Burns
Wheezing in a patient with burns to the face is an indication of what medical emergency?
What is airway swelling or edema.
Your patient's intracranial pressure is being monitored with an intraventricular catheter. What complication of this catheter must the nurse vigilantly prevent and assess for?
What is infection.
Normal P-R Interval must fall between ____ and ____ seconds and be constant.
What is 0.12 and 0.20
What important electrolyte imbalance must a nurse continually assess for S/S in the renal failure patient.
What is hyperkalemia.
High volumes of pale yellow urine output in a head injury patient could indicate what complication and what intervention needs to be rapidly implemented?
What is Diabetes Insipidus and fluid resuscitation to prevent dehydration needs to be started.
The Parkland formula states that half of the fluid replacement is administered over the first ____ hours and the other half over the next _____ hours.
What is 8 hours and 16 hours.
In the ICU, why is it important to ensure that a head injury patient's neck is maintained in a neutral position?
What is neutral position facilitates venous drainage. Malpositioning of the neck could increase ICP.
Normal QRS Interval must fall between ____ and ____ seconds to be considered normal.
What is 0.06 and 0.12
A patient experiences tachycardia after hemodialysis could be experiencing what complications?
What is bleeding or excessive hypovolemia.
One of the complications of hyperparathyroidism is increased calcium levels. When multiple PVC's are a symptom, which pharmaceutical intervention would be indicated?
What is Lasix (furosemide).
The correct nursing intervention for a burn patient with normal Hgb, elevated Hct, decreased urine output and normal electrolyte values.
What is fluid resuscitation.
A patient has a blood pressure of 106/52 mmHg and an intracranial pressure of 14 mm Hg. Calculate this patients MAP and CPP
What is a MAP of 70 and a CPP of 56.
MAP = Diastolic BP X2 + Systolic BP divided by 3
CPP = MAP - ICP
What is the prime characteristic of an atrial arrhythmia?
What is P waves differ in appearance from sinus P waves. QRS complexes are of normal duration if no ventricular conduction disturbances are present.
What hemodynamic monitoring pressure is critical to assess after a kidney transplant?
What is CVP (Central Venous Pressure). Decreasing CVP indicates hypovolemia which can lead to renal hypoperfusion and acute tubular necrosis.
Why would a hypertonic saline infusion be given to a patient with hyponatremia, decreasing LOC and complaining of a headache?
What is to decrease cerebral edema.
Name five priority nursing assessments and interventions in the burn patient.
What is fluid resuscitation, airway maintenance, pain management, initiating enteral feedings, monitoring urine output, monitoring vital signs, watching for signs of hypoxia, initiating high protein and calorie intake, preventing infection, monitoring for electrolyte imbalances and positioning.
What would a low Pressure of oxygen in brain tissue (PbtO2) indicate? What is the normal levels?
What is brain ischemia? Normal is 20 to 40 mmHg.
What are two key characteristics of junctional arrhythmias?
What is 1) absent P waves, 2) QRS < 0.12 and 3) a rate of 40-60.
What nursing intervention can help leg cramps experienced during hemodialysis?
What is NS bolus. Muscle cramps during dialysis are caused by rapid removal of sodium and water.
Which of the following are important dietary considerations for your peritoneal dialysis patient? 1) Restrict oral fluids, 2) Avoid commercial salt substitutes, 3) Take phosphate-binders with each meal, 4) Increase intake of dairy products and 5) Eat a high protein diet.
What is 1 (fluid intake is limited in patients requiring dialysis, 2 (commercial salt substitutes are high in potassium), 3 (to help control serum phosphate and calcium levels) 5 (high protein diets are recommended. Dairy products are high in phosphate and are usually limited
Patients with electrical burns are considered to be high risk for what secondary type of internal injury?
What is cervical spine injury.
Meningococcal meningitis patients are placed in what type of isolation?
What is droplet isolation. (Spread by respiratory secretions)
What are two key characteristics of ventricular arrhythmias?
What is the 1) QRS complex is > 0.12 seconds and 2) P waves are absent or, if visible, have no consistent relationship to the QRS complex 3) rate of 20-40..
What assessment finding on a patient receiving peritoneal dialysis would potentially indicate that the patient has developed peritonitis and should be reported immediately?
What is cloudy appearing peritoneal effluent.
Which of the following signs and symptoms are true for Cushing’s Disease?
1) Increased Cortisol, 2) Eternal tan, 3) Hirsutism, 4) Moon Face, 5) Truncal obesity, 6) Decreased sodium.
What is 1) Increased Cortisol, 3) Hirsutism, 4) Moon Face, 5) Truncal obesity.