NUR2755 / NUR 2755 Exam 2 Blueprint (Latest 2021 / 2022): Multidimensional Care IV / MDC 4, Study Guides, Projects, Research of Nursing

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MDC4 – Examination Blueprint – Exam 2

ATI RN Adult Medical Surgical Nursing REVIEW MODULE EDITION 11.0 pages

included in yellow highlight to help you review material.

Burns (Page 499)

• Assessment – Expected laboratory values – stages -
• Treatment – Fluids - skin grafts - Fluid overload S&S
• Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase
• Total body surface area (TBSA) – Rule of Nines
• Depth of burns
• Parkland Formula
• Urine Output 0.5ml/kg/hr
• Carbon monoxide poisoning
• Complication-eschar, burn shock, stridor, Infection, Curling Ulcers: treatment escharotomy

Respiratory Diseases (Assessment, Nursing interventions)

• Acute respiratory distress syndrome (ARDS) (161-164) – Stridor – Risk Factors o Clinical manifestations:….refractory hypoxemia, non-cardiac pulmonary edema o Treatment: Prone, PEEP
• Hypoxemia
• Pulmonary embolism (pg 149 - 152) – Laboratory Values – Thrombophlebitis - Medications
• Pulmonary edema (205-210)- rhonchi
• Pneumonia (Pg 128) – Aspiration Pneumonia
• Flail chest - Paradoxical respiration (155-158) – paralysis of the diaphragm – respiratory failure
• Pneumothorax – Signs and symptoms o Chest tube management (watch Respiratory SR lecture)
• Treatment (Page 115 - 122)- endotracheal tube – tracheostomy - mechanical ventilation - bag-valve-mask device - pulse oximeter, Chest Tubes (Pg 111 - 114)
• Mechanical Ventilators: o Settings o Complications o Nursing interventions o Low pressure and high-pressure alarms o Ventilator Acquired Pneumonia (VAP) Protocol
• ABG Interpretation

Shock

• Hemodynamics: Central Venous pressure, Wedge pressure
• Meant Arterial Pressure Calculation MAP={SBP + 2(DBP)}/3. Usual Range 70-
• Types, Cause, Risk factors o Hypovolemic o Cardiogenic o Neurogenic o Septic o Anaphylactic
• Stages Progression
• Assessment/Clinical Manifestations/Labs and Diagnostics
• Interventions: o ABC o Specific interventions
• Client teaching/prevention
• Complications:

o DIC o MODS o ARDS o SIRS

Medications: (Therapeutic Effect, Uses, Side effects, Nursing Considerations)

Drug Class: Anticoagulant Heparin Clopidogrel Warfarin Ticlopidine Enoxaparin

Drug Class: Anticoagulant antidote

• Protamine Sulfate
• Vitamin K

Antiulcer Medication: Proton Pump Inhibitors-prazole: omeprazole lansoprazole esomeprazole pantoprazole Histamine blockers: - dine: famotidine ranitidine cimetidine

Drug Class: Antibiotics Vancomycin Ciprofloxacin Silver sulfadiazine Penicillin V

Drug Class: Thrombolytic Alteplase Urokinase Reteplase Streptokinase

Meds for anaphylaxis Epinephrine Drug Class:

• Antihistamines
• Corticosteroids

Drug Class: C orticosteroids Methylprednisolone Hydrocortisone Prednisone Cortisone Fludrocortisone

Drug Class: Inotropes Dobutamine Digoxin

Volume Replacement Normal Saline Lactated Ringers Blood Products

• Consent, 20G, 2RNs, 4 hours max Clotting Factors

Drug Class: Diuretic Furosemide Hydrochlorothiazide Spironolactone

Drug Class: Vasopressors Dopamine Norepinephrine (Levophed) Vasopressin

Drug Class: Vasodilators (afterload Reducers) Nitroglycerine Nitroprusside

Laboratory Values (Highlighted-MUST KNOW)

pH 7.35 – 7.45 mmol/L

Pa02 80 – 100 mm Hg PaCO2 35 - 45 mm Hg HCO3 22 - 26 mEq/L SaO2 ➢ 95%

D-dimer 0.5 mg/l of blood or 500 ng/ml of blood

Lactic Acid (lactate)

3 - 7 mg/dL 0.3-0.8 mmol/L WBC 5,000-10,000 cells/mcl

Hemoglobin (Hgb)

Men 14-18 g/100 ml, Women 12 - 16 g/100 mL Hematocrit Men 42 - 52%,

(Hct) Women 37 - 47% Sodium 136 - 145 mEq/L

Potassium 3.5- 5 mEq/L

Laboratory Value Interpretation

Burns Resuscitative High K+ Hyponatremia Increase WBC

Acute Low K+ Hyponatremia Increase WBC Hypoxemia Low Pa Pulmonary embolism High D-Dimer High CO2 Low PaO Infection High WBC Increase temp

Fluid volume excess Decreased Serum Sodium <

Decreased Urine Specific Gravity

Bounding pulse, Increase BP

Hypovolemic Shock H/H high- dehydration H/H low-bleeding

Increased Lactic Acid

Increased K

Dosage and Calculation – (Know how to work these calculations.)

1. A client needs to receive vancomycin 500mg IV to treat pneumonia. The medication is supplied in a 100ml IV piggyback that is to be given over 1 hour. What rate in ml/hr should the nurse program into the IV pump? mL/hr
2. Calculate the IV flow rate in drips per minute using a drip rate. Administer 2500ml Lactated Ringer's over 16 hours using a tubing with a drip factor of 15 drops/ml. Provide the answer in a whole number gtt/min
3. Determine the infusion rate in milliliters per hour: The client has a vasoactive medication ordered to infuse at 5mcg/kg/min. The client is 188 lbs and the medication supply is 400mg in 250ml. The correct rate is mL/hr
4. The order is to infuse Heparin 1000 u/hr from a solution of 20,000 u in 500 mL of D5W. What is the ml/hr flow rate? mL/hr
5. Order: diltiazem 30 mg PO BID. Available: diltiazem 60 mg per tablet. Dose: Tablets
6. Order: diphenhydramine 25 mg IM now. Available: diphenhydramine 50 mg/ml in a 10 ml vial. How much will

you give? mL

Calculate the Mean Arterial Pressure (MAP) for a client with a BP of 90/48.

Rule of 9s

1. The client has his entire left arm burnt, all of his front torso and the front of both legs. %
2. The client has his entire head burnt, entire back and back of the left leg. %

Parkland Formula

1. The client weighs 200 pounds and has burns to both his legs: %
2. Using the Parkland Formula determine the following: a. Total fluid for the first 24 hours: mL b. Fluid administered the first 8 hours mL. c. How many mLs per hours will that be? mL/hr d. IV rate for the next 16 hours: mL/hr e. What would the IV rate be if the client waited 3 hours to come to the ED? mL/hr

f. Urine output: What would the minimum urine output be for the above client? mL/hr

• 1. Answers:
• MAP=
  • 1. Rule of 9s
  • 1. Parkland Formula
  • a. 13,
  • b.
  • c.
  • d. 409.
  • e. 1310.
  • f. 45.