenoidectomy, BPH, coronary artery disease, hypertension. Allergies to penicillin. Current
medications: Flomax, metoprolol, atorvastatin. Orders received from the Health Care Provider. The nurse starts an
IV to infuse a 500mL bolus of normal saline over 60 minutes X 2. (total of 1000mL over 2 hours). Obtained a urine
clean catch specimen and a large brown liquid stool for cultures. All labs were drawn and sent. Bactrim DS and
Keflex IV piggyback ordered and hung after the specimens were collected. Ondansetron IVP given for nausea. The
patient is admitted to the medical surgical unit with a diagnosis of dehydration.

24 hours later, the nurse is reviewing the results of today’s vital signs and labs.

VS Lab Results
T: 99.9° F (37.7° C) Blood urea nitrogen (BUN) 00 mg/dL (normal: 10-20 mg/dL)
P: 46 Creatinine (Cr) 1.2 mg/dL (normal: 0.6-1.2 mg/dL)
R: 18 Hematocrit 55% (normal: 37-52%)
BP: 90/42 Hemoglobin 22 g/dL (normal: 12-18 g/dL)
O2Sat: 88% on 2Lnc. Serum potassium 7.2 mEq/L (normal: 3.5-5.0 mEq/L)
Pain 5/10 Fasting Blood Sugar: 46 mg/dL (normal: 70-100 mg/dL)
Urinalysis Culture and Sensitivity: cloudy, dark amber, high bacteria
Telemetry strip shows: Sinus Bradycardia. Assessment findings include: Crackles at lung bases and 3+ peripheral
edema, confusion, nausea and abdominal distention. The Health Care Provider sees the patient and changes the
patient’s diagnosis to urinary tract infection and fluid overload.
KEY

Tanner’s Clinical Judgment Step Definition of thinking Skill Application of thinking Skill to Case
Study

Identifying Signs and Symptoms

Gathering Complete and Accurate

Data

Assessing Systematically and

Comprehensively

Predicting (and Managing)

 NUR 200 Week 7 Practice Case Study

Potential Complications

Identifying Assumptions

Clustering Related Information

Recognizing Inconsistencies

Checking Accuracy and Reliability

KEY

Distinguishing Relevant from

Irrelevant

Determining the Importance of

Information

Comparing and Contrasting Data