233 Med Surge 3 Final exam Questions and
Answers Latest updated
1). Chest trauma- complications
Ans: Flail chest is frequently a complication of blunt chest trauma, which may occur
from a steering wheel injury, motor vehicle crash involving a pedestrian or cyclist, a
significant fall onto the chest, or an assault with a blunt weapon. As with rib fracture,
treatment of flail chest is usually supportive. Management includes providing ventilatory
support, clearing secretions from the lungs, and controlling pain. For mild-to-moderate
flail chest injuries, the underlying pulmonary contusion is treated by monitoring fluid
intake and appropriate fluid replacement while relieving chest pain. Pulmonary
physiotherapy focusing on lung volume expansion and secretion management techniques
is performed. The patient is closely monitored for further respiratory compromise.
For severe flail chest injuries, ET intubation and mechanical ventilation are required to
provide internal pneumatic stabilization of the flail chest and to correct abnormalities in
gas exchange.
2). Shock fluid
Ans: At least two large-gauge IV lines are inserted to establish access for fluid
administration. Because the goal of the fluid replacement is to restore intravascular
volume, it is necessary to administer fluids that will remain in the intravascular
compartment to avoid fluid shifts from the intravascular compartment into the
intracellular compartment. As discussed earlier, crystalloid solutions such as lactated
Ringer's solution or 0.9% sodium chloride solution are commonly used to treat
hypovolemic shock, as large amounts of fluid must be given to restore intravascular
volume.
3). Hypovolemic shock
Ans: Hypovolemic shock, the most common type of shock, is characterized by
decreased intravascular volume. Body fluid is contained in the intracellular and
extracellular compartments. Intracellular fluid accounts for about two thirds of the total
body water. The extracellular body fluid is found in one of two compartments:
intravascular (inside blood vessels) or interstitial (surrounding tissues). The volume of
interstitial fluid is about three to four times that of intravascular fluid. Hypovolemic shock
occurs when there is a reduction in intravascular volume by 15% to 30%, which represents
an approximate loss of 750 to 1500 mL of blood in a 70-kg (154-lb) person
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, 4). Cardiogenic shock s&s
Ans: Cardiogenic shock occurs when the heart's ability to contract and to pump blood
is impaired and the supply of oxygen is inadequate for the heart and the tissues. In
cardiogenic shock, cardiac output, which is a function of both stroke volume and heart
rate, is compromised. Patients in cardiogenic shock may experience the pain of angina,
develop arrhythmias, complain of fatigue, express feelings of doom, and show signs of
hemodynamic instability.
5). Hemorrhage- shock
Ans: If the patient is hemorrhaging, efforts are made to stop the bleeding. This may
involve applying pressure to the bleeding site or surgical interventions to stop internal
bleeding. If the cause of the hypovolemia is diarrhea or vomiting, medications to treat
diarrhea and vomiting are given while efforts are made to identify and treat the cause. In
older adult patients, dehydration may be the cause of hypovolemic shock.
6). Shock septic- dopamine
Ans: Dopamine, a naturally occurring precursor of norepinephrine and epinephrine,
functions as a neurotransmitter. Dopamine is useful in hypovolemic and cardiogenic
shock. Adequate fluid therapy is necessary for maximal pressor (increased blood
pressure) effect. Acidosis decreases the effectiveness of the drug. If fluid therapy alone
does not effectively improve tissue perfusion, vasopressor agents, specifically
norepinephrine or dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher
7). Aaa- tests
Ans: The most important diagnostic indication of an abdominal aortic aneurysm is a
pulsatile mass in the middle and upper abdomen. Most clinically significant aortic
aneurysms are palpable during routine physical examination; however, the sensitivity
depends upon the size of the aneurysm, abdominal girth of the patient (i.e., more difficult
to find in the patient with obesity), and the skill of the examiner. A systolic bruit may be
heard over the mass. Duplex ultrasonography or CTA is used to determine the size, length,
and location of the aneurysm. When the aneurysm is small, ultrasonography is conducted
at 6-month intervals until the aneurysm reaches a size so that surgery to prevent rupture
is of more benefit than the possible complications of a surgical procedure. Some
aneurysms remain stable over many years of monitoring.
8). Aaa- post op
Ans: The patient who has had an endovascular repair must lie supine for 6 hours; the
head of the bed may be elevated up to 45 degrees after two hours. The patient needs to
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, use a bedpan or urinal while on bed rest. Vital signs and Doppler assessment of
peripheral pulses are performed initially every 15 minutes and then at progressively longer
intervals if the patient's status remains stable. The access site (usually the femoral artery)
is assessed when vital signs and pulses are monitored. The nurse assesses for bleeding,
pulsation, swelling, pain, and hematoma formation. Skin changes of the lower extremity,
lumbar area, or buttocks that might indicate signs of embolization, such as extremely
tender, irregularly shaped, cyanotic areas, as well as any changes in vital signs, pulse
quality, bleeding, swelling, pain, or hematoma, are immediately reported to the primary
provider.
The patient's temperature should be monitored every four hours, and any signs of
postimplantation syndrome should be reported. Postimplantation syndrome typically
begins within 24 hours of stent-graft placement and consists of a spontaneously
occurring fever, leukocytosis, and occasionally, transient thrombocytopenia. This
condition has been attributed to complex immunologic changes that occur because of
manipulations with sheaths and catheters with the aortic lumen, although the exact
etiology is unknown. The symptoms are thought to be related to the activation of
cytokines. They can be managed with a mild analgesic (e.g., acetaminophen [Tylenol]) or
an anti-inflammatory agent (e.g., ibuprofen [Motrin]) and usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of
persistent coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm
Hg. Most patients can resume their pre-procedure diet and are encouraged to drink fluids.
An IV infusion may be continued until the patient can drink normally. Fluids are important
to maintain blood flow through the arterial repair site and to assist the kidneys with
excreting IV contrast agents and other medications used during the procedure. Six hours
after the procedure, the patient may be able to roll from side to side and may be able to
ambulate with assistance to the bathroom. Once the patient can take adequate fluids
orally, the IV infusion may be discontinued.
Postoperative care requires frequent monitoring of pulmonary, cardiovascular, renal, and
neurologic status. Possible complications of surgery include arterial occlusion,
hemorrhage, infection, ischemic bowel, kidney injury, and impotence.
9). Asystole drug choice
Ans: In such cases, the treatment is the same as for asystole and pulseless electrical
activity (PEA) if the patient is in cardiac arrest or for bradycardia if the patient is not in
cardiac arrest. Interventions include identifying the underlying cause; administering IV
epinephrine, atropine, and vasopressor medications; and initiating emergency
transcutaneous pacing. In some cases, idioventricular rhythm may cause no symptoms of
reduced cardiac output. Ventricular asystole is treated the same as PEA.
10). Dysthythmias and calium
Ans: A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT,
and cardiac arrest. Calcium blood levels help maintain normal heartbeats, while low levels
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