SOLUTION MANUAL
Priorities in Critical Care Nursing, 9th Edition
By Linda D. Urden, Kathleen M. Stacy, and Mary E. Lough
,Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 1
Answer(s): In order to meet established standards of care and legally competent nursing care,
the nurse would first initiate call to surgeon in order to share concerns regarding possible
delirium.
Rationales: The nurse has obligations to meet both the standards of nursing and legal standards.
In this case the client has been demonstrating signs of delirium that can be a result of the low
sodium confirmed by the electrolyte assessment results. A normal blood sodium level is between
135 and 145 milliequivalents per liter (mEq/L). Hyponatremia occurs when the sodium in your
blood falls below 135 mEq/L. The client’s surgeon needs to be immediately notified of the
assessment data that suggests delirium so that it can be corrected before it becomes a chronic
health issue. While reassessing vital signs is appropriate as this nurse assumes care of the client
to assure continued awareness of the client’s health status, it doesn’t have the priority that
treating possible delirium has regarding the care of the client. While it is possible that after
discussing the client focused concerns, the surgeon may order a reassessment of the client’s
electrolytes to determine the current status of the client’s sodium level but again this doesn’t
have the priority that treating possible delirium has regarding the care of the client. Correcting
the sodium deficient would be an intervention in addressing the possibility of a possibly
diagnosis of delirium.
Cognitive Skill: Take Action
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 2: Legal Issues, Priorities in
Critical Care Nursing, 9e. St. Louis: Elsevier.
,Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 2
Answer(s):
Patient is a 78-year-old admitted for an elective total left knee arthroplasty (TKA). The client
tolerated the surgery well and is now being considered for discharge. The client lives with an
adult child in a very rural community. Prior to the surgery the client had been independent in
preforming activities of daily living (ADLs). The client has a history of hypertension, managed
with losartan 50 mg orally once a day and hydrochlorothiazide 25 mg orally once a day and is
diagnosed with stage 3A asymptomatic kidney disease. During hospitalization the client
experienced hyponatremia which contributed to intermittent delirium. While the client has been
oriented to person, time, situation and place since sodium level has returned to within the normal
range, both client and family have expressed concerns that the cognitive signs of delirium may
reoccur. They also expressed concern of an increased risk for falls related to the temporary
physical limits associated with the TKA.
Rationales: The client has several pre-existing issues that present a challenge to effective
transition to home and for minimizing rehospitalization associated with acute health issue. Age,
chronic illness, changes in baseline function, a history of cognitive impairment, and rural living
are all special considerations for an effective transition. In addition, the client’s medication
history presents with an increased risk of falls related to the possible side effects of both losartan
and hydrochlorothiazide as well as a history of hyponatremia. A history of medical issues, in this
case delirium and hyponatremia, increase the risk for development of these issues again. The
concerns expressed related to falls and cognitive function must be addressed before discharge
and monitor for during recovery.
Cognitive Skill: Recognize Cues
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 3: Facilitating Care
Transition, Priorities in Critical Care Nursing, 9e. St. Louis: Elsevier.
, Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 3
Answer(s):
To best address the client’s various risks for injury, the nurse would first Assess the client for
depression to Identify a risk for self-harm.
Rationales: The recovery phase of TKA surgery generally presents issues that can stress both
the client and their family. While there are physical concerns, the client’s comment about stress
on family members and promise “to never be a burden to anyone” should trigger the nurse to
consider the client’s risk for depression and suicidal ideations. The nurse needs to prioritize the
assessment of the client’s psychosocial status and plan interventions as needed. Only after that
issue has been addressed, the other issues regarding alternative rehab options and the
reoccurrence of delirium can be addressed so as to minimize the risk of increasing family-
related stressors and providing early interventions for the management of delirium.
Cognitive Skill: Take Action
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 4: Psychosocial and
Spiritual Considerations, Priorities in Critical Care Nursing, 9e. St. Louis: Elsevier.
Priorities in Critical Care Nursing, 9th Edition
By Linda D. Urden, Kathleen M. Stacy, and Mary E. Lough
,Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 1
Answer(s): In order to meet established standards of care and legally competent nursing care,
the nurse would first initiate call to surgeon in order to share concerns regarding possible
delirium.
Rationales: The nurse has obligations to meet both the standards of nursing and legal standards.
In this case the client has been demonstrating signs of delirium that can be a result of the low
sodium confirmed by the electrolyte assessment results. A normal blood sodium level is between
135 and 145 milliequivalents per liter (mEq/L). Hyponatremia occurs when the sodium in your
blood falls below 135 mEq/L. The client’s surgeon needs to be immediately notified of the
assessment data that suggests delirium so that it can be corrected before it becomes a chronic
health issue. While reassessing vital signs is appropriate as this nurse assumes care of the client
to assure continued awareness of the client’s health status, it doesn’t have the priority that
treating possible delirium has regarding the care of the client. While it is possible that after
discussing the client focused concerns, the surgeon may order a reassessment of the client’s
electrolytes to determine the current status of the client’s sodium level but again this doesn’t
have the priority that treating possible delirium has regarding the care of the client. Correcting
the sodium deficient would be an intervention in addressing the possibility of a possibly
diagnosis of delirium.
Cognitive Skill: Take Action
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 2: Legal Issues, Priorities in
Critical Care Nursing, 9e. St. Louis: Elsevier.
,Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 2
Answer(s):
Patient is a 78-year-old admitted for an elective total left knee arthroplasty (TKA). The client
tolerated the surgery well and is now being considered for discharge. The client lives with an
adult child in a very rural community. Prior to the surgery the client had been independent in
preforming activities of daily living (ADLs). The client has a history of hypertension, managed
with losartan 50 mg orally once a day and hydrochlorothiazide 25 mg orally once a day and is
diagnosed with stage 3A asymptomatic kidney disease. During hospitalization the client
experienced hyponatremia which contributed to intermittent delirium. While the client has been
oriented to person, time, situation and place since sodium level has returned to within the normal
range, both client and family have expressed concerns that the cognitive signs of delirium may
reoccur. They also expressed concern of an increased risk for falls related to the temporary
physical limits associated with the TKA.
Rationales: The client has several pre-existing issues that present a challenge to effective
transition to home and for minimizing rehospitalization associated with acute health issue. Age,
chronic illness, changes in baseline function, a history of cognitive impairment, and rural living
are all special considerations for an effective transition. In addition, the client’s medication
history presents with an increased risk of falls related to the possible side effects of both losartan
and hydrochlorothiazide as well as a history of hyponatremia. A history of medical issues, in this
case delirium and hyponatremia, increase the risk for development of these issues again. The
concerns expressed related to falls and cognitive function must be addressed before discharge
and monitor for during recovery.
Cognitive Skill: Recognize Cues
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 3: Facilitating Care
Transition, Priorities in Critical Care Nursing, 9e. St. Louis: Elsevier.
, Urden: Priorities in Critical Care Nursing, 9th Edition
Case Study 3
Answer(s):
To best address the client’s various risks for injury, the nurse would first Assess the client for
depression to Identify a risk for self-harm.
Rationales: The recovery phase of TKA surgery generally presents issues that can stress both
the client and their family. While there are physical concerns, the client’s comment about stress
on family members and promise “to never be a burden to anyone” should trigger the nurse to
consider the client’s risk for depression and suicidal ideations. The nurse needs to prioritize the
assessment of the client’s psychosocial status and plan interventions as needed. Only after that
issue has been addressed, the other issues regarding alternative rehab options and the
reoccurrence of delirium can be addressed so as to minimize the risk of increasing family-
related stressors and providing early interventions for the management of delirium.
Cognitive Skill: Take Action
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 4: Psychosocial and
Spiritual Considerations, Priorities in Critical Care Nursing, 9e. St. Louis: Elsevier.
