You have been assigned 4 patients on an Intermediate Medical Care Unit. Two of the patients
are post myocardial infarctions at various stages of their infarctions with multiple types of
arrhythmias, the third patient i
...
You have been assigned 4 patients on an Intermediate Medical Care Unit. Two of the patients
are post myocardial infarctions at various stages of their infarctions with multiple types of
arrhythmias, the third patient is having drastic blood sugar fluctuations 218 down to 50 within
minutes and its rebounds back up with changes in mentation and the fourth is reported to be
having frequent TIA's. One of the MI patients is having some dizziness and your TIA patient is
presenting signs of impending stroke.
How would you prioritize your assessments and activities? How would you describe your critical
thinking process and how do you organize and prioritize implementation of care?
My first thought to this scenario is that it is not a realistic assignment for one nurse to handle. I
would prioritize my assessments and activities by first applying the ABC’s (airway, breathing and
circulation). Under these circumstances all of the patients have patent airways and are
breathing. Therefore, I would first address the TIA patient with signs of impending stroke
because of the risk of occluded circulation. My assessment would consist of a full set of vital
signs, facial drooping, slurring of speech or uneven muscle strength in bilateral extremities.
Second, I would address the patient post myocardial infarction with dizziness. Dizziness could
be a symptom of several issues such as medications or another MI. Therefore, I would do
further assessment such as ECG and updated labs. Third, I would address the patient with the
blood sugar fluctuations with mental changes, fluctuations in the blood sugars can cause
cardiac issues so this patient's medications need to be addressed and monitored to get them
stable. Finally, the last patient to be seen is the patient post myocardial infarction because this
patient appears to be the most stable at this time.
As stated above this is definitely not a scenario that one nurse would be managing on their own.
In addition, I believe this is more of a ICU type of patient scenario. These patients on this unit
need critical care and multiple nursing staff to manage all of these conditions and potential
complications.
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