ARF
What is the reference range for:
pH
PaCO2
HCO3
PaO2
SaO2
pH: 7.35-7.45
PaCO2: 35-45 mmHg
HCO3: 22-26 mEq/L
PaO2: 80-100 mmHg
SaO2: >95%
What layer(s) of the skin does a partial-thickness burn involve?
Your patient with ARDS is at risk for decreased cardiac output. Which finding is consistent with decreased cardiac output?
a. central venous pressure (CVP) 5mm Hg
b. HR 75 bmp
c. urine output < 30mL/hr
d. BP 115/75
c. urine output < 30mL/hr
What puts a patient at greatest risk for sepsis?
An infection
If a patient know they have a severe allergy to a specific to peanut butter, what should they carry with them at all times?
epinephrine pen
Analyze the following ABG values:
pH- 7.25
PaCO2- 85 mmHg
PaO2- 60 mmHg
HCO3- 24 mEq/L
Respiratory Acidosis
What are some of nursing priorities when working with a patient that has suffered burns?
Fluid and electrolyte shifts
Gas Exchange
Infection
Pain
You're caring for a patient with ARDS. They have consistent thick secretions. What is your priority goal?
Maintain a patent airway
You're taking care of a patient with sepsis. How often should you measure their urine output?
Every 1-2 hours
Which stage of septic shock do you expect to see signs and symptoms of organ dysfunction?
Name two organ systems that will be affected and how that presents clinically.
Late stage
Neuro- confusion and/or decreased LOC
Cardiovascular- decreased BP
Renal- Cr >2.0, or urine output < 20mL/hr
Respiratory- new need for vent
Name some clinical manifestations of respiratory acidosis.
Restless
Rapid, shallow respirations
Hypoventilation
Tachycardia
Blue tinged hue around lips
What do high pitched crowing sounds on inspiration indicate?
Stridor- may indicate airway obstruction
When the nurse is suctioning an ET tube, the patient begins to cough. What should the nurse do?
Stop suctioning until the patient stops coughing.
You have a patient that has suffered a major trauma related bleed. VS include:
T 98.7, HR 106, BP 72/48 (56), O2 sat- 93%
What is your priority intervention?
a. obtain a 12-lead ECG
b. draw a H&H
c. initiate 0.9% NaCl bolus
d. prepare patient for intubation
c. initiate 0.9% NaCl bolus
A patient in the refractory stage of shock is rapidly declining. What is the expectation of the nurse for a patient that is "Do Not Resuscitate" (DNR)?
Do not perform CPR if the patient's heart stops
1. The term used for lack of O2 transferred to the blood is known as ________?
2. The term used for inadequate CO2 removed from lungs is known as ________?
1. Hypoxemia
2. Hypercapnia
What is the priority goal of the EMT in the field while transporting the patient to the emergency room?
a. prevent scarring
b. manage pain
c. limit severity of burn and support vital function
d. debride eschar formation
c. limit severity of burn and support vital function
What is the FiO2 goal for improvement for a patient on a ventilator?
FiO2 60% or less is a goal for improvement
What are the systemic inflammatory response syndrome (SIRS) criteria?
T- >101F or < 96.9F
HR >90/ min
RR >20/ min
WBC >12,000 or <4,000
What are some compensatory mechanisms you may observe in a patient in the early stages of septic shock?
Name 2
Late stage
Neuro- confusion and/or decreased LOC
Cardiovascular- decreased BP
Renal- Cr >2.0, or urine output < 20mL/hr
Respiratory- new need for vent
Which assessment parameter supports the nursing diagnosis of "Impaired Gas Exchange?"
a. Productive cough of thick mucus
b. paO2 65 on 4L O2 via NC
c. patient using accessory muscles for breathing
d. oxygen 8L/minute via simple mask
b. paO2 65 on 4L O2 via NC
Why would IV pain medications be more beneficial than PO pain medication for a patient with partial-thickness burns?
Onset of IV is faster
GI absorption may be affected by burn injury
When a patient is on a ventilator, a neuromuscular blockade agent is often used. Do these agents contain analgesia or sedation effects?
Neuromuscular blockade agents do not contain analgesia or sedation. It is important for any patient receiving a neuromuscular blockade to receive these as well.
What are the typical orders included in the "sepsis bundle"?
Draw lactate
Draw blood cultures x 2 sets
Administer broad spectrum IV antibiotic
What are the stages of shock?
Initial Stage
Compensatory Stage
Progressive Stage
Refractory Stage