Rapid Response

A case of acute chest syndrome

Quick thinking and anticipating treatment results in a good outcome. Takeaways:  Patients with sickle cell disease are at high risk for rapid deterioration.  Strong nursing assessment skills can…
case obstetrical sepsis

A case of obstetrical sepsis

Chorioamnionitis is diagnosed when maternal fever is accompanied by a minimum of one or more of the following clinical conditions: fetal or maternal tachycardia, maternal leukocytosis, uterine tenderness,…
complicated adenovirus

A complicated case of adenovirus

Immunocompromised patients are at risk for serious complications. Takeaways: Adenovirus, which typically presents as a febrile respiratory illness for 1 week, is most commonly found in infants, children,…

A stubborn case of supraventricular tachycardia

JAKE KARCHNER, age 65, is admitted for treatment of acute myeloid leukemia. Because of his history of supraventricular tachycardia (SVT), the physician has ordered telemetry monitoring. When you…
Acute hypopituitarism, healthcare, registered nurse, nursing, nursing journal

Acute hypopituitarism

Your recognition of troubling signs and symptoms results in prompt diagnosis and treatment. Takeaways: Hypopituitarism is the deficient secretion of one or more pituitary hormones. The most common…

Adult intussusception

Quick action ensures prompt diagnosis and treatment. Takeaways: Metformin-associated induced lactic acidosis (MALA) is a life-threatening condition that requires prompt, aggressive management. Early recognition of signs and symptoms…
Anaphylasxis_schoolnurse

Anaphylaxis in the school setting

School mealtimes are important for socialization and nutrition, but food allergies can be life-threatening. Quick assessment and action by school nurses are essential to help students in distress.…

Aortic dissection

An aortic dissection is caused by a tear in the intimal wall of the aorta forcing blood to flow between layers of the aorta to create a false…
asthma exacerbation ant

Asthma exacerbation

An accurate history reduces risk. By Fidelindo Lim, DNP, CCRN, and Nick Deuz, BSN, RN Yi Rong Huang, a 55-year-old man who speaks only Chinese, comes to the…
Atrial fibrillation

Atrial fibrillation

Patient history, new symptoms, and assessment findings prompt a call for the rapid response team Takeaways: Atrial fibrillation results from rapid electrical activity that arises from different ectopic…
Atypical myocardial infarction

Atypical myocardial infarction

While Jane*, a 47-year-old woman with no significant medical history, visits her neighbor, Helen, in the hospital, Helen notes that Jane appears pale. Jane says that she hasn’t…

Atypical presentation of myocardial infarction

Cardiovascular disease remains the leading cause of death in women, but it’s often under-recognized because of atypical symptoms.  Women may experience vague symptoms that are inconsistent with what’s…

Bacterial meningitis

Rapid recognition prevents patient harm. Takeaways:  Early recognition of bacterial meningitis decreases morbidity and mortality.  Photophobia, nuchal rigidity (stiff neck), severe headache, fever, and confusion are all key…

Barely breathing

After cleft palate repair, 16-month-old Nicholas* is admitted to the general care unit in a children’s hospital for postoperative monitoring. Because of the nature of the procedure, Nicholas has a…
bradykinin induced angioedema

Bradykinin-induced angioedema

Quick treatment results in a good outcome. Takeaways: Angiotensin-converting enzyme inhibitors can increase the release of bradykinin, which can increase tissue permeability with dilatation of the vessels and…
cauda equina

Catching cauda equina in time

Michael Smith, age 45, is admitted for lumbar laminectomy revision and fusion surgery. Despite his operative blood loss of an estimated 800 mL, he’s recovering uneventfully in the…
Cerebral Vasospasm

Cerebral vasospasm

Prompt recognition of subtle signs saves patient’s life. Key Points: Patients who experience an aneurysmal subarachnoid hemorrhage (aSAH) require frequent neurologic assessments to monitor for vasospasm. Vasospasm occurs…
danger respiratory syncytial virus

Danger of respiratory syncytial virus

Education may help avoid decompensation and escalation. Takeaways: Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in children less than age 12 months. RSV manifests…

Decompression sickness

Kachina Montgomery, a 27-year-old woman, is spending her honeymoon in Florida learning to scuba dive. About an hour after her last dive, she develops severe right shoulder pain…
Acute,Compartment,Syndrome,Word,,Medical,Term,Word,With,Medical,Concepts

Early detection of acute compartment syndrome

Acute compartment syndrome (ACS) is a surgical emergency that requires early identification to avoid permanent disability of the affected extremity. ACS is a clinical diagnosis. When assessing for…

Eclampsia

A 28-year-old woman who’s 8 months pregnant arrives at the obstetrics ED with right-side upper abdominal pain, a progressively worsening headache for the past 3 days, blurry vision,…

Ectopic pregnancy

Courtney Thomas*, a 30-year-old patient, is 6 weeks pregnant with occasional mild lower abdominal pain and vaginal spotting. While in the outpatient lab, she experiences a diaphoretic episode…
esophageal

Esophageal varices

Darrel has been drinking 1 pint of whiskey each day for 35 years. He worked in construction until he was terminated for absenteeism. His family reports that he’s…
FES

Fat embolism syndrome

Early identification prevents negative outcomes.    Takeaways: Fat embolism syndrome is a rare complication that can occur after traumatic orthopedic injuries. Early identification of neurologic, respiratory, and dermatologic symptoms…

Herpes zoster ophthalmicus

Caroline Carey*, a 62-year-old woman recently diagnosed with non-small cell lung cancer, arrives at the emergency department (ED) with fatigue, facial pain, and a rash on the left…

Hypertrophic cardiomyopathy

John Benson*, a 45-year-old man, arrives in the emergency department (ED) with chest discomfort, shortness of breath, and palpitations that have been gradually worsening for the past few…

Hypoglycemia and the Rule of 15

The parents of Susie Johnson*, a healthy 8-year-old child, bring her to the emergency department because she’s been experiencing abdominal pain, nausea, and vomiting. Susie recently was diagnosed…

Hyponatremia signals acute adrenal insufficiency

Maryann Ward, age 56, is admitted to the chest pain unit. Sara, her nurse, finds her alert and oriented. Mrs. Ward tells Sara her chest pain started yesterday. When assessing her, Sara…
isopropyl alcohol poisoning ant

Isopropyl alcohol poisoning

Quick action puts a patient on the path to recovery. Takeaways: Isopropyl alcohol poisoning is uncommon and resembles ethanol intoxication because both toxins affect the central nervous system.…
malignant-hyperthermia

Malignant hyperthermia

Malignant hyperthermia is a genetic life-threatening disease that results in an uncontrolled release of calcium that causes the body to go into a hypermetabolic state. It’s triggered by…

Metformin-associated lactic acidosis

Metformin-associated lactic acidosis is associated with a high mortality rate when treatment is delayed or the patient takes an unintentional overdose. Patients at risk for metformin toxicity include…

Opioid overdose

When Tom Smith* finds his mother Mary, age 59, extremely sleepy and difficult to awaken, he calls 911. The emergency medical technician (EMT) notes a prescription bottle labeled…

Patient on the precipice

Richard Hamilton, age 67, is admitted to the telemetry unit from the emergency department (ED) with new-onset chest pain. In the ED, his troponin test is negative, a 12-lead…

Pediatric malignant hyperthermia

Daniel Sanchez*, an 8-year-old boy, arrives in the pediatric recovery unit after an appendectomy. You note that his electronic health record (EHR) indicates Daniel weighs 57 lbs (25.8…

Postoperative atelectasis

Early recognition and prompt action achieve a positive outcome. Atelectasis occurs in 90% of patients who receive general anesthesia. Partial or complete collapse of the lungs’ small airways…

Postpartum hemorrhage

Freya Jenkins*, a 22-year-old woman, delivers 32 week gestation triplets via cesarean birth. In the operating room, she experienced quantitative blood loss of 1,050 mL. Ms. Jenkins had…
prolonged qt syndrome unexpected pause

Prolonged QT syndrome: An unexpected pause

 Knowing what to assess and when can prevent a dangerous complication for older adults.  Takeaways: Older adults are often prescribed psychotropic medications for a variety of conditions. Certain…
RaDonda Vaught, healthcare, nursing journal, nursing

Pulmonary atelectasis and retained secretions

Atelectasis is a serious postoperative pulmonary complication. Risk factors include advanced age, obesity, upper abdominal or thoracic surgery, smoking history, reduced mobility, sedation, neuromuscular disorders, chronic lung disease,…
rapid response team psychiatric hospital

Rapid response team in a psychiatric hospital

A twist on the RRT positions nurses as leaders in responding to non-life-threatening situations. Takeaways Medical emergencies occur in many medical settings, including psychiatric hospitals. Psychiatric nurses are…
pulmonary edema

Re-expansion pulmonary edema

An uncommon complication with serious consequences  Takeaways: Re-expansion pulmonary edema is a rare complication of pleural drainage with potentially fatal consequences. Nurses should suspect re-expansion pulmonary edema and…
recognizing complications oncology patient

Recognizing complications in the oncology patient

Quick response includes paying attention to the details. Takeaways: Rapid assessment is key to identifying early complications in the oncology patient. Sense of urgency for early intervention is…

Rocky Mountain spotted fever

While on a hiking trip Mr. Johnson received a tick bite. Seven days later, he developed a headache, fever, and rash around his wrists and ankles, prompting a…

Seizing the moment

Horace Gunner,* a 65-year-old man with hypertension and type 2 diabetes, is admitted to the hospital after a fall at home. His computed tomography (CT) scan shows a…
sepsis protocol action ant

Sepsis protocol in action

A nurse’s quick action prevents progression to septic shock. Takeaways: Rapid and accurate identification of sepsis improves patient outcomes. The source of infection may not always be obvious,…
Sickle Cell Crisis

Sickle cell crisis in the ED

Following the pain pathway leads to a good outcome.     Takeaways: Quick action and critical thinking leads to optimal pain control for sickle cell patients in crisis. Pain management…
bowel-obstruction

Small bowel obstruction

Abdominal pain, bloating and distension, vomiting, and obstipation are warning signs of small bowel obstruction. Small bowel obstructions are treatable if recognized early. Some bowel obstructions are life-threatening…

Stevens-Johnson syndrome

Jordan Davidson, a 20-year-old Asian-American woman, arrives in the ED with a painful rash that has progressed to blisters on the skin and the mucus membranes of the…
stroke alert ant

Stroke alert

Quick identification of stroke in a postpartum patient yields positive result. Anna Connor, a 30-year-old woman, is admitted to the medical-surgical unit with a diagnosis of pneu­­monia. Her…

Subarachnoid hemorrhage

Karen Thompson*, a 55-year-old woman, ar­rives in the ED via ambulance. She reports the worst headache of her life and sensitivity to light. She has no significant medical…

Supraventricular tachycardia

Quick action reverses SVT and prevents a disastrous outcome. Takeaways: Atrial fibrillation and atrial flutter are the most common subtypes of supraventricular tachycardia, which is relatively common in…

Syncope

An 88-year-old man experiences syncope after sustaining a patellar fracture related to a fall. He’s admitted to the telemetry unit with fall and injury prevention protocols in place,…
TURP

Transurethral resection of the prostate

Quick response to postsurgical complication.     Takeaways: Benign prostatic hypertrophy, if left untreated, may lead to chronic urinary retention. Medical therapy failure may warrant urologic outflow studies and…

Traumatic hyphema

Brian Wright*, a 34-year-old man with a history of essential hypertension, is struck in the right temple with a bat during a softball game. Mr. Wright’s teammates drive…
tube feeding aspiration

Tube feeding aspiration

Know the signs and symptoms of tube feeding aspiration: increased blood pressure, heart rate, and respiratory rate; decreased oxygen saturation; and new onset audible rhonchi and wheezes.

Vancomycin flushing syndrome

Shantae Demano*, a 62-year-old woman with a history of recent total left knee surgery, is admitted to the ICU with sepsis and an infection of the knee, which…

Wernicke’s encephalopathy

Amber White*, a 35-year-old woman who’s 21 weeks pregnant, arrives in the ED with an altered level of consciousness, blurred vision, weakness, and ataxia. The nurse notes slurred…

When all signs point to tension pneumothorax

Key takeaways Initial presentation of tension pneumothorax in patients with unassisted breathing is slower and more subtle than in patients who are mechanically ventilated. Early detection of tension…

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