The Good, Bad, and the Ugly
The patient reports the following symptoms: chest pain radiating down the left arm, jaw pain, headache, and SOB.
What is a myocardial infarction or heart attack?
The first intervention when a patient ceaases to breathe.
What is CPR?
The sound and sensation in the lungs in a patient with subcutaneous emphysema.
What is Creptius?
This therapy is indicated for a patient with a pulmonary embolism.
What is heparin therapy, possible fibrinolytics, coumadin, lovenox? (any of these).
When reviewing the patient's medical record, a Type 2 diabetic patient on Metformin has been NPO and is scheduled for a computed tomography (CT) of the brain with contrast.
What is the need to report to the provider that the patient is taking Metformin?
This medication may be given to pull fluid into the intravascular space.
What is Albumin?
The first intervention if a mechanically ventilated patient alarms "high pressure" from the vent. (one correct answer will give you full points)
What is checking the tubing (biting), check for kinks, respiratory assessment for presence fo secretions?
The lung sound you hear "like a nasal sound of a patient's voice," when a patient has one of the following: pneumonia, pleural effusion, or fibrosis.
What is Egophony?
This may be indicated for a patient in cardiogenic shock to help reduce afterload and increase the aortic diastolic pressure.
What is intra-aortic balloon pump (IABP)?
Here are your patient's conditions after being given morning shift report:
1. 61-year-old man with COPD who has just completed his scheduled bronchodilator.
2. 48-year-old man admitted with cellulitis of his right hand after a construction accident, currently on IV antibiotics, with a temperature of 101.8.
3. 72-year-old woman with a hx of asthma with HR 90 and is due for her beta blocker.
What patient should the nurse call the provider on and get new orders for?
This medication may be utilized in a patient who is hypotensive, despite aggressive fluid resuscitation.
What is Norepinephrine? (and others)
The following ABG results indicate this acid base imbalance: pH=7.25, PaCO2=60, HCO3= 12, PaO2=50.
What is partially compensated respiratory acidosis?
This condition is a result of damage to the alveoli, causing impaired gas exchange, alveoli being filled with fluid, and formation of scar tissue.
What is acute respiratory distress syndrome?
This type of ventilation may be indicated for a patient who is able to provide her/his own breaths, but still needs volume and PEEP regulated.
What is synchronized intermittent mandatory ventilation (SIMV)?
A patient is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours post-op, what type of drainage should the nurse expect:
1. Serous
2. Bloody
3. Serosanguinous
4. Bloody, with frequent small clots
What is Bloody? (number 2).
This medication may be given to a patient with the following hemodynamic pressures: B/P 60/40, CVP 13, CO2 3.5.
What is Epinephrine? (or similar constrictor)
These would be primary concerns with a patient who has just been extubated. (Any two correct answers will give you full points).
What is maintaining the airway, respiratory assessment (presence of stridor?), recheck ABG's (later), cardiac assessment, suction prior to extubation?
Deviation of the trachea to the uneffected side indicates the presence of what.
What is tension pneumothorax?
A "low pressure" alarm sounds on your mechanically ventilated patient. You assess for these problems. (one is required for full points).
What is disconnection from the ventilator, leak in the tubing?
When caring for the patient with ARDS, the nurse knows that therapy is appropriate for the patient when which goal is being met:
1. pH is 7.32
2. PaO2 greater than or equal to 60 mmHg
3. PEEP increases to 20 cmH2O caused BP to fall to 80/40
4. No change in PaO2 when the patient is turned from suoine to prone poisition
What is PaO2 greater than or equal to 60 mmHg? (number 2).
This medication may be given to a patient with an output of 20 mL in the last two hours.
What is furosemide, bumetanide, torsemide? (diuretics)
A patient who has sustained a blunt chest injury suddenly complains of severe chest pain and dyspnea. You anticipate this condition.
Whatb is pneumothorax?
These would indicate a decrease in cardiac outout. (only two required for full points).
What is decreased urinary output, changes in LOC, poor peripheral perfusion? (others accepted include: SOB, altered mental status, fatigue, arrhythmia, cool extremities, low blood pressure).
These are some priority concerns in a patient who has an arterial line. (one is required for full points).
What is risk for infection, risk for hemorrhage due to removal, maintaining patency of line, decrease in circulation (assess extremities)?
The most common early clinical manifestations of ARDS that the nurse may observe are:
1. Dyspnea and tachypnea
2. Cyanosis and apprehension
3. Hypotension and tachycardia
4. Respiratory distress and frothy sputum
3.
What is Dyspnea and tachypnea? (numner 1).