All things PVHC
Respiratory Failure
ARDS
Shock
Fluids and Medications
100

What is the mission of Powell Valley Healthcare?

Caring for You

100
Which of the following signs and symptoms differentiate hypoxemic respiratory failure from hypercapnic respiratory failure (select all that apply)? A. cyanosis B. Tachypnea C. Morning headache D. Paradoxic breathing E. Use of pursed -lip breathing
What is A. Cyanosis B. Tachypnea D. Paradoxic Breathing
100
PaO2/FIO2= <200mm is _________; This condition is considered: The most common early clinical manifestations of ARDS that the nurse may observe are: A) dyspnea and tachypnea B) cyanosis and apprehension C) hypotension and tachycardia
What is compromised;ARDS A) dyspnea and tachypnea
100
Name This Type of Shock: Objective: 68y male, wt- 185 lbs S&S: HR 110, Pulse 50, BP 90/72, Resp 38, urine o/p: 30ml/hr skin cool/clammy, mental status: anxious/confused, Absent bowel sounds, absent JVD. Labs: Hematocrit 32%, Hemoglobin 8
What is Hypovolemic Shock
100
Inhaled corticosteroids take ____ before therapeutic effect takes place.
What is 4-5 days.
200

Name one of the core values of PVHC? Hint 5 of them

Integrity, Respect, Compassion, Quality, Accountability

200
PaO2/FIO2= <300mm is _________; caused by:
What is Respiratory Distress; Lung injury
200
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems: A) Hypotension, hyperoxemia, and hypercapnia B) Hyperventilation, hypertension, and hypocapnia C) Hyperoxemia, hypocapnia, and hyperventilation D) Hypercapnia, hypoventilation, and hypoxemia
What is D) Hypercapnia, hypoventilation, and hypoxemia
200
You have determined the patient is experiencing symptoms of shock: Anxiety, ↑ HR, ↓ BP, faint peripheral pulses, ↑ Resp, ↓ SaO2., steady decrease in MAP (80>75>70) minimal urinary out put, 0 bowel sounds Name the first 4 priority treatments.
What is ABCs: A. Oxygen: Administer oxygen B. Fluid Resuscitation:I.V. Catheter, admin fluids C. Circulatory: Drug therapy (Do-Boys) Dopamine, Dobutamine D. Nutritional Therapy (Enteral Nutrition w/i 24hr)
200
Drug Therapy Beta adrenergic used to reverse broncho spasms. Used every 15-30 minutes until a response is acquired.
What is Albuterol
300

The best way to prevent the spread of infection

What is hand hygiene?

300
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for resiratory alkalosis? A) Myasthenia gravis B) Type 1 diabetes mellitis C) Extreme anxiety D) Opioid overdose
What is C) Extreme anxiety
300
ARDS: Treatment: ICU
What is Goal: PaO2 at least 60mm Hg; lung vent to keep normal pH. Oxygen therapy Positioning strategies: turn from supine to prone Nutrition: enteral feeding w omegads-3 fatty acids
300
What 2 symptoms differentiate cardiogenic shock from other types?
1. JVP 2. (↑) Post Cath Wedge Pressure (PCWP)
300
This fluid is contraindicated in these clinical circumstances: * resuscitation, because the solution won't remain in the intravascular space * early post op. * in patients w/ known or suspected ICP (intracranial pressure
What is D5W
400

Before performing any procedure, you must obtain this from the patient.

What is informed consent?

400
What should you always have at the bedside of a mechanically ventilated patient?
What is BMV (ambu bag)
400
Name the pathophysiology of ARDS:
What is Causes: Most common is sepsis; direct lung injury, pneumonia, aspiration of gastric contents, massive trauma, SIRS, MODs Neutrophils are attracted to lung > damage Lung changes occur: injury (exudative), reparative (proliferative), fibrotic(chronic, late phase)
400
Which types of applications are appropriate for the administration of oxygen to a pt in rapid decline? (select all that apply) A. High flow nasal cannula B. High flow non-rebreather mask C. Bag-valve-mask D. ET tube
What is B. High flow non-rebreather mask C. Bag-valve-mask
400
These drugs should be administered to a patient on mechanical ventilation. A) Versed, lasix, Levophed B) Propofol, fentanyl, Protonix C) Dobutamine, vasopressin, epinephrine
What is B) Propofol, fentanyl, Protonix
500
How to you confirm placement of Endotracheal intubation?
What is A) End-tidal CO2 detector. (detects CO2. Misplacement into the esophagus would not produce CO2 and needs to be reinserted) B) Auscultate the lung bases for bilateral breath sounds.
500
Name disorders which compromise lung ventilation and CO2 removal; influence hypercapnic respiratory failure:
What is CNS: OD with CNS depressants; opiods, benzos; head injury Neuromuscular diseases: Myasthenia Gravis, Lou Gherigs, Guillain Barre syndrome, multiple sclerosis Chest Wall: disease of the spinal cord; obesity; chest wall abnorms Airways: acute asthma or abnormalities of airway and alveoli; COPD
500
Name the "Normals" for the following measures: A. MAP (Mean Arterial Pressure) SBP + (DBPx2)/3= MAP B. CVP (Central Venous Pressure) C. PP (Pulse Pressure) SBP-DBP= PP The nurse determines that a large amt of crystalloid fouids administered to a pt. in septic shock are effective when invasive pressure monitoring reveals: A. BP of 98/60 B. CVP of 12 mmHg C. PAWP of 4 mm Hg D. HR of 106 bpm
What is A. MAP: 70 - 105 B. CVP: 2-8 mm Hg (Critically Ill pt., maintain 10-12mm) C. PP: 30-50 mm Hg. Question: B. CVP is the best indicator of fluid status!
500
Which fluid is used replacement of GI tract fluid loss, loss due to burns and trauma, acute blood loss or hypovolemia due to third-space fluid shifts and is an alkalinizing agent? Contraindicated for pts w/ metabolic acidosis or liver damage
What is Lactated Ringer's
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