Sharp ESO 2024 Exam Preparation | Actual Questions and Answers Latest Updated 2024/2025 (, Exams of Nursing

Download Sharp ESO 2024 Exam Preparation | Actual Questions and Answers Latest Updated 2024/2025 ( and more Exams Nursing in PDF only on Docsity! Sharp ESO 2024 Exam Preparation | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+) Nurse initiating ESO will document - ✔✔1. Life threatening condition 2. Precipitating factors 3. Specific ESO implemented 4. Patient response 5. When and which physician was notified ESO are initiated: - ✔✔For life-threatening patient conditions in the absence of the physician or specific orders Adequate CPR - ✔✔1. Push hard 2. Full chest recoil 3. Minimize interruptions 4. 100-120 compressions/min 5. 15 L O2 by bag mask (10 breaths per min) 6. 30:2 ETCO2 monitoring - ✔✔Use to assess quality of CPR and evaluate return of rosc How many breaths with advanced airway? - ✔✔1 breath every 6 seconds Targeted temperature management - ✔✔Should be used on all patients not following commands or purposeful movement within 120 mins after ROSC What is a rapid bolus? - ✔✔Fluids administered in 5-15 mins Non invasive cardiac monitoring - ✔✔Device that uses bioreactane to determine cardiac output and is implemented where available by RRT or ICU RN to determine fluid responsiveness and guide fluid resuscitation Passive leg raise - ✔✔Position patient flat on their back, and their legs are elevated to 45 degrees. These interventions are instituted for all emergency situations outlined in the ESO Standardized Procedure: - ✔✔1. Obtain intravenous (IV)/intraosseous (IO) access 2. Begin IV infusion of normal saline (NS) at keep vein open (KVO). If IV access is unavailable: Lidocaine, Epinephrine, Atropine, and Naloxone (Narcan) may be administered via endotracheal route at doses of 2-2 1/2 times the IV dose. 3. If IV access is unavailable, Naloxone (Narcan) may be administered IM at the same dose as IV administration 4. Flush the IV line with 20mL of NS after each IV medication given and elevate the extremity if applicable. 5. In applicable situations, obtain oxygen (O2) saturation 6.Monitor and document ETCO2 for code blue events. 7. Titrate oxygen to patients' response. Signs (objective): - ✔✔Tachypnea, apnea, respiratory depression, tachycardia, bradycardia, arrhythmias, hypotension, decreased O2 saturation, dyspnea, change in level of consciousness, increased intracranial pressure (ICP), status epilepticus Symptoms (subjective) - ✔✔Dizziness, lightheadedness, chest pain, shortness of breath (SOB), chest pain, weakness, cold, diaphoresis, heart palpitations, anxiousness What is Ventricular Fibrillation (VF)? - ✔✔VF is characterized by disorganized ventricular depolarization that is irregular and unable to generate any cardiac output. It can be coarse or fine. What is the difference between coarse VF and fine VF? - ✔✔Coarse VF usually indicates a recent onset of VF that may be corrected with immediate defibrillation, while fine VF indicates a more prolonged VF that is approaching asystole. How should Ventricular Fibrillation/Pulseless Ventricular Tachycardia be treated? - ✔✔1. CPR 2. Giving medications during CPR, 3. Immediate defibrillation if witnessed arrest and defibrillator is available 4. Administering O2 5. Defibrillating with specific joules 6. Giving medications like Epinephrine and Amiodarone. What are the common presentations of an acute coronary syndrome? - ✔✔Chest pain is the most common presentation of an acute coronary syndrome, including unstable angina, non Q wave MI, and Q-wave MI. How is chest pain suggestive of ischemia described? - ✔✔Chest pain suggestive of ischemia may be described as uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting several minutes, pain spreading to the shoulders, neck, arms, jaw, or back, chest discomfort with light- headedness, fainting, sweating, nausea, or shortness of breath, and a global feeling of distress, anxiety, or impending doom. What is the immediate response required when symptoms of myocardial ischemia are present? - ✔✔It is important to respond immediately when symptoms of myocardial ischemia are present. A high priority is to provide pain relief. How should chest pain be treated? - ✔✔1. O2 at a minimum of 4 L/min to maintain SpO2 greater than or equal to 94% 2. nitroglycerin (NTG) 0.4mg sublingual if SBP ≥ 90 and/or MAP ≥ 60 mmHg and HR >50 bpm 3. morphine sulfate 2mg IVP/IO every 5 minutes up to a total of 10mg if SBP ≥ 90 4. aspirin 325 mg What diagnostic tests are recommended for chest pain evaluation? - ✔✔1. 12-lead ECG t 2. Drawing serum CBC, BMP, PT/INR, PTT, and Troponin-HS if not done within 6 hours. Clinical Signs of Hypotension - ✔✔Clinical signs of hypotension include cool, clammy skin, oliguria, increased heart rate, and impaired sensorium. Symptoms of Symptomatic Hypotension - ✔✔Symptomatic hypotension is indicated by unstable symptoms such as decreased level of consciousness and confusion. Treatment of Hypotension - ✔✔Hypotension should be treated based on its cause, such as fluid replacement for hypovolemia and addressing arrhythmias first if present. Management of Post-Anesthesia Hypotension - ✔✔Post-anesthesia hypotension is treated with fluid replacement and Ephedrine. How should symptomatic hypotension be treated if hypovolemia is known or suspected? - ✔✔Infuse 250ml NS rapid bolus. Repeat in 5 minutes if no clinical improvement. What is the next step if SBP is less than 90mmHg after two 250 ml fluid boluses? - ✔✔Start Norepinephrine 4mg/250 mL NS at 2mcg/minute. Titrate until SBP ≥ 90 mmHg and/or MAP ≥ 65 mmHg (max dose 32 mcg/minute). What should be done if obvious blood loss is present? - ✔✔Draw stat hemoglobin and hematocrit (H&H) and type and cross for 2 units PRBC. What is the protocol for treating immediate post-anesthesia patients with persistent hypotension? - ✔✔Administer Ephedrine 5mg IVP/IO. If no improvement within 3 minutes, repeat Ephedrine at 10mg IVP/IO. In the presence of obvious blood loss, draw stat H&H and Type & Cross 2 units PRBCs. What is the first sign of increased intracranial pressure (ICP)? - ✔✔Decreased level of consciousness What are signs of increased ICP that may indicate herniation? - ✔✔Hemiparesis, decorticate or decerebrate posturing, fixed and dilated pupils How is increased ICP defined when being monitored? - ✔✔ICP > 15 mmHg or as specified by the MD How should increased ICP be treated? - ✔✔1. Elevate HOB at least 30° 2. Hyperventilate the intubated patient with 100% FIO2 to maintain PCO2 26-30 mmHg. 3. Draw serum BMP, serum osmolality, and ABG What are the causes of respiratory depression? - ✔✔Respiratory depression may be caused by oversedation secondary to opioids or sedatives. How is respiratory depression demonstrated? - ✔✔Respiratory depression is usually demonstrated by a respiratory rate less than 10/minute and elevated ETCO2. 2. Heart rate > 90 bpm 3. Respiratory rate > 20 per minute 4. Temperature > 38.3 C or < 36C What are the organ dysfunction criteria for suspected sepsis? - ✔✔1. SBP < 90, MAP < 65, or SBP drop > 40 2. Lactate > 2 3. Creatinine > 2.0 or urinary output (UOP) < 0.5 mL/kg/hr 4. T. Bili > 2 5. Platelet < 100,000 6. INR > 1.5, aPTT > 60 sec What actions should be taken if a patient meets sepsis criteria? - ✔✔Obtain serum lactate, blood cultures x 2. Rapid Response Team may order a POC lactate. What should be done if Noninvasive Cardiac Output Monitoring (NICOM) is available in suspected sepsis? - ✔✔1. RRT or ICU RN to obtain, document, and communicate baseline and post bolus measurements to include cardiac output (CO), stroke volume (SV), and stroke volume index (SVI) 2. RRT or ICU RN to perform a Passive Leg Raise (PLR) maneuver to determine fluid responsiveness. If patient has SVI change of 10% or greater, rapid bolus 500 mL of NS/LR x 1 IV/IO and reassess SVI using PLR on bolus completion. Further boluses will require a provider order in the absence of departmental specific protocol 3. If SBP remains < 90 mmHg or MAP remains < 65 mmHg after completion of boluses, RRT or ICU RN will start Norepinephrine 4 mg/250 mL at 2 mcg/minute and titrate until SBP≥90 mmHg and MAP≥65 mmHg, up to 32 mcg/minute If NICOM unavailable: - ✔✔1. Administer LR or NS fluid bolus of 30 mL/kg at 126 mL/hr 2. If SBP remains < 90 mmHg or MAP remains < 65 mmHg, RRT or ICU RN will start Norepinephrine 4 mg/250 mL at 2 mcg/min and titrate until SBP≥ 90 mmHg and MAP≥65 mmHg, up to 32 mcg/minute Amiodarone - ✔✔Antiarrhythmic agent that prolongs refractory period, lengthens cardiac action potential, and causes negative chronotropic effect. Has vasodilator action that decreases cardiac workload and myocardial oxygen consumption VF/Pulseless VT Amiodarone dose - ✔✔300 mg IVP followed by 20 mL NS flush, may repeat with 150 mg IVP if rhythm persists Amiodarone side effects - ✔✔May produce hypotension, bradycardia, exacerbation of arrhythmia, and prolong QT interval Amiodarone use - ✔✔VF/Pulseless VT What is the mechanism of action of Atropine on the sinus node? - ✔✔Enhances sinus node automaticity via direct vagolytic action How does Atropine affect atrioventricular conduction? - ✔✔Enhances atrioventricular conduction via direct vagolytic action What is the initial dose of Atropine for bradycardia? - ✔✔1 mg, may repeat every 3-5 minutes up to 3 mg How should Atropine be administered via endotracheal tube (ETT)? - ✔✔2-2.5 times the IV dose diluted in 10mL normal saline What are potential side effects of Atropine? - ✔✔May cause tachycardia, angina; use cautiously in acute MI or myocardial ischemia Why should Atropine not be given slowly? - ✔✔May cause paradoxical slowing of pulse What receptors does dopamine stimulate? - ✔✔Dopaminergic, B-adrenergic, and alpha adrenergic receptors What effect does dopamine have at low doses? - ✔✔Causes renal, mesenteric, and cerebrovascular dilation What effect does dopamine have at moderate doses? - ✔✔Increased myocardial contractility, cardiac output, and blood pressure What effect does dopamine have at high doses? - ✔✔Peripheral arterial and venous vasoconstriction What is a potential complication of dopamine administration related to the heart? - ✔✔May induce/exacerbate supraventricular and ventricular arrhythmias What complication can occur if dopamine extravasates? - ✔✔Tissue necrosis and sloughing Dopamine dose - ✔✔5-20 mcg/kg/minute, titrate to patient response What are the effects of epinephrine on the cardiovascular system during pulseless arrhythmia? - ✔✔Increases BP, HR, systemic vascular resistance (SVR), automaticity, AV conduction, myocardial contraction, myocardial oxygen requirements (MVO2) 8. EKG tech: Available for 12-lead if needed i 9. Lab tech: Available for lab draws if needed NRBM - ✔✔The NRBM is a mask/reservoir bag system that has an inflatable bag to store 100% oxygen and a one-way valve between the bag and the mask to prevent exhaled air from entering bag. Mask has one-way valves covering one or both of the exhalation ports to prevent entry of room air on inspiration. TCP indication - ✔✔Unstable bradycardia TCP mechanism of action - ✔✔1. The heart is paced through skin electrodes at a current of 40-80 mA 2. TCP is used as a bridge until the underlying cause can be reversed 3. It can also be used on standby in unstable patients 4. Chest compressions can be administered directly over the insulated electrodes while pacing How to use transcutaneous pacing - ✔✔1. Turn TCP unit on. Turn therapy dial to Pacer 2. Use One Step Complete pads or apply radiolucent pads to patient and ensure proper display of patient's rhythm 3. Apply pads to patient 4. Connect pacing cable to pacer electrodes 5. Set rate between to achieve best cardiac output. Remember cardiac output is HR x SV so increase up to 90 beats per minute to achieve adequate perfusion (unless otherwise ordered) 6. Initiate pacing by increasing current (mA) until consistent capture achieved 7. Identify and troubleshoot failure to pace and failure to capture. TCP current (mA) - ✔✔1. mAs start on zero (0), increase current by turning or turning output control button until consistent capture is achieved - a pacer spike followed by a QRS complex 2. Determine Stimulation Threshold: the minimum amount of mAs required to elicit consistent capture a. Obtain consistent capture by increasing current (mAs) and observing monitor for evidence of capture (stimulation threshold) 3. Increase mAs until 10% above stimulation threshold 4. Check patient's pulse and vital signs for adequate perfusion Invasive temporary pacing indication - ✔✔Unstable Bradycardia . Invasive Temporary Pacing - ✔✔1. If transvenous leads or epicardial wires are present, connect to a generator and initiate emergency invasive pacing 2. Default values for emergency pacing on the Medtronic 5392: mode-DOO, rate-80, A Output-20, V Output 25, AV Interval-170ms 3. If competition occurs or anticipated, change mode to demand by pressing 'on'. It is appropriate to initiate drug therapy and pacing simultaneously to stabilize the patient as quickly as possible Epinephrine - Bradycardia - Unstable (Main actions) - ✔✔Increases BP, HR, systemic vascular resistance (SVR), automaticity, AV conduction, myocardial contraction, myocardial oxygen requirements (MVO2) Epinephrine - Bradycardia - Unstable (Dose/admin) - ✔✔Epinephrine 2 mg/250 mL NS at 2 mcg/min, titrate to patient response up to 10 mcg/minute Epinephrine - Bradycardia - Unstable (considerations) - ✔✔May induce or exacerbate ventricular ectopy Famotidine - ✔✔- H2 blocker -ESO: Severe ansphylaxis Dose: 20mg IVP Flumazenil (Romazicon) MOA - ✔✔Benzodiazepine antagonist. Used for resp depression Flumazenil (Romazicon) dose - ✔✔Apnea to RR <10: 0.2mg IVP/IO over 15 seconds; may repeat every 45 seconds (not to exceed 0.6 mg) Flumazenil (Romazicon) consideration - ✔✔Associated with occurrence of seizures and dysrhythmias. Can cause pain on injection. If both an opioid and benzodiazepine have been administered and the patient develops respiratory depression, treat with Naloxone (Narcan) first. May precipitate seizures in patients with chronic benzodiazepine use Hydrocortisone (Solucortef) MOA - ✔✔A naturally occurring glucocorticoid, has antiinflammatory, antipruritic, vasoconstrictive effects Hydrocortisone (Solucortef) dose - ✔✔100 mg IVP/IO Hydrocortisone (Solucortef) consideration - ✔✔May cause an increase in intracranial pressure and hypertension Lidocaine MOA - ✔✔Decreases the permeability of the neuron membrane to sodium, which causes inhibition of depolarization, resulting in blocked conduction Lidocaine ESO use - ✔✔Refractory Pulseless VF, Pulseless VT Changes from 2021-23 ESO Unstable VT Algorithm: - ✔✔1. Clarification of number and frequency of cardioversion attempts 2. 12 Lead ECG added to algorithm Changes from 2021-23 ESO Ventricular Fibrillation Algorithm: - ✔✔i. Clarification of "per approved energy dose" to 200 joules ii. Separation of CPR cycles and Epinephrine/Amiodarone doses iii. Addition of Lidocaine 1 mg/kg for refractory Ventricular Fibrillation/Pulseless Ventricular Tachycardia Changes from 2021-23 ESO Chest Pain Algorithm: - ✔✔i. Addition of labs: CBC, BMP, PT/INR, PTT, Troponin-HS if not done within 6 hours Changes from 2021-23 ESO Hypotension-Symptomatic Algorithm: - ✔✔. NORepinephrine added for vasopressor if bolus ineffective, dopamine removed Changes from 2021-23 ESO Increase Intracranial Pressure Algorithm: - ✔✔Labs: K+, Na+, BUN, Cr, Glucose labs condensed to BMP Changes from 2021-23 ESO Respiratory Depression Algorithm: - ✔✔i. If patient is apneic, administration of oxygen by ambu bag added ii. Narcan repeat doses and IM route of administration added iii. Direction to treat with Naloxone first in cases of suspected combined opioid and benzodiazepine associated respiratory depression/arrest iv. Note of potential harm from Flumazenil in patients at risk for seizures or dysrhythmias v. End Tidal CO2 monitoring added vi. Note to call a Code Blue for life-threatening respiratory arrest Changes from 2021-23 ESO Respiratory Distress Algorithm: - ✔✔i. Suctioning added Changes from 2021-23 ESO Status Epilepticus Algorithm - ✔✔i. Name changes from "Status Epilepticus" to "Prolonged Seizures" ii. Repeat dose of Ativan added iii. Labs: Na+, K+, Ca, Glucose, BUN, Cr labs simplified to BMP Changes from 2021-23 ESO Anaphylaxis Algorithm: - ✔✔Epinephrine 0.1 IV mg removed Changes from 2021-23 ESO Suspected Sepsis Algorithm: - ✔✔i. Noninvasive Cardiac Output Monitoring (NICOM) added where available ii. If indicated by NICOM, ICU/RRT RN may administer a 500 mL bolus of LR. No change to fluid administration if NICOM unavailable