Lab Detective
A patient presents with:
Labs:
The nurse recognizes the most concerning lab abnormality is causing increased neuromuscular excitability and places the patient at risk for this life-threatening complication.
💰 What is the lab abnormality and what complication are you worried about?
What is hypocalcemia and seizures/laryngospasm?
The nurse receives report on four patients.
A.
A patient with hypothyroidism:
B.
A child with RSV:
C.
A patient with pyelonephritis:
D.
A child with gastroenteritis:
💰 Who dies first?
What is D- A child with gastroenteritis?
A patient presents with:
The nurse clusters these cues and recognizes the most likely condition is:
What is DI?
😈 Simple diagnosis. But I want the nursing reasoning too.
A 2-month-old infant presents with:
The nurse recognizes this condition and knows the infant is most at risk for:
💰 What is the diagnosis and what complication are you trying to prevent?
what is pyloric stenosis, metabolic alkalosis and dehydration/decreased perfusion?
A patient with SIADH has:
The new graduate nurse says:
"The patient is dehydrated because the urine is concentrated."
The experienced nurse recognizes the patient is actually experiencing:
Why is the urine concentrated and why are they not dehydrated?
What is high ADH and the patient is retaining water not losing it?
A patient with cirrhosis has the following labs:
The patient is:
The nurse is most concerned about this lab because it represents the highest immediate risk if the patient falls.
💰 What lab is it and why?
What is INR, decreased clotting factor/production?
The nurse receives report on four patients.
A.
A patient with hyperthyroidism:
B.
A patient with SIADH:
C.
A patient with DKA:
D.
A patient with ulcerative colitis:
💰 Who dies first?
Answer:
A patient presents with:
Labs:
The nurse clusters these findings and recognizes the patient is experiencing a condition characterized by:
💰 What physiologic process is occurring?
What is hypothyroidism due to excess thyroid hormone causing increased metabolic rate?
A 4-year-old child presents with:
Two hours later the nurse notes:
The nurse recognizes the child is most likely developing:
💰 What is happening?
What is Intussusception and Bowel ischemia progressing toward perforation and sepsis?
A patient with ulcerative colitis is admitted for a severe flare.
Assessment:
The new graduate nurse says:
"The biggest problem is the diarrhea because the patient is losing fluid."
The experienced nurse recognizes the patient's most immediate threat is:
💰 What is the most immediate threat?
What is toxic megacolon?
A patient is admitted with:
Labs:
The new graduate nurse is most concerned about the sodium level.
The experienced nurse recognizes that the lab most responsible for the patient's current symptoms is:
What is high TSH and Low T4 (hypothyrodism)?
The nurse receives report on four patients.
A.
A patient with cirrhosis:
B.
A patient with SIADH:
C.
A patient with ulcerative colitis:
D.
A patient with hyperparathyroidism:
💰 Who dies first?
What is B- A patient with SIADH?
A patient presents with:
The new graduate nurse says:
"The main problem is dehydration."
The experienced nurse recognizes the patient is actually experiencing:
💰 What physiologic process is occurring?
what is hypovolemic shock due to decreased perfusion?
A 7-year-old is admitted with suspected sepsis.
Assessment:
The new graduate nurse says:
"The blood pressure is normal, so the child is stable."
The experienced nurse recognizes the child is actually experiencing:
💰 What is happening?
What is compensated/early septic shock?
A patient with cirrhosis has the following labs:
Assessment:
The new graduate nurse says:
"The ammonia is the most concerning lab because it's abnormal."
The experienced nurse says:
"No. One of these labs changes my nursing priorities immediately."
What is the most concerning lab and why?
What is INR, patient is scheduled to ambulate later?
A patient with cirrhosis has the following labs:
Assessment:
The new graduate nurse says:
"The ammonia is the biggest problem because it's the most abnormal."
The experienced nurse recognizes that one lab best explains the patient's current fluid status.
💰 What lab is it and why?
What is albumin, low albumin causes decreased oncotic pressure, fluid shifts into tissues
The nurse receives report on four patients.
A.
A patient with DKA receiving insulin:
B.
A patient with cirrhosis:
C.
A child with suspected sepsis:
D.
A patient with Addisonian crisis:
💰 Who dies first?
What is D - A patient with Addisonian crisis?
Answer:
A patient with cirrhosis is admitted for increasing confusion.
Assessment:
The new graduate nurse says:
"The confusion is worsening because the ammonia is high."
The experienced nurse recognizes that the patient's deterioration is actually being driven by a DIFFERENT physiologic process.
💰 What physiologic process is occurring?
What is GI bleeding causing hypovolemia and decreased cerebral perfusion?
A 2-day-old newborn is admitted with:
At 1400, the nurse notes:
The new graduate nurse says:
"Good! The baby finally had a bowel movement."
The experienced nurse immediately becomes concerned because the infant may be developing a life-threatening complication.
What is the diagnosis and complication?
What is Hirschsprung disease, enterocolitis?
A patient with known Addison's disease arrives in the ED with:
The new graduate nurse says:
"The biggest problem is that the patient has Addison's disease."
The experienced nurse recognizes that the diagnosis is NOT the immediate concern.
What is the immediate life threatening problem and what is the priority?
What is adrenal crisis and IV corticosteroids (hyrdocortisone)
A patient is admitted with DKA.
Current labs:
Assessment:
The new graduate nurse says:
"The glucose is still too high and the anion gap is elevated. Those are the biggest problems."
The experienced nurse recognizes that one lab represents the most immediate threat to life.
What is hypokalemia?
The nurse receives report on four patients.
A. DKA Patient
B. SIADH Patient
C. Pediatric Sepsis Patient
D. Cirrhosis Patient
Who dies first?
What is C- pediatric sepsis patient?
A 14-year-old with Type 1 Diabetes is being treated for DKA.
At 0700:
At 1200:
At 1400:
The new graduate nurse says:
"The patient is deteriorating because the DKA is getting worse."
The experienced nurse says:
"No. The DKA is actually improving. A different physiologic process is now threatening the patient's life."
What physiological process is currently threatening the patient?
What is hypokalemia?
A premature infant born at 30 weeks gestation is in the NICU.
At 0700:
At 1300:
At 1500:
The new graduate nurse says:
"The biggest problem is that the baby isn't tolerating feeds."
The experienced nurse immediately recognizes a life-threatening physiologic process is occurring.
What is the diagnosis and what are the first priorities?
What is NEC, NPO, NG/OG decompression, IV fluids?
PRIORITIZE THESE 4 PATIENTS
A. DKA Patient
B. SIADH Patient
C. Cirrhosis Patient
D. Pediatric Sepsis Patient
Rationale:
D- decompensated shock with multiple organ hypoperfusion
A- Cardiac dysrhythmias (runs vs sustained V tach otherwise this would be first, but arguable)
C- Hypovolemic shock from active GI bleeding
B- Seizure is an emergency, but the others are more immediate.