A bowel obstruction, a suspected malignancy, and multiple comorbidities — this case had all the makings of a clinical storm. In this episode of Clinical Adventurer, we walk through the complex hospital course of a 72-year-old male whose sigmoid stricture led to large bowel obstruction, feculent peritonitis, and septic shock. From emergent surgeries and ICU-level vasopressor support to managing cardiac instability and thrombocytopenia, we unpack the critical decision points, pathophysiology, and bedside nursing priorities that shaped his care. All patient identifiers have been changed. If you’re ready for a deep dive into surgical complications, sepsis physiology, and real-world nursing strategy, this is one you won’t want to miss.

The coagulation cascade isn’t just a lecture topic—it’s a life-or-death system unfolding in real time in trauma bays, ORs, and ICUs. What happens when the cascade misfires? In this episode, we explore not just the science, but the stories, of three patients whose bleeding or clotting disorders reveal the power and peril of the clotting cascade. From a child with hemarthrosis to a septic patient in DIC, you’ll see how lab values like INR and aPTT are more than just numbers—they're clinical lifelines.

Ever wonder what PT, INR, or aPTT actually mean—and why they matter right now at the bedside? In this episode, we’re cracking open the coagulation cascade to uncover how common clotting labs can reveal life-threatening risks like bleeding, clot formation, liver dysfunction, or anticoagulant overdose. Whether you’re titrating heparin, checking warfarin levels, or ruling out a PE, you need more than just a normal range—you need context.

When seconds count, your patient’s lab results can be the difference between catching a heart attack early or missing a silent killer. In this episode, we break down cardiac biomarkers — what they really mean, how to interpret them, and why troponins reign supreme in today’s high-stakes cardiac care. We’ll walk you through the science, the pitfalls, and the nursing implications so you can make sense of those critical labs in real time.

🧠 Key Topics Covered:

• What Are Cardiac Biomarkers?

  • Substances released during cardiac muscle injury

  • Their role in diagnosing Acute Myocardial Infarction (AMI) and Acute Coronary Syndromes (ACS)

• Troponin I and T – The Gold Standard:

  • Why they replaced AST, LDH, and CK-MB

  • Sensitivity, specificity, and timing of elevation

  • Clinical relevance of high-sensitivity troponin assays

• Other Biomarkers in Context:

  • CK-MB and myoglobin: When they’re still used

  • BNP and NT-proBNP: For heart failure assessment (vs ischemia)

• Timing and Trends Matter:

  • Serial troponin testing and rise/fall patterns

  • How early peaks and delayed elevations affect diagnosis

• False Positives and Interfering Factors:

  • Sepsis, renal failure, pulmonary embolism, and chronic disease

  • Pre-analytical issues: Hemolysis, improper timing, and specimen handling

• Diagnostic Criteria for AMI (Fourth Universal Definition):

  • Troponin changes + clinical signs + ECG changes

  • Type 1 vs Type 2 MI differentiation

• Nursing and Interprofessional Implications:

  • When to alert the provider

  • How to prepare patients for serial testing

  • Collaborating with lab, cardiology, and emergency teams for timely action

Not all kidneys fail loudly. Sometimes the earliest signs are hidden in the labs — if you know where to look. In this episode, we go deep into renal function testing, breaking down how to spot trouble early, stage chronic kidney disease accurately, and make sense of the numbers that don’t always tell the full story. Whether you're monitoring a dialysis patient or picking up subtle trends in a post-op patient, this episode equips you with the clinical insight to interpret renal labs with confidence.

Key Topics Covered:

• GFR (Glomerular Filtration Rate):

  • Why it’s the gold standard

  • Estimated vs measured GFR

  • Creatinine vs cystatin C

  • Limitations and influencing factors (age, muscle mass, etc.)

• KDIGO CKD Staging:

  • GFR and albuminuria categories

  • Clinical relevance in guiding treatment

• Creatinine and BUN:

  • What they measure and what they miss

  • BUN/Cr ratio and what it tells you about prerenal vs intrinsic causes

• Albuminuria/Proteinuria:

  • Spot urine vs 24-hour collection

  • Why microalbuminuria matters

• Urinalysis (UA):

  • Key elements: Specific gravity, pH, protein, casts, sediment

  • Clues for glomerular vs tubular vs post-renal pathology

• Tubular Function Tests:

  • Fractional excretion of sodium (FeNa), urine osmolality, and concentrating ability

• Clinical Pearls:

  • How hydration, medications, and diet can skew results

  • When to question the numbers and what to do next

  • Nursing implications for trending renal labs, fluid management, and alerting providers

Think a high AST or ALT means your patient’s liver is failing? Think again. Liver function tests are one of the most misunderstood panels in clinical practice — often called "function" tests, yet many don’t measure function at all.

In this episode, we break down the real meaning behind LFTs, explore the different patterns of liver injury, and help you interpret these labs like a pro. Whether it’s differentiating between cholestasis and hepatocellular injury, or figuring out when to worry about that isolated bilirubin bump, we’ve got you covered with pathophysiology, clinical reasoning, and nursing implications.

🧠 Key Topics Covered:

• Why “LFT” is often a misnomer

• True measures of liver function: Albumin, PT/INR

• Injury patterns:

  • Hepatocellular (↑ AST/ALT)

  • Cholestatic (↑ ALP/GGT)

  • Mixed patterns

  • Isolated hyperbilirubinemia

• What each test actually tells you:

  • ALT/AST – hepatocellular enzymes

  • ALP/GGT – biliary obstruction clues

  • Bilirubin – excretory function vs hemolysis

  • Albumin, PT/INR – synthetic function markers

• Common causes of abnormal labs:

  • Medications, alcohol, viral hepatitis, fatty liver, hemolysis, specimen error

• How to link lab patterns to clinical conditions

• When to escalate care or consult hepatology

Ever wonder why a patient’s SpO₂ is normal, but their tissues are still starving for oxygen? Or why a low SpO₂ isn’t always a crisis? Welcome to the world of the oxyhemoglobin dissociation curve — where hemoglobin plays by different rules depending on your patient’s pH, CO₂, temperature, and more.

In this episode, we unpack what a right shift versus a left shift really means for oxygen delivery, how to spot trouble early, and what every nurse and clinician should know about interpreting oxygen saturation in context. Whether you’re at the bedside, teaching students, or troubleshooting ABGs, this is the episode that brings it all together.

🧠 Key Topics Covered:

• What the oxyhemoglobin dissociation curve actually shows (SpO₂ vs PaO₂)

• Right shift vs left shift – what happens and why it matters

• Clinical scenarios that trigger each shift (e.g., sepsis, hypothermia, COPD, alkalosis)

• The problem with “normal” SpO₂ readings when tissue hypoxia is still present

• Real-world tips for using the curve to interpret ABGs and guide care

When a 91-year-old woman presents with shortness of breath and back pain, the initial concern might be pneumonia or a musculoskeletal issue—but what if it’s much more? This case unravels into a multi-system diagnostic challenge involving pulmonary embolism, atrial fibrillation with RVR, and suspicious findings pointing to possible metastatic disease. It’s a deep dive into the complexity of geriatric presentations—and the clinical judgment required when intervention decisions aren’t clear-cut.Key Topics Covered:

• Pulmonary Embolism in an Older Adult
• New-Onset Atrial Fibrillation with RVR
• Concurrent Pneumonia and Lung Nodules
• Back Pain and Bone Lesions
• Holistic Discharge Planning

Source: StatPearls via the National Center for Biotechnology Information (NCBI) Bookshelf

This comprehensive clinical reference explains the components of the Complete Blood Count (CBC) with differential, breaking down its critical role in patient assessment. It outlines:

• Key Components:

  • Red Blood Cell (RBC) Indices: Includes RBC count, hemoglobin, hematocrit, MCV, MCH, and MCHC.

  • White Blood Cell (WBC) Differential: Evaluates the relative percentages of neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

  • Platelets (PLT): Count and morphology, including mean platelet volume (MPV).

• Normal Ranges: Standard reference intervals for each parameter, with reminders that values can vary based on the local laboratory.

• Clinical Interpretation:

  • Elevations: Potential causes such as infection, inflammation, malignancy, or chronic disease.

  • Decreases: Can suggest bone marrow suppression, autoimmune disease, nutritional deficiencies, or bleeding.

  • Spurious Results: Highlights common pitfalls in automated analysis—e.g., platelet clumping or cold agglutinins—requiring manual smear review.

• Clinical Integration: Stresses the need to interpret CBC values in the context of the whole patient, including symptoms, history, and other diagnostics.

A seemingly routine fall turns out to be only the tip of the clinical iceberg. An elderly female presents with generalized weakness, right-sided rib and hip pain—but what starts as an orthopedic case quickly evolves. As the team investigates, imaging and labs uncover a urinary tract infection and developing pneumonia, shifting the differential and the treatment strategy. This case underscores the importance of maintaining a wide diagnostic lens when assessing older adults and how non-specific symptoms can signal something far more systemic.

Key Topics for Clinical Learning:Geriatric Red Flags Post-Fall→ Why every fall in an elderly patient warrants a full systemic workup.

Imagine you're in the ED, and a previously mobile 55-year-old male arrives with sudden, severe leg weakness, worsening back pain, and fecal incontinence. Alarming, right? This is more than a typical sciatica flare. As the team dives deeper, they uncover a medical maze—chronic vascular disease, prior urinary issues, new neurological deficits, and even a possible Guillain-Barré or neurosarcoidosis diagnosis on the table. With imaging revealing everything from spinal neuroforaminal narrowing to bilateral avascular necrosis and labs pointing to a urinary tract infection, this case demands clinical curiosity, multidisciplinary collaboration, and a whole-lot of critical thinking.

Key Topics for Clinical Learning:

• Differential Diagnosis of Sudden Neurologic Decline
  → How to evaluate lower extremity weakness with incontinence: spinal vs. autoimmune vs. infectious.

• Imaging Insights
  → MRI findings: Cervical to lumbar narrowing, femoral head necrosis, and how they connect (or don’t) to the clinical picture.

• Infectious Complications
  → Urinary tract infection or red herring? When to dig deeper.

• Labs & Pharmacology
  → Interpreting lab trends in complex cases and managing polypharmacy across neurology, vascular, and infectious disease concerns.

• Multidisciplinary Collaboration
  → Navigating consults between neurology, infectious disease, orthopedics, and internal medicine.

What started as a suspected STEMI turned out to be something far more catastrophic. This case takes us inside the emergency hospitalization of an 85-year-old male who collapsed at home, later found to have a ruptured infrarenal abdominal aortic aneurysm. With intubation, central line placement, and emergent endovascular repair, this is a deep dive into rapid response, cross-disciplinary coordination, and critical decision-making.

But the story doesn’t stop in the OR—acute kidney injury, persistent low-grade fevers, and an unexpected gout flare complicated this patient’s post-op course. How do you balance aggressive life-saving interventions with the nuanced challenges of post-op management in older adults?

Key Topics for Clinical Learning:

• Emergency Presentation & Initial Misdiagnosis
  → Differentiating STEMI-like symptoms from AAA rupture in older adults.

• Rapid Interventions & Surgical Management
  → Intubation, central access, and endovascular repair for AAA.

• Post-Op Complication Management
  → AKI protocols, febrile workups, and managing comorbidities like gout in the acute setting.

• Discharge Planning & Rehab Goals
  → Transitioning from ICU to rehab: setting expectations for functional recovery and long-term monitoring.

He’s just 40 years old—but walks into the ED with a rapidly worsening neck mass, a history of oropharyngeal squamous cell carcinoma, and signs of full-blown sepsis. Add to that a history of substance use, non-compliance with treatment, and a storm of social barriers, and you’ve got a case that forces you to ask: When the patient’s body and choices are both failing—how do you lead with both clinical skill and compassion?

This episode dives into a case that’s as much about medical decision-making as it is about real-life complexity.

Key Topics

• Cancer Recurrence vs. Infection:
  → How to differentiate between tumor progression and abscess in head and neck masses.

• Diagnostic Workup:
  → CT of neck, chest, abdomen/pelvis, and abdominal ultrasound: what imaging tells us—and what it doesn’t.

• 💉 Managing Sepsis in Immunocompromised Patients:
  → When aggressive fluid resuscitation, broad-spectrum antibiotics, and electrolyte management take center stage.

• Treatment Non-Compliance:
  → Understanding the implications of missed radiation and chemotherapy: tumor biology, patient autonomy, and public health risks.

• Substance Use and Social Determinants of Health:
  → Navigating pain management, discharge planning, and radiation compliance in the setting of addiction and housing instability.

Imagine you're on call, and EMS rolls in an 88-year-old nursing home resident with bright red rectal bleeding. He’s on dual anticoagulation, has a history of an aortic aneurysm repair, and the CT angiogram lights up a suspicious bleed in the sigmoid colon. Now you’re juggling active bleeding, bleeding risks, thrombotic history, and meds you can’t just stop without a team huddle.
This case isn’t just about treating the bleed—it’s about managing the intersection of geriatrics, cardiology, GI, and pharmacology under pressure.

Key topics covered include:

• Anticoagulation Dilemma: Plavix & Xarelto in a Bleeding Patient

• Lab Trends & Electrolyte Flags

• Interdisciplinary Decision-Making

• Geriatric-Specific Considerations

This inpatient case study follows the complex hospitalization of a 65-year-old male admitted for worsening edema and dyspnea—symptoms that ultimately unveiled acute on chronic heart failure with reduced ejection fraction. As the care team navigates his comorbidities—including uncontrolled diabetes, hypertension, and a long-standing history of tobacco use—the evolving treatment plan reveals how intricate chronic disease management becomes during acute exacerbations. Diagnostic findings, daily clinical decisions, and multidisciplinary discharge planning come together to highlight the clinical, social, and financial dimensions of caring for a medically fragile patient. Key topics include:

• Pathophysiology of HFrEF (Heart Failure with Reduced Ejection Fraction):
  Mechanisms of fluid overload, neurohormonal activation, and the role of diabetes and tobacco in accelerating myocardial decline.

• Diagnostic Highlights:
  Interpretation of chest X-ray, venous duplex, and lab findings (e.g., BNP, Cr, HbA1c) in diagnosing decompensated heart failure and poor glycemic control.

• Medication Adjustments and Rationale:
  Diuretic titration, insulin initiation or adjustment, and antihypertensive strategies in the setting of low cardiac output and end-organ strain.

• Nursing Priorities:
  Monitoring fluid status, strict I&Os, education on sodium restriction, medication adherence, foot care for neuropathy, and recognizing signs of worsening HF.

• Discharge Planning Challenges:
  Coordination with social work regarding financial limitations, need for medication access, and post-discharge support to reduce readmission risk.

This case delves into the intricate unraveling of a seemingly straightforward fall in a 75-year-old legally blind male. What began as trauma evaluation quickly evolved into a layered clinical puzzle—uncovering severe dysphagia, fractures, subclinical alcohol withdrawal, and ultimately, an unexpected diagnosis of advanced head and neck cancer. Through this single patient, we explore how chronic alcoholism, malnutrition, and limited social support silently sculpt clinical outcomes. The conversation connects pathophysiology with real-world care priorities, from early recognition of withdrawal to navigating the transition from curative intent to compassionate, patient-centered comfort care.

In this episode, we take you inside one of the most intense trauma cases we've encountered. This isn’t just a case—it’s a masterclass in managing catastrophic polytrauma.

We’ll walk you through every layer of this complex cascade—from life-threatening abdominal herniation and pulmonary collapse, to vertebral artery transection, brachial plexus avulsion, and the heartbreaking aftermath of a likely permanent neurological injury.

You’ll hear how a multidisciplinary trauma team responded in real time: prioritizing interventions, balancing anticoagulation with bleeding risks, interpreting lab shifts minute by minute, and adapting pain management to honor the patient’s history and parole concerns.

This episode is for the critical thinkers—the nurses, students, and providers who want to understand why behind the interventions, and how we support recovery that goes beyond survival.

Stick around—this is one you’ll be talking about long after the episode ends.

Today’s journey is dedicated to nursing students at the University of Hawai‘i Maui College and to every nurse-in-the-making learning to navigate the complexity and compassion required in end-stage care.

In this deep dive, we follow the story of Colton Reyes, a 52-year-old patient with advanced heart failure, whose case reveals how clinical judgment, pharmacology, pathophysiology, and human-centered care all converge. From managing inotrope dependence and worsening renal function to engaging in honest, life-altering palliative care conversations, this episode explores what it truly means to care for the whole patient. So, if you're ready to connect the head with the heart, this one’s for you.

What starts as back pain on the Big Island quickly spirals into a high-stakes battle with sepsis, acute respiratory failure, atrial fibrillation, and a massive loculated pleural effusion. In this episode, we take you inside the twists and turns of a case where early decisions, critical thinking, and teamwork made all the difference. From thoracentesis to the call for surgical decortication, we’ll break down how pathophysiology, rapid intervention, and nursing vigilance intersected to shape the outcome. This is real-world clinical adventure at its most intense — let’s dive in!

Aloha and welcome to Clinical Adventurer — your shortcut to owning your clinical practice with confidence. Today, we’re ripping the lid off one of the most misunderstood parts of nursing: documentation. It’s not just paperwork — it’s your most powerful tool for patient safety, professional protection, and legal defense. We’ll unpack the real purpose of your notes, reveal how documentation can literally make or break a patient’s care — and your career — and share eye-opening lessons from real-world cases. This is the mindset shift that transforms charting from a chore into your ultimate act of advocacy. Let’s dive in!