During CRRT initiation, continuous assessment for hemodynamic instability and circuit clotting is the most critical intervention as these complications can be life-threatening and require immediate intervention. Other options are important but secondary to preventing acute complications.
심화 해설
Clinical Judgment
This question assesses which Core Concept a nurse should base the priority of interventions on when initiating a new treatment (CRRT) for a critically ill patient with multi-organ failure. The key is to prevent and detect early immediate, life-threatening complications that can occur when starting the therapy. Option 3 (Assessing for hemodynamic instability and circuit clotting) encompasses the two most common and dangerous major complications in the initial phase of CRRT. The importance of this intervention is further highlighted because COVID-19 patients present with a hypercoagulable state and cardiovascular instability. While the other options are important, they rank lower than option 3 in terms of urgency and comprehensiveness as the 'most critical' initial intervention.
Memory Tip:
Hemodynamics & Clotting = High Criticality. The two things to check first when starting CRRT are "H and C".
KR vs US
While the importance of hemodynamic monitoring and circuit management during CRRT is the same in Korea, the US NGN exam particularly emphasizes clinical judgment and prioritization in risky situations. The question "What is the most critical intervention?" requires Clinical Judgment that integrates an analysis of the patient's condition and the risks of the therapy, not just simple technical performance.
임상 시나리오
Clinical Practice Guide
Key nursing roles when starting CRRT:
1. Notify HCP! Immediately report if there is a sudden drop in blood pressure, a sharp rise in circuit pressure (signs of clotting), severe tachycardia, etc.
2. Circuit monitoring: Continuously observe arterial pressure, venous pressure, and TMP (transmembrane pressure) to detect early signs of clotting.
3. Patient monitoring: Comprehensive hemodynamic status assessment including vital signs, level of consciousness, and peripheral perfusion.
Caution
In SATA (Select All That Apply) questions, if the question asks "What interventions are needed?" rather than "What is the most critical single intervention?", options 1, 2, 3, and 4 could all be correct. The first step is to accurately identify the question type (single best answer vs. multiple choice).
학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.