Critical Care Review!!!!

Trauma

300

The nurse has just admitted to the nursing unit a patient with a basilar skill fracture who is at risk for increased ICP. Which of the following positions could the nurse safely place the patient. (Select all that apply) 1. Head midline 2. Neck in neutral position 3. HOB elevated 30-45* 4. Head turned to the side when flat in bed 5. Neck and jaw flexed forward when opening the mouth

What is 1, 2, 3 The head should be placed in a neutral, midline position and the HOB raised 30-45 degrees to promote venous drainage

400

The nurse reviews the arterial blood gas results of an assigned patient: pH 7.30 PCO2 58mmHg PO2 80 mHg HCO3 27 mEq/L What can these results be interpreted as?

What is Respiratory Acidosis In Respiratory Acidosis, the pH is low and the PCO2 is elevated.

ICU

100

You are assessing a patient with multiple trauma who is at risk for developing acute respiratory distress syndrome. Which of the following is the earliest sign? A. Bilateral Wheezing B. Inspiratory Crackles C. Intercostal Retractions D. Increased Respiratory Rate

What is D (increased respiratory rate) The first sign is increased respiratory rate, followed by increasing dyspnea, air hunger, retractions, and cyanosis. Breath sounds may or may not be clear.

200

The HCP prescribes 2000 mL of 5% dextrose and 1/2 NS to infuse over 24 hours. The drop factor is 15 drops (gtt)/1ml. The nurse should set the flow rate to how many drops per minute?

What is 21 gtt/min (total volume prescribed X drop factor) / (time in minutes) (2000 mL X 15 gtt/mL)/1440 mins

CCU

100

3. The client is in the cardiac intensive care unit on dopamine, a vasoconstrictor, and BP increases to 210/130. Which intervention should the intensive care nurse implement first? A. Discontinue the client’s vasoconstrictor, dopamine B. Notify the client’s health care provider C. Administer the vasopressor hydralazine D. Assess the client’s neurological status

What is A

200

A positive synthetic sympathomimetic inotrope that increases myocardial contractility and stroke volume, thus increasing cardiac output; decreases afterload and preload; decrease pulmonary artery occlusion pressure; and is typically used for pulmonary congestion, a left ventricular dysfunction, a right ventricular infarct and/or septic shock.

What is DOBUTAMINE

300

Anti-arrhythmic the prolongs the myocardial cell potential duration and refractory period; decreases the SA node and AV node conduction; typically used on patients experiencing ventricular tachycardia, ventricular fibrillation. Side effects are: hypotension, nausea, fever, bradycardia.

What is AMIODARONE.

400

An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart. This has three primary effects on heart function. What are they?

What is: a. Increased right and left ventricular end diastolic pressures; falling systolic b. Decreased venous return c. Inability of the ventricles to distend and fill adequately (decreased CO)

500

A patient's ECG strip shows atrial and ventricular rates of 110 bpm. The PR interval is 0.14 seconds, the QRS complex measures 0.08 second and the P-P and R-R intervals are regular. What is this rhythm?

What is Sinus Tachycardia

Pediatrics ICU

100

Your 8-year old patient is 26 kgs. Calculate the maintenance fluid requirements for this child in mls/hour. :)

What is 66 mls/hour

200

A 14 yo female picked up from a Halloween house party is unresponsive and is presenting with a RR of 9-10 breath per minute, HR of 58, temp of 35.0 and a BP of 90/60. She also has vomited twice in EMS and once now in ER. Her blood gas reveals she is in respiratory acidosis as well. What conclusions may you initially make on her condition and what assessment will you use to confirm this??

What is drug overdose of opiates (unresponsive, altered mental status, resp depression, hypotension, bradycardia, hypothermia, and Asprin (vomiting, acidosis, shock) Assess using toxidromes!!!!!

300

A 3 month old 8kg pediatric patient has come to the PICU after suffering severe partial thickness burns to both anterior/posterior sides of his R and L arms, his neck, anterior torso and genitals. Calculate his TBSA and how much fluid he will be needing now at what rate. (This is 8 hours post admission)

What is TBSA of 1% (neck) + 13% (torso & genitals) + 2%, 1%, 1.25% x 4 (anterior & poster, L and R)=31% Fluids: 3 mL x 8kg x 31 = 744cc (half is administered already: 372 cc over 23cc/hr!!!

400

At low doses this medication leads to vasodilation and increases blood flow to the kidneys. At higher doses it stimulates beta1-adrenergic receptors causing the heart to beat more forcefully and increase cardiac output. :)

What is Dopamine

Transplants

100

The importance of discharge teaching regarding regular dental checkups and the maintenance of good dental hygiene (minimum twice a day) for a patient's who received heart transplant surgery is crucial. WHY?

What is endocarditis.