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Week 1 Skill Builders questions with complete solutions
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Week 1 Skill Builders questions with complete solutions
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Week 1 Skill BuildersYou have been volunteering at the university medical center, as you anticipate applying to the college of
nursing next fall. You are assigned to transport patients from the emergency department's trauma unit
to the medical intensive care unit (MICU) when JD is admitted to the hospital. JD has been intubated and
placed on a ventilator to protect his airway. His head and neck are immobilized to prevent any
movement and further damage, which indicates he likely has a spinal cord injury. You notice that JD's
heart rate fluctuates between 35 and 50 beats per minute, which you recognize as bradycardia (a heart
rate less than 60 beats per minute). You ask the nurse who you have established an educational
relationship with what he thought was happening to the patient. The MICU nurse confirmed that JD had
a spinal cord injury. There was concern that the patient may be suffering from spinal shock and possibly
neurogenic shock, - correct answer ✔✔Increased parasympathetic activation and decreased sympathetic
activation.
You recall that the sympathetic nervous system is responsible for the "fight-or-flight" response. It
seemed like a cycling accident would trigger a strong response from this division of the ANS. However,
bradycardia did not fit this picture; as a matter of fact it seemed like the opposite response you would
expect from sympathetic activation. Was there something preventing the sympathetic nervous system
from functioning properly? As you were leaving the MICU, you heard the medical resident ask the nurse
to increase the rate of JD's intravenous fluid administration. She also asked the nurse to call the
pharmacy to prepare a norepinephrine drip immediately. JD's blood pressure had become dangerously
low, below the level that provides adequate blood flow to his brain and other vital organs. Wasn't
norepinephrine a neurotransmitter associated with the sympathetic nervous system?JD's medical team
has initiated a norepinep - correct answer ✔✔Norepinephrine triggers smooth muscle contraction in the
blood vessels supplying the digestive, urinary, and integumentary systems, which causes
vasoconstriction.
JD was in shock, specifically neurogenic shock. The MICU nurse who asked you to read about the ANS
was explaining this condition to another nurse. Apparently, the sympathetic nervous system can be
affected if the spinal cord is damaged, especially when the injury involves the cervical or upper thoracic
region. That made sense when you considered the anatomy of the sympathetic nervous system. This
disrupts the balance between the two divisions of the ANS, allowing the parasympathetic nervous
system to exert too much control over many vital systems.The administration of intravenous fluids
(sometimes referred to as a fluid challenge) and norepinephrine therapy had stabilized JD's blood
pressure for the time being, but his heart rate continued to fluctuate. The nursing staff had administered
several atropine injections according to the MICU protocol for severe episodes of bradycardia. Atropine
seemed to work, but its eff - correct answer ✔✔Blood vessels dilate due to a reduction in sympathetic
activity
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