Scenario Two
A 68-year-old female was admitted
to the medical-surgical unit following
a total abdominal hysterectomy
for ovarian cancer. The patient
arrived from the post-anesthesia
recovery unit confused and with 2+
pitting edema in her bilateral extremities.
Laboratory findings revealed
potassium (K+) of 3.4 mEq/L, sodium
(Na+) of 128 mEq/L, chloride (Cl-) of
93 mEq/L, carbon dioxide (CO2
-) of
25 mEq/L, blood urea nitrogen (BUN)
of 8 mg/dL, creatinine of 0.7 mg/dL
and a blood glucose of 108 mg/dL.
The patient was lethargic, but denied
pain. A large abdominal dressing was
dry and intact. A peripheral IV of 5%
dextrose in water (D5W) was infused
at 120 mL/hour. The patient was on
oxygen at 2 L per nasal cannula.
Scenario Three
A neurosurgical intensive care
nurse was assigned to care for a 23-
year-old male who sustained severe
head trauma following a motor vehicle
crash the day before. He had an
intracranial pressure (ICP) monitor in
place with readings between 15 and
22 mmHg. He was on a ventilator and
was responsive to noxious stimuli,
didn’t follow commands or open his
eyes during wake trials from sedation.
He had an arterial line in place and a
peripheral IV of 5% dextrose in 0.9%
normal saline (D5/0.9% NS) infusing
at 60 mL/hr.