Hemodynamics
You are titrating vasopressors for a patient in shock; you know your priority is to maintain this hemodynamic parameter at an absolute minimum of 60 to ensure adequate organ perfusion.
What is Mean Arterial Pressure (MAP)?
A patient's lab results show this anaerobic waste product is >4; you prioritize immediate interventions because this correlates directly with high cell death and mortality.
What is Lactate?
A trauma patient arrives with massive hemorrhage from their leg; you know that checking "Circulation" moves to the very beginning of this 5-letter primary survey acronym.
What is ABCDE?
An ARDS patient's PaO2 fails to increase despite you increasing their FiO2 on the ventilator; this hallmark diagnostic finding is known as this.
What is Refractory Hypoxemia?
Your patient suffers a massive hemorrhage, leading to decreased renal perfusion and this most common category of Acute Kidney Injury.
What is Prerenal AKI?
To accurately document your patient's fluid intake, you know that an 8-ounce cup of water is equal to this many milliliters.
What is 240 mL?
Your post-operative patient has a Central Venous Pressure (CVP) of 2 mmHg; to improve cardiac output, you anticipate an order for this specific intervention to increase preload.
What is fluid administration (or a fluid bolus)?
You suspect a patient meets SIRS criteria; according to the 1-hour bundle, you must draw this specific lab test before administering any broad-spectrum antibiotics.
What are blood cultures?
To prevent the Trauma Triad of Death, you warm your patient, monitor for coagulopathy and this dangerous acid-base imbalance.
What is Acidosis?
To improve oxygenation and disburse blood for better ventilation/perfusion in your severe ARDS patient, you implement this positioning technique.
What is Prone Positioning?
A patient with an intrarenal injury presents with hypoalbuminemia, hyperlipidemia, and this hallmark clinical finding in their urine.
What is Proteinuria?
If a patient has a Heart Rate of 100 bpm and a Stroke Volume of 50 mL/beat, you calculate their Cardiac Output to be this many Liters per minute.
What is 5 L/min?
A patient in septic shock has an SVR of 600 dynes/sec/cm5; you recognize this low value indicates the systemic vessels are in this specific physiological state.
What is dilated (or vasodilated)?
A septic patient's urine output drops below 30 mL/hr; you notify the provider because this organ dysfunction signals the transition into this specific stage of shock.
What is Severe Sepsis?
During a mass casualty event, a patient who cannot follow simple commands due to an altered mental status should immediately be tagged with this color under START triage.
What is Red (Emergent)?
A mechanically ventilated patient begins biting their endotracheal tube; the nurse must quickly respond to this specific type of ventilator alarm.
What is a High Pressure Alarm?
A patient develops Acute Kidney Injury due to an outflow obstruction caused by an enlarged prostate (BPH); you classify this as this type of AKI.
What is Postrenal AKI?
You are adjusting a ventilator for a patient with a respiratory rate (f) of 12 and a tidal volume (VT) of 500 mL; you calculate their Minute Volume to be this many Liters per minute.
Daily double:
Is this a safe minute volume?
What is 6 L/min?
Yes. (5-8 L/min)
Your patient's heart rate is 110 bpm and stroke volume is 60 mL/beat; you calculate this resulting value to be 6.6 L/min, which falls within the normal 4-8 L/min range.
What is Cardiac Output (CO)?
Your patient in septic shock remains persistently hypotensive despite receiving 30 mL/kg of crystalloid fluids; you prepare to administer this specific first-line vasoactive medication.
What is Norepinephrine?
A trauma patient is diagnosed with a hemothorax; the nurse anticipates the provider will place a chest tube in this position to properly drain the blood.
What is low?
You assess lung sounds frequently for a patient on high PEEP because the pressure can cause alveolar rupture, known as this complication, leading to a tension pneumothorax.
What is Barotrauma?
During this phase of AKI, your patient's urine output drops below 400 mL/day, their specific gravity fixes at 1.010, and they may require dialysis.
What is the Oliguric Phase?
Using the Parkland Formula (4mL x kg x %TBSA), a 100kg patient with a 10% burn requires this total volume of fluid in the first 24 hours.
What is 4,000 mL?
To get a more individualized picture of your patient's perfusion than Cardiac Output alone, you look at this value, which factors in Body Surface Area (BSA) and should normally be 2.4-4.0 L/min/m2.
What is Cardiac Index (CI)?
A trauma patient presents with massive hemorrhage; as the nurse, you follow this 3-step priority management phrase to fix their hypovolemic shock.
What is "Find the leak, Stop the leak, Replace the volume"?
A trauma patient in Colorado cannot speak and lacks an advanced directive; you know medical decisions will be made by a Proxy chosen using this specific method.
What is a group consensus?
To prevent Ventilator-Associated Pneumonia (VAP), you elevate the HOB >30 degrees, administer a PPI, and perform this crucial hygiene intervention at least every 4 hours.
What is Oral Care?
According to the Parkland Formula, after calculating the total 24-hour fluid requirement for a burn patient, you must divide the total by this number to find the amount needed in the first 8 hours.
What is 2?
If a burn patient's total 24-hour fluid requirement is 8,000 mL, you will program the IV pump to deliver this total volume over the first 8 hours of resuscitation.
What is 4,000 mL?
If your patient's Cardiogenic shock is caused by a decreased ejection fraction, you know the primary problem lies with this specific component of stroke volume.
What is contractility?
A patient presents with Beck's Triad (JVD, muffled heart sounds, and pulsus paradoxus); you urgently prepare the patient for a cardiocentesis to treat this specific type of shock.
What is Obstructive Shock, (caused by Cardiac Tamponade)?
A patient with a blunt abdominal injury is admitted; the provider uses this specific type of ultrasound scan to quickly assess for free-floating fluids.
What is a FAST scan?
You calculate your ARDS patient's PaO2:FiO2 ratio and get a score of 85; you know a score less than 100 falls into this specific severity category.
What is Severe ARDS?
A patient arrives with full-thickness burns to their entire anterior chest and abdomen; using the Rule of 9's, you calculate their total body surface area burned to be this percentage.
What is 18%?
The provider orders a Norepinephrine infusion to start at 15 mcg/min to maintain a MAP >65. The pharmacy dispenses a premixed IV bag containing 4 mg of Norepinephrine in 250 mL of D5W.
how many mL/hr will you program the IV pump to deliver? (Round your final answer to the nearest tenth).
56.3 mL/hr
Step 1: Convert the ordered dose from mcg to mg (so it matches your supplied bag).
Step 2: Convert the per-minute dose to an hourly dose.
Step 3: Calculate the volume (mL) needed to deliver that hourly dose.
Step 4: Apply rounding rules.
(Note: You could also solve this by converting the 4 mg bag into 4,000 mcg first to find your concentration of 16 mcg/mL, and then dividing your hourly dose of 900 mcg/hr by 16 to get the exact same answer of 56.25 mL/hr).
In a patient with an obstructive pulmonary embolism, this right-atrial hemodynamic parameter increases not because of extra fluid, but because blood is backed up in the system.
What is Central Venous Pressure (CVP)?
A patient with a T4 spinal cord injury has a heart rate of 55 and decreasing blood pressure; you realize they lack compensation due to this type of distributive shock.
What is Neurogenic Shock?
A patient with heart failure wants aggressive treatment but also wants symptom management; you suggest this proactive approach, which is not restricted to the last 6 months of life.
What is Palliative Care?
In ARDS, inflammation causes capillary damage that leads to increased permeability and leaking into the alveoli, ultimately resulting in this fluid-related pulmonary condition.
What is Pulmonary Edema?
During dialysis, urea, creatinine, and potassium are cleared from the blood into the dialysate through this specific process where particles move across a membrane.
What is Diffusion?
To help manage the patient's electrolyte abnormalities, the provider orders a liquid phosphate binder. The order is to administer 1.5 Tablespoons (TBSP) of the medication orally every 8 hours.
To ensure strict adherence to the patient's fluid restriction, how many total milliliters (mL) of this medication will you document for the patient's intake over a 24-hour period?
67.5 mL
Rationale: To solve this, you must apply household-to-metric conversions, factor in the frequency of administration over a full day, and recognize the clinical importance of fluid tracking in an oliguric AKI patient.
Step 1: Convert the ordered dose from Tablespoons (TBSP) to milliliters (mL).
Step 2: Determine how many doses the patient will receive in 24 hours.
Step 3: Calculate the total 24-hour volume.
Clinical Application: Because patients in the oliguric phase of AKI have a marked decrease in urine output (less than 400 mL/day) and are at high risk for fluid overload and pulmonary edema, nurses must meticulously calculate and document every milliliter of fluid intake, including liquid medications!
To continuously measure a patient's Systemic Vascular Resistance (SVR) and afterload, the nurse knows this specific invasive line must be utilized.
What is an arterial line?
Your shock patient begins bleeding from their IV sites; you check their labs and expect to see an increase in Fibrin Degradation Products and a decrease in this specific clotting factor.
What is Fibrinogen (or Platelets)?
A trauma patient arrives via EMS; you rush to reestablish perfusion because you know that 30% of trauma deaths occur within this specific timeframe.
What is The Golden Hour?
Your patient with refractory hypoxemia is diagnosed with ARDS after their chest x-ray reveals these hallmark visual findings indicating alveolar damage.
What are Ground Glass Opacities?
A patient suffers a severe burn that destroys the epidermis, dermis, and extends into the hypodermis, exposing adipose tissue; you classify this as this degree of burn.
What is a 3rd degree (or full-thickness) burn?
A patient suffers a severe burn in a garage explosion at 1900, arrives at the ED at 1940, and has their IV fluids initiated at 2030; according to the Parkland Formula, you must complete the administration of the first half of their calculated fluids by this specific time.
What is 0300?
(Rationale: The 8-hour fluid resuscitation clock always begins at the exact moment of the injury, regardless of when the patient arrives at the hospital or when the fluids actually start. 1900 + 8 hours = 0300).