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

Download Sharp Memorial ESO Exam | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+ and more Exams Nursing in PDF only on Docsity! Sharp Memorial ESO Exam | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+) Asystole - ✔✔1. CPR (2 mins) 2. O2 at 15 L/min ambu bag 3. Epinephrine 1 mg IVP/IO (Use Epinephrine 0.1 mg/1ml) Repeat 3-5 mins Bradycardia - Unstable - ✔✔1. O2 at minimum 10 L/min NRBM 2. If transvenous leads or epicardial pacing wires present, connect to a pulse generator and initiate pacing per protocol. 3. Atropine 0.5 mg IVP/IO, repeat q3-5 minutes (max 3mg) 4. Transcutaneous pacing as soon as available. 5. If above algorithm is ineffective, start Dopamine 400 mg/250ml D5W infusion at 5 mcg/kg/min. Titrate to patient response up to 20 mcg/kg/min. 6. If above algorithm is ineffective, start epinephrine 2 mg/250mL NS at 2 mcg/min, titrate to patient response up to 10 mcg/min. (Note: Assess patient for adequate intravascular volume and volume status when using vasoconstrictors) Pulseless Electrical Activities (PEA) - ✔✔1. CPR (2 min) and assess for possible causes*. 2. O2 at 15 L/min ambu bag 3. Epinephrine 1 mg IVP/IO (use 0.1mg/ml), repeat q 3-5 minutes. 4. If hypovolemia known or suspected, infuse 250 mL NS (may be substitute with LR if currently infusing). Repeat in 5 minutes if no clinical improvement. 5. Stat CXR. Possible Cause of PEA - ✔✔1. Hypovolemia 2. Hypoxia 3. Hydrogen ion (Acid) 4. Hypo/Hyperkalemia 5. Hypoglycemia 6. Hypothermia 7. Tamponade 8. Toxins 9. Thrombosis 10. Trauma 11. Tension Pneumothorax Ventricular Tachycardia: Stable - ✔✔1. Call the physician for orders 2. O2 at minimum 4L/min NC and adjust per patient status 3. Obtain 12 lead EKG 4. Draw serum K and Mag ** Administer Amio 150mg SLOW PIVvover 10 mins. **Consider Adenosine (only if regular and monomorphic) Ventricular Tachycardia: Unstabel - ✔✔1. O2 at minimum 10 L/min NRBM 2. If ventricular rate greater than 150, Biphasic, synchronized cardioversion per approved energy dose listed on defibrillator. 3. If patient is awake and responsive, give midazolam (Versed) 0.5 mg IVP/IO prior to cardioversion. May report to a total of 1mg to achieve sedation. 4. Draw serum K and Mag Reverse agent for Midazolam - ✔✔Romazicon. If patient has signs and symptoms of oversedation (e.g. decreased level of consciousness, respiratory rate less than 10 breaths/ min), Romazicon 0.2 mg IVP/IO, over 15 second. May repeat in 45 seconds based on patient's response, not to exceed 0.6 mg Unstable signs - ✔✔1. Hypotension 2. Tachycardia 3. Bradycardia 4. Arrhythmia Increased Intracranial Pressure - ✔✔In the neurologically impaired patient with dilated pupil associated with other signs of impending herniation (Note: implement only in the absence of specific ICP order) 1. Raise HOB to at least 30 degrees if patient is not hypotensive; place patient's head in midline position. 2. Hyperventilate the intubated patient with FiO2 100% to maintain pCO2 30-35 mmHg 3. Mannitol 20% (100gm/500mL) rapid IVP/IO using a filter (if filter is readily available) 4. Draw baseline serum K, Na, BUN, Cr, Glucose, and ABG. 5. Insert urinary catheter. Respiratory Depression: associated with prior narcotic or benzodiazepine administration - ✔✔1. O2 at minimum 10L/min NRBM 2. Narcotic-associated respiratory depression Administer Naloxone (Narcan) as follow (maximum dose of 0.4 mg): A: Apnea: 0.4 mg IVP/IO once B: RR less than 10: 0.1mg IVP/IO every 1 minute, may repeat x3 3. For benzodiazepine-associated respiratory depression (apnea to RR less than 10), administer flumazenil (Romazicon) 0.2 mg IVP/IO over 15 seconds. May repeat in 45 seconds based on patient's response, not to exceed 0.6 mg. Respiratory Distress: Demonstrated by change in RR and/or use of accessory muscles, altered level of consciousness or cyanotic nail beds - ✔✔1. O2 at minimum 10 L/min NRBM 2. STAT portable CXR 3. In the presence of bronchospasm: Albuterol 0.5 mL in 3 mL NS aerosol inhalation 4. The Rapid Response Team may obtain an ABG 5. The RRT may initiate non-invasive ventilation (NIV) for the following conditions in the absence of any contraindications. A: Exacerbation of COPD, asthma, acute CHF B: As a bridge to mechanical ventilation C: Contraindications for NIV i: Respiratory arrest II: Inability to maintain a patent airway or clear secretions iii: Risk for aspiration of gastric contents (nausea, vomiting or bowel obstruction) vi: Pre-existing pneumothorax without chest tube or pneumomdiastinum v: Epistaxis vi: Recent facial, oral or skull surgery or trauma vii: Encephalopathy/altered mental status viii: Hypotension due to suspected intravascular volume depletion ix: Unable to tolerate BIPAP Status Epilepticus (generalized tonic-clonic movements lasting more than 3 minutes or recurrent seizures without return of consciousness) - ✔✔1. Protect airway, position patient in lateral decubitus position, protect patient from injury 2. O2 at minimum 10 L/min NRBM 3. Lorazepam (Ativan) 2 mg IVP/IO over 1 minute 4. Draw Na, K, glucose, BUN, Cr, and anticonvulsant levels if appropriate. Severe Anaphylaxis: (strider, wheezing, respiratory distress, pallor, cyanosis, or clinical signs of shock) - ✔✔1. O2 at minimum of 10 L/min NRBM 2. Epinephrine 0.3 mg IM (use epinephrine 1 mg/ml). Repeat in 5 minutes if no clinical improvement. 3. If no response and patient still showing signs of shock, give epinephrine 0.1 mg IV/IO (use epinephrine 0.1 mg/ml) SLOWLY over 5 minutes. 4. (Hydrocortisone) Solucortef 100 mg IVP/IO 5. Diphenhydramine (Benadryl) 25 mg IVP/IO 6. Infuse 250 mL NS. Repeat in 5 minutes if no clinical improvement. Suspected Sepsis Algorithm - ✔✔1. If hypovolemia known or suspected, infuse 250 mL NS. Repeat in 5 minutes after infusing is completed if not improvement. 2. Evaluate if patient meets at least 2 SIRS criteria: a. WCB count greater than 12,000 or less than 4,000 or greater than 10 % bands b. Heart rate greater than 90 bmp c. Respiratory rate greater than 20 per minutes d. Temperature greater than 38.3 C or less than 36 C 3. If patient meets two SIRS criteria, assess for infection (confirmed or suspected) and organ dysfunction (any one of the below criteria) a. SBP less than 90, MAP less than 65, or decrease in SBP greater than 40 mmHg b. Lactate greater than 2 c. Creatinine greater tah 2 or UOP less than 0.5 mL/kg/hr d. Bili greater than 2 e. Platelet less than 100,000 f. INR greater than 1.5, aPTT greater than 60 sec g. New onset of respiratory failure requiring BIPAP or intubation 4. If criteria in #3 met: a. Obtain serum lactate (if not done within 6 hours; repeat in 4 hours if initial level greater than 2. RRT may order a POC lactate. b. Obtain blood culture x2 c. Consult RRT and consult MD.