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2755 Final Exam Multi dimensional
Care IV / MDC 4 – Rasmussen
2023/
MDC4 FinalExam Whyteachpatienttodeepbreathandcoughaftersurgery
- preventpneumonia Gavedoubledoseofmedication,whattodofirst?
- Assesspatient Whattodowhenpatientcomesbackfromsurgery,andthey'redeclining(rapid,shall owrespirations,elevatedheartrate,bloodpressuredropping),whatdoyoudo??
- Callrapidresponseteam Allergyexposuresituation
- moreexposuretoallergenthemorerisktodevelopingareaction
Patientinlithotomypositionforsurgery,wherewouldtheirexperiencepostopdisco mfort??
- Shoulders Whydowehavedrainagetubes/what'sthepurpose??
- Tohelppreventinfection WhydowegiveapatientwithmultiplesclerosisBaclofen??
- Totreatmusclespasms PatienthasheadtotoetraumaandatriskfordevelopingARDS,whatistheearliest sign?
- Increasedrespiratoryrate WhatisthemostcommonfirstsymptomwithapatientwithaPE?
- Chestpain Painresponseinanunconsciouspatient?(peripheralpainresponse)
- Squeezingthenailbeds
Whataremeasuresforapatientwithaheadinjury,howdowepreventincreaseintrac ranialpressure?
- Decreasestim ulusSlowmov ements Don'tcoughhardorblow noseDeepBreaths Slowexhaletohelpwithpaincontrol
Patienthasclearfluidcomingfromnose,whattestswouldwedoorsee?
- Positiveforglucose Yellowhaloonwhitelinenorfilterpaper Patientwithspinalcordinjury,howtolessenchangeofAD?
- Bowel/BladderProgram PatientwithParkinson's,whenshouldyouscheduletheirmostdemandingactivities ???
- Whenthedrugtherapy/medicationpeaksforthem. Normaldrainageforsurgicalsite?
- Clear(serous)orpale/red/watery(serosanguineous) Worrisomesignofpostoppatient??
- Restlessness
Communitydisasterpreparedness,whatwouldbeanorganizationtohelp?
- MedicalReserveCorporation FEMA RedCross
DMAT??
- DisasterMedicalAssistance TeamFederalemployees LicenseisgoodinALL50states Howmanydaysofmedicalsuppliesshouldyouhaveifneededforadisaster,just makingadisasterplan?
- 3days Cimetidineforburnpatients??Why??
- Helpwithgastriculcers Triagetags...whatwouldweputonthemtohelp??
- Nam eAg eInj ury (Anythingtohelpiden tify)Anytreatments wedid Whowecancontact/whohasbeenconta cted.Triagecolors
Somebodythathasathromboticstroke,whatisimportantassessmentitem,espec iallyinthefirst24hours??
- Pupilresponsetolight/size Someonehadanischemicstrokeandgettingthrombolytictreatment,whatarewetr yingtocontrolinthefirst24hours??
- Bloodpressure HowtodetermineifpatientcanhavetPAafterstrokeAFTERCT??
- Onsetofsymptomswithin3hours. LongtermPhenytointherapy(seizures),whatdoweexpecttosee/asideeffect,but wewouldn'tstopthemedication?(Expectedsideeffect)
- Excessivegumtissuegrowth DONOTSTOPMEDICATIONSUDDENLY
Whatwouldbeapotentialfindinginposticalphaseofageneralizedtonicclonics eizurewhatwewouldwanttomonitorfor??
- Drowsiness Priorityinterventioninposticalphaseoftonicclonicseizure??
- Airway-assessbreathingpattern PrepforanEEG??Theyknowthey'llhaveoneinthemorning,sowhatprepdothe yneedtodoornotdobeforehand??
- Caneat NOCaffeine Whatdoyouexpecttoseeinapatientinictalphaseofgeneralizedtonicclonicseiz ure??
- Jerkin gStiffn ess Loss of consciousnessLosso fbowel/bladder
Whattodowhensomeoneiscomingoutofacoma- hadheadinjuryandthey'restartingtowakeupnowafterafewdays .........................................whatwouldwewanttodo???
- Orientthem Decerebrateassessment
- rigidarms,wrists/handscshaped&flexedo utwardpossiblearchedback PatientisgettingIVheparinforaPE,whatwouldPTTbeatfortherapeuticlevels??
- Higher-->likeifitsat25,wewouldwanttoincreasetherateofheparin
GeneAlterationCYP2C19andhistoryofPE,whattodotopreventfurtherissues?
- IVCF-InferiorVenaCavaFilter MeanArterialPressure,howtocorrelatewithbloodloss??
- Lowerbloodvolume=lowerMAP HowtocalculateMAP??
- Doublethebottomnumberofbloodpressure,addthattothetopnumbe randthendivideby3. Example:BPis120/80, 80+80= 160+120= 280/3=93. MAPwouldbe93. Whattoeducateelderlypatientsonaboutrehydrationtopreventshock??
- Increasefluids,drinkonaregularschedule Whatlabvaluewillbeoffinapatientwithshock,septicshock?
- LacticAcid Whattorememberwhendeterminingtriageorprioritizationofpatients??
- ABCs Sickcallsandtensionwithstaffafteralongweekofcriticalcarepatients,whatisim portanttorememberinthisaspect>>
- Debriefing
Externaldisasterexamples
- Tornad oFloodi ngHurri cane Whenweseeapatientpassedout/unconsciousathome,withcherryredskincolor ,whatdoweassume???
- Carbonmonoxidepoisoning MakesurethatifapatientwedidParklandFormula,andstilllowurineoutput,w hatelsecanwedo??
- Increase fluid rateMonitorurin eoutputCheckel ectrolytes Parklandformula
- 4mLxTBSA(%)xbodyweight(kg).50%giveninfirst8hours,50%givenov erthenext16 hours.
Patientwithaburn,whatelectrolytewouldwetypicallyinitiallyseewith3rdspaci ngoffluid??
- Highpotassium WhatpatientwouldbeathighriskfordevelopingaPE??
- HxofDV TSmoki ng Oralbirthcont rolPregnancy Immobility Majorlongbonefract ureHxoffalls PostOppatients
Howwouldyoudetermineifpatientisreceivinggoodventilation??
- Equalchestri seStable vitalsSkin colorCapilla ryRefill Whattypeofalarmwouldyouhearifpatienthasmucousplugandneedssuctioning??
- Highpressurealarm initialphaseofshock
- MAP decreased by 10 mmHg from baseline. Mild vasoconstriction.Increased heartrate.VitalorganfunctionisNOTdisrupted.Indicatorsofshockarediff iculttodetectatthisstage.THISSTAGEISSTILLREVERSIBLE. Nonprogressivephaseofshock
- MAPdecreasesby10- 15mmHgfrombaseline.Moderatevasoconstriction.Increasedheart rate and decreased pulse pressure. Chemical compensation. Decreased urineoutput,stimulationofthirstreflex,mildacidosis,mildhyperkalemi
a.Tissuehypoxiaoccurs in nonvital organs and in the kidneys but is not great enough to causepermanent damage. Restlessness, tachycardia, increased respiratory rate, fallingsystolic blood pressure, narrowing pulse pressure, cool extremities, and a 2%- 5%changeinoxygensaturation.THISSTAGEISSTILLREVERSIBLE. Progressivephaseofshock
- Decrease of more than 20% MAP. Anoxia of nonvital organs, hypoxia of vital organs.Moderateacidosis,moderatehyperkalemia,tissueischemia.So metissuesdie.Patientmay have a sense of impending doom or "something bad". Patient may becomeconfused and thirst increases. Rapid weak pulse, low blood pressure, pallor tocyanosis of oral mucosa and nail beds, cool and moist skin, anuria, and 5%-20%decreaseinoxygensaturation.
Refractoryphaseofshock
- FINALPHASE Final stage and also irreversible stage.Occurs when too much cell death and tissuedamage has happened. Vital organs have extensive damage and cannot respondeffectivelytointerventions,soshockcontinues.Severetissuehy poxiawithischemiaandnecrosis.Buildupoftoxicmetabolites.MODS. Death. ClearlyifpatientispresentingtoERwithheatexhaustion,whatisthepriorityacti onofthenurse?
- IVFluids Actionispatienthasbeesting..ifavailable?
- Epi WhenpatientpresentstoERwithsuspicionofsepsis,whattodointhefirstfewhou rs??
- Lactic acidBloodc ultures AntibioticsAFTERbloodcultures
HowtocalculateTBSA?
- A&Phead:each4.5%(9%entire head)A&Pchest:18%each A&Parm:4.5%eachsideoneacharm(9%entiree acharm)A&P leg: 9% each side, each leg. (18% entire each leg)Groin:1% Deeppartialthicknessburns
- Red to whiteModera teEdemaYesp ain Blistersarerate Yeseschar(itssoftand dry)Healingtimeis2- 6weeks Graftscanbeusedinprolongedhealingtime Whathappenstoapatientthathasdrowned?
- Alveoliarecollapsing,andpulmonaryedemaoccurs
Whatkindofscenarioswouldweseehospitaldisasterplanactivated??
- Largeinfluxofpatie ntsExample:explo sion WellnessfornursestopreventburnoutandPTSD
- Counseling Encourage & Support coworkersMonitoreachot her'sstresslevelsTakebrea kswhenneeded Talk about feelingsDrinkple ntyofwater Healthysnacksforenergy Keepintouchwithfamily,friends andSODonotworkmorethan12h ours Howdowetreatfrostbite?
- rapidrewarming:bathwithwarmwater,painmanagement
Whataresomeconcernswithfrostbite?
- Edemaandswelling-->elevationabovelevelofheart. Patienthasoverheated,hottotouch,flushedfaceandpassedoutatasportingevent.( HeatStroke).Whatdowedo?
- Getoutofthesun,hydration(sips),coolthemdown- getclotheswet.Thepriorityistogetthemoutofthesunandintothesh adeandcoolthemdown! Withoverheating/heatstroke,dowewanttocauseshivering??Whyorwhynot?
- No!Shiveringisthebody'swasofwarmingthebody.
What othersymptoms(objective findings) would yousee in apatient that overheated/heatstroke?
- Sweatinglighthead ed/dizzyconfusion/ hallucinations elevatedheartrate(couldbeirregular)el evatedbloodpressure decreasedurineoutput Comeuponacarcrashwithmultiplevictims,whatispriority/whatpatientisatbiggest risk?
- Airway/breathingissuefirst Termforinitialsurveillanceofinjury
- triage HowtoteachCNAeasiestwaytocooldownapatient?
- Removeclothing&blankets Frostbite2nddegree
- largeclear-to- milkyfluidfilledblistersdevelopwithpartialthicknessskinnecrosis. Rednessandblistersfilledwithfluid Inapatientwithhypothermiawhatareweconcernedaboutwiththeheart?and whydowemonitortheheart?
- Towatchforseriousarrhythmias Whatcausesseriousarrhythmiasinpatientswithhypothermia??
- Bloodpoolingintheextremities,bloodisshuntedfromgettingtot heheart.Therefore,lacticacidlabwillbeabnormal.Thiswillcau sethearrhythmias.
WhatwillweHEARwithapneumothorax?Expectedfinding
- Diminishedbreathsounds Whatdoyouseewithaflailchest?Themostdistinctivesign??
- Paradoxicalchestmovements Whatistheinitialreactionforalow-pressurealarm,whatwouldyoucheckfirst??
- lowpressurealarm=notgettingenoughoxygen.Bagthepatientmanually . Highpressurealarm,absentbreathsoundsinrightupperchest....... ...................................................................................whatisitlikelytobe??
- Pneumothorax Howtoknowifspinalshockisstillcontinuinginaspinalcordinjurypatient?
- Absent/decreasedreflexes **Protectthehead! Patientishavingaseizure,whatwouldyoudo?
- Left sideLa yflat loosen clothingpadd ed side railsprotect headsuctionat bedsideSAFET Y! Patienthadastrokeandhavinghomonymoushemianopsiaafter,howdowehelpthe m?
- Checkallfields(turnheadsidetoside) MyastheniaGravis:howdowepreventchlorogeniccrisis?
- Medicationregimen Parkinson's:howtohelpmaintainmobility??
- encouragemobility
Bradykinesia(SlowMovement)
- rockingbackandforthtogetuphelpswiththis GillianBarreSyndrome:whatwouldbesomethingthatcouldhavehappenedinthe recenthistorythatyouwouldwanttoaskthathappened??
- Infections/Virusinthelastmonth WhatcanyoudoforaGillianBarreSyndromepatient??
- Activelisteni ngSupportSy stem Encourage/PositiveFeedback HowdoesparalysisoccurwithGillianBarreSyndrome??
- Ascendin g(bottom up) Firstsignsofmeningitis?
- Positive Kernig