Trauma Under Pressure
A trauma patient has BP 88/54, HR 124, cool skin, and increasing restlessness. Which finding best indicates worsening organ perfusion?
What is increasing restlessness/altered mental status?
A patient with persistent diarrhea should generally receive a diet lower in this nutrient to decrease stool frequency and volume.
What is fiber?
A dying patient receiving comfort care becomes increasingly dyspneic and anxious. What should the nurse prioritize?
What is relief of dyspnea, anxiety, and suffering?
Four patients require assessment. One reports incisional pain 7/10, one has HR 104 after ambulation, one has urine output 45 mL/hr, and one has new confusion and difficulty following commands. Who should the nurse see first?
Who is the patient with new confusion?
A patient has MAP 58, CVP 3, and low urine output. Which hemodynamic problem should the nurse address first?
What is decreased preload/intravascular volume?
A trauma patient arrives with clothing soaked in blood from a leg wound. What action takes priority while circulation is assessed?
What is applying direct pressure to control the hemorrhage?
A patient with chronic constipation asks what dietary change may improve bowel function. Increasing this nutrient adds stool bulk and stimulates peristalsis.
What is fiber?
A patient with decision-making capacity refuses continued aggressive treatment, but the healthcare proxy demands it continue. Whose decision guides care?
What is the patient's decision?
One patient has AF with HR 118 and BP 124/72. Another has occasional PVCs with K 4.0. A third has HR 52 while sleeping. The fourth has HR 38, BP 84/46, dizziness, and weakness. Who should the nurse see first?
Who is the patient with symptomatic bradycardia and hypotension?
A hypotensive trauma patient has low preload and low cardiac output following hemorrhage. This initial treatment is expected to improve ventricular filling.
What is volume/fluid resuscitation?
After initial trauma interventions, which finding best demonstrates that circulation is improving: HR 108, BP 104/64, urine output 40 mL/hr, or cool extremities?
What is urine output of 40 mL/hr?
A patient develops dumping syndrome after gastric surgery. Name TWO dietary changes that should be included in the teaching plan.
What are any two of the following?
A ventilated patient has a directive declining prolonged life support. The family asks that “everything” continue despite no expected recovery. What should guide the plan of care?
What are the patient's previously expressed wishes/advance directive?
One patient receiving norepinephrine has MAP 68 and cool extremities. Another receiving dobutamine has HR 108 and BP 102/64. A third receiving norepinephrine through a peripheral IV develops burning, swelling, and blanching at the site. Who should the nurse see first?
Who is the patient with suspected norepinephrine extravasation?
A patient with K 2.9 develops frequent PVCs followed by three consecutive wide-complex beats. How should the nurse interpret the rhythm change?
What is progression to nonsustained ventricular tachycardia?
A trauma patient becomes increasingly agitated. SpO₂ is 96%, BP 118/70, and glucose is normal. What assessment should the nurse prioritize next?
What is a neurologic assessment/GCS?
A patient with severe burns develops significant weight loss despite receiving what would normally be an adequate calorie intake. This metabolic state following major injury increases the patient’s energy and nutritional requirements.
What is a hypermetabolic/catabolic state?
Before withdrawal of mechanical ventilation, the family worries that morphine will hasten death. What is the appropriate purpose of the medication?
What is relief of pain, dyspnea, and suffering?
Four patients require assessment: a tube-fed patient coughing with SpO₂ 86%, a trauma patient with leg pain rated 9/10, a TPN patient with glucose 220 mg/dL, and an EOL patient reporting dry mouth. This patient is the priority.
Who is the tube-fed patient who is coughing with an SpO₂ of 86%?
A patient in cardiogenic shock has adequate BP but low cardiac output and poor contractility. Which ICU medication best addresses the underlying hemodynamic problem?
What is dobutamine?
A trauma patient has received fluids and blood. BP improves from 78/42 to 106/64, but HR remains 126 and urine output is 15 mL/hr. How should the nurse interpret the response?
What is inadequate resuscitation/persistent impaired perfusion?
A malnourished patient beginning nutritional support develops new heart failure and neurologic changes. In addition to closely monitoring electrolytes, the nurse should ensure supplementation of this vitamin emphasized in prevention of refeeding complications.
What is thiamine?
After life-sustaining therapies are withdrawn, a patient becomes hypotensive and unresponsive. The family asks the nurse to restart the vasopressor. What should the nurse do?
What is continue comfort-focused care consistent with the established goals of care?
One patient has MAP 64, UOP 35 mL/hr, and is alert. A second has MAP 72 but UOP has fallen to 15 mL/hr and the patient is increasingly confused. A third has HR 128 after reporting severe pain. A fourth has BP 94/58 but is alert with UOP 40 mL/hr. Who should the nurse see first?
Who is the patient with decreasing urine output and increasing confusion despite a MAP of 72?
A patient with a pulse develops a wide-complex tachycardia at 180/min, BP 76/40, chest pain, and confusion. What treatment should occur rather than giving another medication first?
What is immediate synchronized cardioversion?