Download FISDAP FINAL EXAM (200 Questions with SOLUTIONS 100% GUARANTEE PASS and more Exams Nursing in PDF only on Docsity! FISDAP FINAL EXAM (200 Questions with SOLUTIONS 100% GUARANTEE PASS BVM Respiratory Rates..How do we determine adequate respiration? - SOLUTION - theoretically less than 8 or more than 25-ish - assess via adequate chest rise/fall, skin signs, respiratory status. - is patient getting job done on their one or do they need hel? Wheezing - SOLUTION High pitched on exhale Lower airway obstruction (bronchioles) Asthma + allergic reaction/anaphylaxis RONCHI - SOLUTION Denser fluid in lungs (pneumonia, cystic fibrosis, chronic bronchitis) CRACKLES (RALES) - SOLUTION Fluid in lungs ("underwater") Blood or water CHF, PE STRIDOR - SOLUTION High pitched during inspiration Upper airway obstruction Croup, epiglottitis, anaphylaxis Corrective action if no longer see chest rise/fall during PPV ventilations? - SOLUTION Reposition airway Supplemental O2 Flow Rates - SOLUTION NC: 2-6 l/min NRB: 10-15 l/min BVM: 15-25 l/min Nebulized breathing treatment: 6-8 l/min Witness patient collapse..airway obstruction..first objective? - SOLUTION Check breathing pulse —> begin compressions (active 911/AED if possible) What to ask chokng patient? How to approach? - SOLUTION "Are you choking?" "Can you cough?" Keep coughing Approach from front and go to back if need to perform abdominal thrusts How to treat pt w/ Stoma with inadequate respirations? - SOLUTION BVM Pediatric mask w/ adult bag Attach directly to stoma tube Humidified oxygen candidates - SOLUTION Croup Epiglottitis Adults - long transport time, long term o2 therapy "Hoarse" "dry" "something is stuck" How to ask questions to patient w/ extreme SOB and what to ask? - SOLUTION Simple yes/no questions How long has this been going on? Acute vs chronic - acute more emergent NPA - SOLUTION Tip of nose to ear lobe IND: semiconscoius or conscious w/ intact gag reflex, any patient who doesn't tolerate OPA CI: severe head injury w/ bleeding in nose, history of nasal fracture OPA - SOLUTION Corner of moth to ear lobe IND: unresponsive w/o gag reflex, apneic patients being ventilated w/ BVM CI: conscious pt, intact gag reflex, heavy oral trauma TENSION PNEUMOTHORAX - SOLUTION Results from ongoing/uncorrected pneumothorax Increasing respiratory difficulty Diminished/absent lung sounds on affected side JVD + tracheal deviation to opposite side SPONTANEOUS PNEUMOTHORAX - SOLUTION Acute SOB Diminished/absent lung sounds on affected side Tall, thin males w/ history of smoking, asthma Trauma, non-traumatic, exertion (i.e. heavy lifting) PNEUMONIA - SOLUTION Infection causing pus/mucous blocking bronchioles Fever, productive cough (green/brown/yellowish) Ronchi, wheeze, diminished lung sounds in affected lobes Starts in one lobe and progresses Chest pain (increased respiratory effort) Back pain, body aches, night sweats Dyspnea Often in elderly, SNF, close quarters living S/S CHRONIC BRONCHITIS - SOLUTION Excessive mucuous productive — airway obstruction "Blue bloaters" Sputum production Difficulty w/ inspiration Overweight + cyanotic Easily fatigued No pulse > start compressions How to handle equipment when treating patient w/ potential communicable disease? - SOLUTION Disinfect w/ germicidal wipes What are track marks, what kind of OD should you suspect? - SOLUTION Sites of needle injection (arms, web spaces, hands, feet) Suspect heroin overdose Considerations before administering oral glucose gel - SOLUTION IND: decreased LOC + history of diabetes CI: unconscious + inability to swallow When/why remove patient from enclosed space before treating? - SOLUTION Remove from potential air irritant Fresh air/o2 What is priority when treating patient w/ possible communicable disease? - SOLUTION PPE + our own safety S/S Narcotic Overdose - SOLUTION Pinpoint pupils Hypoperfusion Hypoventilation S/S Internal Bleeding - SOLUTION Confused/anxious Tachycardic Dropping BP Distended abdomen PCD skin signs Cholecystitis - SOLUTION Inflammation of gallbladder Pain RUQ increased after fatty/greasy meal N/V (bile green/yellow) Gas/bloating 4 F's - female, fat, fair, forties How to talk to psych patient who appears suicidal? - SOLUTION Don't say: - think about how much family will miss you - i know how you must feel right now CUSHING'S TRIAD - SOLUTION Increased ICP - widening pulse pressure - bradycardic - irregular breathing (cheyne-stokes, biots) S/S CARBON MONOXIDE POISONING - SOLUTION Headache + cherry red skins Altered LOC + dizzy Signs of respiratory distress Weakness, chest pain, N/V * increased incidence with supplemental heating units (incomplete combustion of carbon) How to remove stinger? - SOLUTION Scrape w/ credit card Pt w/ sickle cell anemia needs? - SOLUTION Supplemental O2 + transport position of comfort * cells bind up in joints causing pain HEAT CRAMP - SOLUTION Remove from environment Loosen restrictive clothing High flow o2 if indicated Cool w/ water spray/moist towels HEAT STROKE - SOLUTION Remove from environment + into ambulance w/ MAX AC Remove pt's clothing High flow o2 + assist ventilations if needed Cover w/ wet towels/sheets + fan patient Rule out other causes of altered LOC Notify ALS if pt starts to shiver Transport ASAP Bleeding from dialysis shunt - SOLUTION Treat as arterial bleed —> direct pressure at port site * increased risk of infection S/S PANCREATITIS - SOLUTION N/V Pain in upper quadrants History of chronic alcohol abuse (homeless population) PETITE MAL SEIZURE - SOLUTION Aka absence seizure Brief lapse of memory Pt "blanks out" for a few seconds and then comes to like nothing happened No LOC or other symptoms FOCAL MOTOR SEIZURE - SOLUTION Aka partial seizure SIMPLE - no change in LOC, may have n/t or weakness, visual changes, "aura" - may have twitching or brief paralysis - pt aware this is occurring in the moment COMPLEX - altered LOC - abnormal discharge in temporal lobe - lip smacking, eye blinking, isolated jerking - unpleasant smells, visual hallucinations, uncontrollable fear, repetitive physical behaviors GRAND MAL SEIZURE - SOLUTION Abnormal discharges throughout brain Typically unconscious + severe tonic/clonic behavior Most last 3-5 minutes Tachycardia, hyperventilation, diaphoresis, intense salivation Possible incontinence, tongue biting, trauma injuries Postictal state - 5-20 minutes after w/ brain slowly coming back online STATUS EPILEPTICUS - SOLUTION Most serious Seizures last more than 5 minutes and up to 30 minutes Can continue every few minutes w/o person regaining consciousness AURA - SOLUTION Abnormal taste/visual change alerting impending seizure Metallic taste is common Do not always occur S/S APPENDICITIS - SOLUTION Rebound tenderness RLQ Pain (may radiate to belly button or shoulder blades) N/V Gradual or sudden onset How to address nuchal cord? - SOLUTION Unwrap if enough slack If not slack, clamp and cut. Do NOT PULL on cord to unwrap PLACENTA'S ROLE - SOLUTION Exchange of blood, o2, and nutrients between mom/fetus ECTOPIC PREGNANCY - SOLUTION Embryo develops outside of uterus - typically in fallopian tube Rupture —> severe internal hemorrhage Occurs in 1st trimester Suspect in young women, missed period Sudden/severe pain in RLQ or LLQ May present w/ s/s of internal bleeding (DR GERM) ABRUPTO PLACENTA - SOLUTION Placenta shears off uterine walls Heavy bleeding + very painful Trauma (falls/MVA) or uncontrolled HTN Occurs 3rd trimester Unique to infant = bulging fontanelle *contagious so ensure proper PPE (gloves, gown, eyewear) ACROCYANOSIS - SOLUTION APGAR Score 1 Pink core w/ bluish extremities Normal finding Stimulate to increase respiration/circulation and re-assess Primary concern with allergic reaction - SOLUTION Airway obstruction via swelling When do we consider compressions on a newborn? - SOLUTION Pulse rate < 60 bpm S/S SPLENIC RUPTURE CHILD - SOLUTION Trauma to LUQ Bleeding/ecchymosis to area (DR GERM) S/S EPIGLOTTITIS - SOLUTION Bacterial infection of epiglottis (can swell 2-3x) High grade fever (103+) Drooling, bubbling around mouth Dysphagia, dysphonia, denies food/drink Tripod position, head bobbing in respiratory distress Tenderness/redness around neck TX: humidified air, position of comfort, rapid transport What to observe after newborn head delivered indicating respiratory complication? - SOLUTION Meconium staining + nuchal cord When/why do we place newborn at level of placenta? - SOLUTION Decrease traction on umbilical cord Keep there until cord is done pulsating If head just delivered, on next contraction guide head towards perineum to allow for first shoulder to be delivered Regardless of traumatic injury type, if patient is unresponsive what is our FIRST priority? - SOLUTION ABCs External life threatening bleeds Best way to treat frostbite to extremities... - SOLUTION Remove any wet, restrictive clothing and jewelry Do not break blisters or rub tissue Cover w/ dry sterile dressings Do not actively rewarm Potentially splint to limit movement GSW w/ injuries to thoracic cavity becomes increasingly SOB, how do we assist? - SOLUTION If occlusive dressing, remove 1 side to create 3 sided dressing Chest wall puncture injury, how do we place semi-occlusive dressing? - SOLUTION Taped w/ 3 sides down Open side to allow any discharge to drain out Head injury + blood thinners, why a bad combo and how might patient present? - SOLUTION Decreased ability to clot = increased internal bleeding Cushing's Triad or stroke presentation depending on bleed location Penetrating chest injury, bubbling/bleeding, best dressing? - SOLUTION Occlusive dressing - taped on 3 sides only Femur fracture vs his dislocation presentation - SOLUTION Increased shortening/rotation in hip dislocation Less angulation in femur fracture How to treat open femur fracture - SOLUTION Partner holds manual stabilization Check CMS - realign in no pulse present Splint + stabilize open region Cardboard splint + immobilize to back board Knife impaled in sternum - SOLUTION Remove in interrupting CPR If not, stabilize in place S/S PULMONARY CONTUSION - SOLUTION Hit in chest with bat Trouble breathing Coughing up blood S/S AORTIC DISSECTION - SOLUTION Abrupt pain w/o other symptoms "Tearing" = hallmark sign (also "sharp") Max pain from onset & does not decrease Uncontrolled HTN primary cause Decrease in carotid pulse + BP discrepency between arms Affected side is usually LEFT ANEURYSM - SOLUTION Weakening/ballooning of walls Dissection occurs when blood digs in and starts tearing layers of vessel walls Rupture = death How to position nosebleed? - SOLUTION Pinch nose and lean forward Rule of Nines - SOLUTION - burn to anterior arm elbow to wrist = 4.5% Laceration to medal neck, worried about sub-q emphysema, what dressing? - SOLUTION Occlusive dressing taped on all 4 sides Landing zone for air medical aid? - SOLUTION 100' x 100x' Pt w/ acute status cardiac symptoms, delaying getting on gurney, what is best course of action? - SOLUTION Ask spouse for help Call MICN to assist/explain When do we consider requesting additional resources? - SOLUTION More than 1 patient Heavy extrication required Hazmat Where to place evidence/bloody clothing - SOLUTION Brown paper bag If DNR paperwork not present? - SOLUTION Continue w/ resuscitation per protocols until paperwork present Quality improvement in EMS - SOLUTION System of internal + external reviews When to consider rapid extrication even if c-spine is indicated? - SOLUTION Immediate ABC compromise Patient cannot be assessed/treated in position found BSI/PPE if patient is profusely bleeding - SOLUTION Gloves, goggles, face shield, mask Notifying law enforcement w/ hospice death? - SOLUTION If death doesn't add up I.e. intentional OD Who can refuse treatment/transport - SOLUTION A/O x 4 legal adult Conscious, rational, able to make decisions *emancipated minor w/ same status When consider heavy rescue tools in a TC? - SOLUTION Patient entrapped, wedged, etc Treat/transport adult patient, what to do w/ a minor on scene? - SOLUTION Bring them with you How far apart are hands during power grip? - SOLUTION 10 inches Infant - alleviated obstruction in airway - SOLUTION 5 back blows + 5 chest thrusts Stimulation for acrocyanosis? - SOLUTION Towel stimulation Ped patient having allergic reaction, primary concern? - SOLUTION Airway (respiratory swelling) Ped patient w/ impaled object in cheek. They are crying & bleeding has stopped. You should? - SOLUTION Stabilize object and transport Ped pt hit by car, ecchymosis to LUQ - SOLUTION Suspect spleen injury Infant signs of respiratory distress - SOLUTION Grunting Nasal flaring Intercostal retractions After delivery of newborn's head? - SOLUTION Check for meconium staining + nuchal cord *suction airway if see meconium Ventilating patient w/ BVM or pocket mask, don't see chest rise/fall. First step? - SOLUTION Reposition airway Amputated digit/limb - SOLUTION Wrap in dry sterile dressing —> sealed plastic bag —> place in cool water Arrive on scene of stabbing, already treated and now tranferred to you. As you're transporting, pt starts to tank and diminished lung sounds? - SOLUTION Unseal one side of occlusive dressing Older pt struck in head w/ HA. Most concerning statement? - SOLUTION "I'm on daily blood thinners" Liquid chemical in eye - SOLUTION Flush w/ copious water Lateral to avoid other eye Evisceration treatmet - SOLUTION Moist, sterile dressings Tourniquet application - SOLUTION 2 inches proximal to injury Tighten until bleeding stops Write time applied Kicked in chest, JVD + tracheal deviation - SOLUTION Tension pneumothorax Circumferential burn - SOLUTION All the way around affected area Flail segment - SOLUTION 2 or more ribs broken in 2 or more places This segment moves opposite of rest of chest (paradoxical movement) Crew turns ambulance over to you. Backboard isn't clean. You should? - SOLUTION Disinfect board yourself 5 car MVA, initially what should you do? - SOLUTION Request more ambulances Cardiac arrest in public place, family says don't resusciate - SOLUTION Continue w/ resus until DNR present Mass people runing out of building coughing/difficulty breathing - SOLUTION Look for triage site upwind + call for additional resources Pt has laceration and blood gets on your pants - SOLUTION Continue treatment and clean/change pants afterward PPE for active arterial bleed - SOLUTION Gloves, goggles, face shield, mask EMS call stats to support community request to reduce speed limit - SOLUTION % of people injured/died at this intersection due to car accidents 1st step treating patient who has been sexually assaulted - SOLUTION Re-assure patient Calm, safe demeanor Treatment in PCR gave them oxygen. Where to put in PCR - SOLUTION Plan What do you do w/ expired medications at patient's home? - SOLUTION Bring with you to hospital to properly dispose Pregnant patient says she has to go to bathroom, contractions 2 mins apart - SOLUTION Don't let her, prepare for imminent delivery Pt weights 500 lbs, in 3rd story apartment building w/ some kind of fracture - SOLUTION Consider additional resources MCI, pt unresponsive, apneic, open head injury. What triage tag? - SOLUTION Black Pericardial tamponade - SOLUTION Blunt trauma to heart causing pericardium to fill with blood and restricts heart's ability to expand/fill w/ blood Beck's Triad - muffled heart tones - low BP (+ tachycardic) - JVD What do you do for labored breathing, constriction, or lack of tidal volume? - SOLUTION Assist w/ BVM What do you do for acid in eyes? - SOLUTION Irrigate, copious amount of water If contacts, take them out S/S TENSION PNEUMO - SOLUTION Progressive SOB Decreasing LOC JVD Tracheal deviation Absent/diminished lung sounds Sub-q Emphysema - SOLUTION Crackling sensation of skin on palpation Caused by presence of air in soft tissues Apgar criteria - SOLUTION Appearance Pulse Grimace Activity Respiration Initial assessment unconscious patient - SOLUTION Responsiveness Pulse Chest rise/fall Pt collapses w/ airway obstruction - SOLUTION Check for pulse —> start compressions Checking pulse on hypothermic patient - SOLUTION At least 30 seconds NTG actions - SOLUTION Vasodilator - opens BVs to increase blood supply to heart Relaxes smooth muscle Solid organ rupture presentation - SOLUTION Internal bleeding Distended abdomen Ecchymosis Abdominal pain - first thing you do? - SOLUTION Expose + examine