NUR 2755 Final Exam: Multidimensional Care IV /MDC 4 - Rasmussen, Exams of Pharmacology

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NUR 2755 Final Exam(Latest2021/2022): Multidimensional Care IV /MDC 4 - Rasmussen NUR 2755 Multidimensional Care IV MDC4 Final Exam Why teach patient to deep breath and cough after surgery - prevent pneumonia Normal drainage for surgical site? - Clear (serous) or pale/red/watery (serosanguineous) Worrisome sign of post op patient?? - Restlessness Clearly if patient is presenting to ER with heat exhaustion, what is the priority action of the nurse? - IV Fluids Action is patient has bee sting. . if available? - Epi Community disaster preparedness, what would be an organization to help? - *Medical Reserve Corporation* FEMA Red Cross DMAT?? - Disaster Medical Assistance Team Federal employees License is good in ALL 50 states How many days of medical supplies should you have if needed for a disaster, just making a disaster plan? - 3 days Cimetidine for burn patients?? Why?? - Help with gastric ulcers Triage tags. . . what would we put on them to help?? - Name Age Injury (Anything to help identify) Any treatments we did Who we can contact/who has been contacted. Triage colors Gave double dose of medication, what to do first? - Assess patient Patient is getting IV heparin for a PE, what would PTT be at for therapeutic levels?? - Higher --> like if its at 25, we would want to increase the rate of heparin Gene Alteration CYP2C19 and history of PE, what to do to prevent further issues? - IVCF - Inferior Vena Cava Filter Mean Arterial Pressure, how to correlate with blood loss?? - Lower blood volume = lower MAP How to calculate MAP?? - Double the bottom number of blood pressure, add that to the top number and then divide by 3. Example: BP is 120/80, 80+80 = 160 160 + 120 = 280 280/3= 93.333 MAP would be 93. What to educate elderly patients on about rehydration to prevent shock?? - Increase fluids, drink on a regular schedule What lab value will be off in a patient with shock, septic shock? - Lactic Acid What to remember when determining triage or prioritization of patients?? - ABCs Sick calls and tension with staff after a long week of critical care patients, what is important to remember in this aspect>> - Debriefing External disaster examples - Tornado Flooding Hurricane When we see a patient passed out/unconscious at home, with cherry red skin color, what do we assume??? - Carbon monoxide poisoning Make sure that if a patient we did Parkland Formula, and still low urine output, what else can we do?? - Increase fluid rate Monitor urine output Check electrolytes Parkland formula - 4 mL x TBSA (%) x body weight (kg). 50% given in first 8 hours, 50% given over the next 16 hours. Patient with a burn, what electrolyte would we typically initially see with 3rd spacing of fluid?? - High potassium What patient would be at high risk for developing a PE?? - Hx of DVT Smoking Oral birth control Pregnancy Immobility Major long bone fracture Hx of falls Post Op patients How would you determine if patient is receiving good ventilation?? - Equal chest rise Stable vitals Skin color Capillary Refill What type of alarm would you hear if patient has mucous plug and needs suctioning?? - High pressure alarm initial phase of shock - MAP decreased by 10 mmHg from baseline. Mild vasoconstriction. Increased heart rate. Vital organ function is NOT disrupted. Indicators of shock are difficult to detect at this stage. THIS STAGE IS STILL REVERSIBLE. Nonprogressive phase of shock - MAP decreases by 10-15 mmHg from baseline. Moderate vasoconstriction. Increased heart rate and decreased pulse pressure. Chemical compensation. Decreased urine output, stimulation of thirst reflex, mild acidosis, mild hyperkalemia. Tissue hypoxia occurs in nonvital organs and in the kidneys but is not great enough to cause permanent damage. Restlessness, tachycardia, increased respiratory rate, falling systolic blood pressure, narrowing pulse pressure, cool extremities, and a 2%-5% change in oxygen saturation. THIS STAGE IS STILL REVERSIBLE. Progressive phase of shock - Decrease of more than 20% MAP. Anoxia of nonvital organs, hypoxia of vital organs. Moderate acidosis, moderate hyperkalemia, tissue ischemia. Some tissues die. Patient may have a sense of impending doom or "something bad". Patient may become confused and thirst increases. Rapid weak pulse, low blood pressure, pallor to cyanosis of oral mucosa and nail beds, cool and moist skin, anuria, and 5%-20% decrease in oxygen saturation. stroke? - Sweating lightheaded/dizzy confusion/hallucinations elevated heart rate (could be irregular) elevated blood pressure decreased urine output Come upon a car crash with multiple victims, what is priority/what patient is at biggest risk? - Airway/breathing issue first Term for initial surveillance of injury - triage How to teach CNA easiest way to cool down a patient? - Remove clothing & blankets Frost bite 2nd degree - large clear-to-milky fluid filled blisters develop with partial thickness skin necrosis. *Redness and blisters filled with fluid* In a patient with hypothermia what are we concerned about with the heart? and why do we monitor the heart? - To watch for serious arrhythmias What causes serious arrhythmias in patients with hypothermia?? - Blood pooling in the extremities, blood is shunted from getting to the heart. Therefore, lactic acid lab will be abnormal. This will cause the arrhythmias. hat will we HEAR with a pneumothorax? Expected finding - Diminished breath sounds What do you see with a flail chest? The most distinctive sign?? - Paradoxical chest movements What is the initial reaction for a low-pressure alarm, what would you check first?? - low pressure alarm = not getting enough oxygen. Bag the patient manually. High pressure alarm, absent breath sounds in right upper chest......what is it likely to be?? - Pneumothorax Patient has head to toe trauma and at risk for developing ARDS, what is the earliest sign? - Increased respiratory rate What is the most common first symptom with a patient with a PE? - Chest pain Pain response in an unconscious patient? (peripheral pain response) - Squeezing the nail beds What are measures for a patient with a head injury, how do we prevent increase intracranial pressure? - Decrease stimulus Slow movements Don't cough hard or blow nose Deep Breaths Slow exhale to help with pain control Patient has clear fluid coming from nose, what tests would we do or see? - Positive for glucose Yellow halo on white linen or filter paper Patient with spinal cord injury, how to lessen change of AD? - Bowel/Bladder Program How to know if spinal shock is still continuing in a spinal cord injury patient? - Absent/decreased reflexes **Protect the head! Patient is having a seizure, what would you do? - Left side Lay flat loosen clothing padded side rails protect head suction at bedside SAFETY! Patient had a stroke and having homonymous hemianopsia after, how do we help them? - Check all fields (turn head side to side) Myasthenia Gravis: how do we prevent chlorogenic crisis? - Medication regimen Parkinson's: how to help maintain mobility?? - encourage mobility Bradykinesia (Slow Movement) - rocking back and forth to get up helps with this Gillian Barre Syndrome: what would be something that could have happened in the recent history that you would want to ask that happened?? - Infections/Virus in the last month What can you do for a Gillian Barre Syndrome patient??