Sharp Grossmont ESO | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+), Exams of Nursing

Download Sharp Grossmont ESO | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+) and more Exams Nursing in PDF only on Docsity! Sharp Grossmont ESO | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+) What is an emergency standing order - ✔✔ESO are initiated for life threatening patient conditions in the absence of a physician. What must you document when you institute an ESO - ✔✔MD communication, life threatening condition, ESO implemented, Patient response, when/which md was notified what type of documents do you need to complete when implenting an ESO - ✔✔Interdisciplinary note, provider communication, code blue record, RRT note (by RRT) CPR with an airway - ✔✔100-120/min, o2 delivered by 15 L bag mask (10 breaths/min) CPR no airway - ✔✔30 compressions/2 breaths target temperature management - ✔✔should be considered for patients not FSC or showing purposeful movement in 120 minutes after ROSC If IV access unavailable, what is the dose you administer meds at via ETT - ✔✔atropine, narcon, and epi at 2-2.5 x the IV dose Define unstable condition - ✔✔serious signs and conditions related to life threatening rhythm or condition unstable signs - ✔✔tachypnea, respiratory distress, tachycardia, bradycardia, arrhythmias, LOC, decreased o2, hypotension, increased ICP, status epilepticus, apnea unstable symptoms - ✔✔dizziness, lightheadedness, chest pain, SOB, weakness, cold, diaphoretic, palpitations, anxious what is asystole - ✔✔absence of ventricular activity and contraction, no pulse asystole treatment - ✔✔CPR 100-120 (2 min) o2 15L/min via ambu bag (10 breaths/min) epi at 1 mg ivp/io (epi .1mg/ml) repeat every 3-5 minutes repeat CPR/EPI of no signs of ROSC transcutaneous pacing NOT recommended define bradycardia - ✔✔HR less than 50 beats per min. too slow to maintain adequate BP. define first degree AV block - ✔✔delay of impulse from atria to ventricles. characterized by long PR .20 seconds that is CONSTANT second degree av block, type 1 (wenckebach) - ✔✔progressive lengthen of PR interval until p wave not conducted. 3 conductive p waves with progressively lengthening PR intervals and 4th p wave not followed by QRS define second degree av block type 2 - ✔✔constant lengthened PR intervals in conducted beats with one non-conducted p wave. when associated with MI, carries risk of progressing to complete heart block define third degree AV block - ✔✔absence of conduction between atria and ventricles. no consistent PR intervals. atria and ventricles are depolarized from different pacemakers unstable bradycardia treatment - ✔✔1. o2 at min 10L/min nonrebreather mask 2. if transverse or epicardial pacing wires present connect to pulse generator and initiate pacing 9. defib 200 joules 10. resume CPR immediately for 2 minutes 11. EPI 1 mg iv/io 12. defibrillator biphasic 200 13. amio 150 mg iv/io 14. resume CPR for 2 minutes 15. if rhythm persists, repeat, and continue alternating CPR/epi/defib what is chest pain - ✔✔most common presentation of ACS (e.g. unstable angina, non-q wave MI, q-wave MI); described as uncomfortable pressure, fullness, squeezing, pain in center of the chest lasting several minutes, pain spreading to shoulders/neck/arms/jaw chest discomfort with lightheadedness. fainting, sweating, nausea, or shortness of breath, impending doom chest pain treatment - ✔✔1. o2 at 4 LNC to have spo2 >94% 2. NTG .4 mg SL if SBP >90 or MAP >60 mmHG and HR > 50 BPM. may repeat x2 every 3-5 minutes 3. morphine 2 mg ivp/io q5 min up to total of 10 mg if SBP >90 4. aspirin 325 mg if not contraindicated and no dose given on this date 5. hypotension occurs and no CHF, give 250 NS bolus 6. 12 lead EKG - if ST segment is > 2 mm in 2 leads or has new onset of BBB it is suggestive of stemi goal for PCI with MI - ✔✔PCI or thrombolytics in <90 minutes symptomatic hypotension - ✔✔SBP <90. clincial signs: clammy skin, cool, oliguria, increased HR, impaired sensorium if hypotension is associated with arryhthmia, treat the rhythm! hypotension post anesthesia is tx with fluid replacement and ephedrine treat symptomatic hypotension - ✔✔1. o2 min 10 L/min NRBM 2. if hypovolemia is suspected infuse 250ml/NS. repeat in 5. can use LR if running. 3. if SBP <90, start dopamine 400 mg/250 at 5 mcg/kg/min. Titrate to max of 20 mcg to achieve of SBP >90/MAP 60 mmhg. 4. if obvious blood loss draw stat H&H and type and cross for 2 units PRBCs. 5. if sepsis is suspected follow sepsis algorithm. for PACU patients hypotension - ✔✔1. o2 at 10 L/min NRBM 2. infuse 250 ml NS, repeat in 5 min. 3. if bolus is ineffective administer ephedrine 5 mg ivp/io 4. if no improvement within 3 minutes, repeat at 10 mg ivp/io 5. in presence of blood loss draw stat h/h, type and cross 2 units hypoglycemia - ✔✔serum glucose or finger stick <70 or <60 if pregnant Intracranial Pressure - ✔✔first sign of ICP is decreased LOC, later signs are hemiparesis, decorticate/decerebate posturing, signs of herniation (unilateral or bilateral fixed/dilated pupils). Increased ICP >15 mmhg. normal is 7-15 mmhg increased ICP treatment - ✔✔HOB 30 degrees or more if pt not hypotensive, place head midline to prevent obstruction of venous outflow hyperventilate intubated patients with 100% fio2 to maintain pco2 26-30 (this causes vasoconstriction and decreases blood in cranium which lowers ICP) draw baseline K, NA, bun, Cr, BMP, serum osmo, ABG What is respiratory depression - ✔✔associated with narcotic or benzo, RR <10, elevated ETCO2. treatment for narcotic associated respiratory depression - ✔✔o2 at 10 L/min NRBM narcan - apnea: 0.4 mg ivp/io ONCE ; RR <10 .1mg iv/io q1 repeat x3, max of .4 mg treatment for benzo associated resp depression - ✔✔o2 at 10 L/min NRBM romazicon/flumazenil for apnea to RR <10 (max 0.6 mg): 0.2 mg IVP/IO over 15 seconds q45 seconds based on patient respose, not more than .6 mg. consider capnography monitoring define respiratory distress - ✔✔demonstrated by a change in respiratory rate/use of accessory muscles/ALOC/cyanotic nail beds can be caused by pulmonary disorders like bronchospasm, cardiogenic or noncardiogenic pulmonary edema, parenchymal infiltrates, pneumo or hemothorax, atelectasis. treatment for respiratory distress - ✔✔o2 at 10 L/min NRBM stat cxr bronchospasm - albuterol 0.5. ml in 3 ml NS aerosol ABG/VBG RRT RN can initiate NIV for exac of COPD, asthma, CHF contraindications for noninvasive ventilation - ✔✔respiratory arrest, inability to maintain patent airway/clear secretions, risk of aspiration gastric contents, preexisting pneumo, epitaxis, facial/oral trauma, AMS, hypotension status epilepticus - ✔✔associated with generalized tonic clonic seizures lasting >3 min or recurrent seizures without return of consciousness