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Root Cause: What Caused it? Game 2

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Root Cause: What Caused it? Game 2

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Root Cause Builder

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RNPRPEPBESTIE
RNPRPEPBESTIE
United States

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Root Cause: What Caused it? Game 2
 

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Root Cause: What Caused it? Game 2Online version

Root Cause Builder

by RNPRPEPBESTIE
1

A client remains in the ICU after treatment for septic shock and is receiving a titrated norepinephrine infusion to maintain blood pressure . Over the past hour the nurse notes the blood pressure has increased from 92 / 54 to 146 / 88 mmHg and heart rate has slowed slightly . The client ? s hands are now cool and pale with delayed capillary refill . Peripheral pulses are difficult to palpate and urine output has dropped from 45 mL / hr to 18 mL / hr despite stable IV fluid administration . The client reports new numbness and burning pain in the fingertips . Lactate level is beginning to rise again .

These changes most likely developed because of .

2

A client admitted for chest pain has a history of stable angina and is prescribed sublingual nitroglycerin as needed . Late in the evening the client presses the call light after feeling suddenly lightheaded while walking to the bathroom . The nurse finds the client pale , diaphoretic , and unsteady . Blood pressure has dropped from 132 / 78 to 82 / 50 mmHg and heart rate has increased to 118 / min . The client reports taking a recently prescribed medication for erectile dysfunction earlier that afternoon . Cardiac monitoring shows sinus tachycardia without ST elevation .

This sudden deterioration is most likely related to .

3

A client at 36 weeks gestation is admitted for worsening preeclampsia and reports new severe right upper abdominal pain and persistent nausea . Over the past several hours the nurse notes increasing restlessness and a complaint of headache that is not relieved by acetaminophen . Blood pressure has risen from 150 / 94 to 168 / 104 mmHg . Urine output has begun to decrease and the client ? s reflexes are brisk . Laboratory results now show falling platelet count , rising liver enzymes , and evidence of hemolysis . Fetal monitoring reveals decreased variability .

The client ? s worsening condition is most likely due to .

4

An older adult is hospitalized for upper gastrointestinal bleeding and is receiving scheduled IV famotidine therapy . By the second hospital day the nurse observes that the client is increasingly restless at night and has begun pulling at monitoring leads . This morning the client is disoriented to place and attempts to climb out of bed . Vital signs remain stable and hemoglobin has improved since admission . Oxygen saturation is 97% on room air . Serum electrolytes are within normal limits . Family members report the client became similarly confused during a previous hospitalization .

The change in mental status is most likely related to .

5

A warehouse employee presents to the emergency department with fever , fatigue , and mild chest discomfort several days after handling damaged packages at work . Initial assessment shows heart rate 112 / min , respiratory rate 24 / min , and oxygen saturation 95% on room air . The client becomes increasingly anxious and reports worsening shortness of breath despite clear lung sounds . Chest imaging later reveals mediastinal widening and small pleural effusions . Blood pressure begins trending downward and diaphoresis develops .

The client ? s rapid deterioration is most likely due to .

6

On the first postoperative day following abdominal surgery , a client reports increasing shortness of breath and fatigue . The nurse notes respiratory rate has increased from 16 / min to 24 / min and oxygen saturation has decreased to 92% on room air . Breath sounds are diminished at the lung bases with fine crackles that improve after coughing . The client has been reluctant to use the incentive spirometer due to incisional pain and has remained mostly in bed . Temperature is now 100 . 4°F ( 38°C ) .

These findings most likely developed because of .

7

An older adult with type 2 diabetes is brought to the emergency department after family members notice increasing confusion and extreme fatigue over the past two days . The client reports excessive thirst and has been urinating frequently . On assessment the nurse notes dry mucous membranes , poor skin turgor , and delayed capillary refill . Vital signs show blood pressure 88 / 54 mmHg , heart rate 122 / min , and respirations 22 / min . Laboratory results reveal very high serum glucose and significantly elevated serum osmolality with little to no ketone production .

The client ? s condition is most likely caused by .

 
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