REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Use the following expanded scenario from
Chapter 40 in your textbook to answer the
questions below.
Scenario:Jack Soo Park, a 78-year-old man
receiving intravenous (IV) therapy with antibi-
otics, states, “I’m having trouble breathing. It
just started a little while ago.” Physical exami-
nation reveals a bounding pulse, distended
neck veins, shallow, rapid respirations, and
crackles and wheezes in the lungs. Excess fluid
volume is suspected. Further checking reveals
an IV fluid-administration error that has
resulted in overhydration.
1.Based on the data in this scenario, what body
systems are involved in Mr. Park’s fluid
volume excess? What interventions would be
appropriate?2.What would be a successful outcome for
Mr. Park?3.What intellectual, technical, interpersonal,
and/or ethical/legal competencies are most
likely to bring about the desired outcome?4.What resources might be helpful for Mr. Park?PATIENT CARE STUDY
Read the following patient care study and use
your nursing process skills to answer the
questions below.
Scenario:Rebecca is a college freshman who
had her wisdom teeth removed yesterdaymorning. She had a sore throat several days
before the extraction but did not mention this
to the oral surgeon. Because of her sore throat,
she had greatly decreased her food and fluid
intake. The night of the surgery, she had an
oral temperature of 39.5C (103.1F). Friends
gave her some Tylenol, which brought her tem-
perature down, and encouraged her to drink
more fluids. When they checked on her this
morning, her temperature was elevated again
and she said she had felt too weak during the
night to drink. They took her to the student
health service, where the admitting nurse
noticed her dry mucous membranes, decreased
skin turgor, and rapid pulse. At 5 feet 2 inches
and 98 pounds, Rebecca had lost 4 pounds in
the past week.
1.Identify pertinent patient data by placing a
single underline beneath the objective data in
the case study and a double underline beneath
the subjective data.
2.Complete the Nursing Process Worksheet on
page 282 to develop a three-part diagnostic
statement and related plan of care for this
patient.
3.Write down the patient and personal nursing
strengths you hope to draw on as you assist
this patient to better health.
Patient strengths:Personal strengths:4.Pretend that you are performing a nursing
assessment of this patient after the plan of
care has been implemented. Document your
findings.CHAPTER 40 FLUID, ELECTROLYTE, AND ACID–BASE BALANCE 281
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