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Care nurse practitioner covering the ICU

You are the critical care nurse practitioner covering the ICU at a busy teaching hospital. You are called to accept a transfer from an outside hospital. The patient is a 35-year-old native American female who lives on the Navaho Reservation. Prior medical history includes obesity, T2DM, and ETOH use/abuse. Patient presented to outside hospital complaining of RUQ abdominal pain, nausea/vomiting, jaundice, and confusion.

Per the patient’s husband, she developed nausea/vomiting with body aches 3-4 days ago. She “felt like she had the flu” and was taking Tylenol for the body aches.

Labs from the outside hospital are significant for:

WBC 12.8 Gl 86 Tbili 20.4
HGB 9.5 BUN 14 AST 946
HCT 28.3 Cr 0.83 ALT 1110
PLT 73 Na 149 ALP 142
K 4.7
PT 34.6 Cl 112 Lactic acid 12.4
INR 3.6 CO2 13 Ammonia 281
Patient’s mental status quickly deteriorated, and she was intubated for airway protection and is being transferred to your facility for higher level care.

Respond to each of the questions below and support your answer with two or three peer-reviewed resources.

What are the differentials for acute liver failure?
What potential risk factors does this patient have for liver failure?
What are the diagnostic criteria for acute liver failure?
What are your priorities in the medical management of acute liver failure?
What is involved in the pretransplant work-up for liver transplant?
Why do you want to avoid transfusions in a potential transplant candidate?

Sample Solution

form of reckoning a population mean (e.g. mean income per person) or proportion (e.g. proportion of voters favouring the Brexit vote). However, the problem with surveys is that information costs money and as a result, the experimenter must determine how much information he or she needs. Too little information prevents the experimenter from making good estimates, whereas too much of it results in a waste of money. So, the purpose of sampling is to reduce this cost and/or the amount of data that it would take to survey the entire target population, [see 2, “Survey Sampling”, para. 1]. According to Graham Kalton [see 3], sample surveys are nowadays widely accepted as a means of providing statistical data on an extensive range of subjects for both research and administrative purposes. Indeed, businesses and researchers have the need to conduct surveys for several reasons. To begin with, the main purpose is to uncover answers regarding the investigating subject by gathering meaningful opinions, comments, and feedback. Secondly, a survey evokes discussion, gives the survey respondents an opportunity to discuss important key topics and helps the experimenter to dig deeper into the survey and can incite related topics with a broader perspective. Finally, the most important objectives are to base the business decisions on unbiased information and compare results for providing a well-based conclusion for your target survey population. One of the most common real life examples is that governments make considerable use of surveys to get informed of the conditions of their populations in terms of employment and unemployment, income and expenditure, housing conditions, education, nutrition, health, travel patterns, and many other subjects. They also conduct surveys of organisations such as manufacturers, retail outlets, farms, schools, and hospitals. Local governments equally make use of surveys for local planning purposes. Generally, surveys are also used in many other sciences such as sociology, political science, education and public health, [see 3, Kalton 1983]

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