SOLUTIONS MANUAL
Priorities in Critical Care Nursing, 9th Edition
by Kathleen M. Stacy, Linda D. Urden
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, Table of Content
UNIT ONE: FOUNDATIONS IN CRITICAL CARE NURSING
1. Caring for the Critically Ill Patient
2. Ethical and Legal Issues
3. Facilitating Care Transitions
UNIT TWO: COMMON PROBLEMS IN CRITICAL CARE
4. Psychosocial and Spiritual Considerations
5. Nutritional Alterations and Management
6. The Older Adult
7. Pain and Pain Management
8. Sedation and Delirium Management
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9. Palliative and End-of-Life Care
UNIT THREE: CARDIOVASCULAR ALTERATIONS
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10. Cardiovascular Clinical Assessment and Diagnostic Procedures
11. Cardiovascular Disorders
12. Cardiovascular Therapeutic Management
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UNIT FOUR: PULMONARY ALTERATIONS
13. Pulmonary Clinical Assessment and Diagnostic Procedures
14. Pulmonary Disorders
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15. Pulmonary Therapeutic Management
UNIT FIVE: NEUROLOGICAL ALTERATIONS
16. Neurological Clinical Assessment and Diagnostic Procedures
17. Neurologic Disorders and Therapeutic Management
UNIT SIX: KIDNEY ALTERATIONS
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18. Kidney Clinical Assessment and Diagnostic Procedures
19. Kidney Disorders and Therapeutic Management
UNIT SEVEN: GASTROINTESTINAL ALTERATIONS
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20. Gastrointestinal Clinical Assessment and Diagnostic Procedures
21. Gastrointestinal Disorders and Therapeutic Management
UNIT EIGHT: ENDOCRINE ALTERATIONS
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22. Endocrine Clinical Assessment and Diagnostic Procedures
23. Endocrine Disorders and Therapeutic Management
UNIT NINE: MULTISYSTEM ALTERATIONS
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24. Trauma
25. Burns
26. Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
27. Hematological and Oncological Emergencies
,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.
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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
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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
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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
SE
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
G
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 2: Legal Issues, Priorities in
Critical Care Nursing, 9e. St. Louis: Elsevier.
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R
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, 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
N
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
U
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
R
physical limits associated with the TKA.
Rationales: The client has several pre-existing issues that present a challenge to effective
SE
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
G
and monitor for during recovery.
Cognitive Skill: Recognize Cues
U
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.
R
U
Priorities in Critical Care Nursing, 9th Edition
by Kathleen M. Stacy, Linda D. Urden
N
U
R
SE
G
U
R
U
, Table of Content
UNIT ONE: FOUNDATIONS IN CRITICAL CARE NURSING
1. Caring for the Critically Ill Patient
2. Ethical and Legal Issues
3. Facilitating Care Transitions
UNIT TWO: COMMON PROBLEMS IN CRITICAL CARE
4. Psychosocial and Spiritual Considerations
5. Nutritional Alterations and Management
6. The Older Adult
7. Pain and Pain Management
8. Sedation and Delirium Management
N
9. Palliative and End-of-Life Care
UNIT THREE: CARDIOVASCULAR ALTERATIONS
U
10. Cardiovascular Clinical Assessment and Diagnostic Procedures
11. Cardiovascular Disorders
12. Cardiovascular Therapeutic Management
R
UNIT FOUR: PULMONARY ALTERATIONS
13. Pulmonary Clinical Assessment and Diagnostic Procedures
14. Pulmonary Disorders
SE
15. Pulmonary Therapeutic Management
UNIT FIVE: NEUROLOGICAL ALTERATIONS
16. Neurological Clinical Assessment and Diagnostic Procedures
17. Neurologic Disorders and Therapeutic Management
UNIT SIX: KIDNEY ALTERATIONS
G
18. Kidney Clinical Assessment and Diagnostic Procedures
19. Kidney Disorders and Therapeutic Management
UNIT SEVEN: GASTROINTESTINAL ALTERATIONS
U
20. Gastrointestinal Clinical Assessment and Diagnostic Procedures
21. Gastrointestinal Disorders and Therapeutic Management
UNIT EIGHT: ENDOCRINE ALTERATIONS
R
22. Endocrine Clinical Assessment and Diagnostic Procedures
23. Endocrine Disorders and Therapeutic Management
UNIT NINE: MULTISYSTEM ALTERATIONS
U
24. Trauma
25. Burns
26. Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
27. Hematological and Oncological Emergencies
,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.
N
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
U
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
R
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
SE
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
G
Reference: Urden, L.D., Stacy, K.M., Lough, M.E. (2024). Chapter 2: Legal Issues, Priorities in
Critical Care Nursing, 9e. St. Louis: Elsevier.
U
R
U
, 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
N
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
U
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
R
physical limits associated with the TKA.
Rationales: The client has several pre-existing issues that present a challenge to effective
SE
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
G
and monitor for during recovery.
Cognitive Skill: Recognize Cues
U
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.
R
U
