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NR341 Complex Adult Health Exam 7 2024 $13.08
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NR341 Complex Adult Health Exam 7 2024

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NR341 Complex Adult Health Exam 7 2024

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  • January 21, 2025
  • 47
  • 2024/2025
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NR341 Complex Adult Health Exam 7 2024
Critical Care Environment - - reorient patient
- tell them what you're doing
- day and night adjust lights, recognize day and night
- provide care to family (in room for code)

Rapid Response - - prevents code
- s/s of septic shock

Advance Directive - - have before admission
- NO SLOW CODES
- right to say no

Visitation - - based on the needs of the patient
- hospital will never restrict visitation

Brain Death - perfusion and oxygenation until organ transplant

Respiratory Failure - - decreased pH
- increased CO2
- decreased PaO2

Intubation - - sedate
- paralyze
- auscultate
- chest xray
- fall and rise bilateral
- CO2 detector - gold is good

ARDS - - decreased Pa02 despite increasing FaO2
- injury to lungs
- tachypnic and tachycardic
- respiratory acidosis
- decreased compliance
- INCREASED PEEP

ARDS: Intervention - - prone (maintain airway)
- elevate HOB 30-45 degrees

VAP Bundle - - HOB 30-45 degrees
- Oral care w/ Chlorhexidine
- DVT Care - Heparin and Lovenox
- PPI's prevent PUD
- Sedation Vacation
- Drain condensation away from patient

,What should you do after 7 days on a Ventilator? - Trach them

Terminal Weaning - - DNR
- take them off ventilator to die
- COMFORT IS KEY, NO PAIN (benzos, pain meds)

American Association of Critical Care Nurses: Focus of the Group - - assists NURSES to attain
knowledge and influence
- healthy work environment initiative

Highest setting you can put a Nasal Cannula? - 6 L, humidify at 4L

Patient is on 90% Fi02 (10L), Respiratory Distress...What do I do? - INTUBATE

Overdose on CNS Depressant? - - respiratory depression
- respiratory acidosis
- hypoventilation

Panic Attack: Respiratory - - respiratory alkalosis
- hyperventilation
- tingling, numbness in fingers (decreased perfusion)

What is a sign of decreased Perfusion? - cyanosis

ARDS: Chest Xray? - - broken glass
- white out

What does PEEP increase? - PaO2

Ready to wean? - - PaO2 >60 and FiO2 <.4
- PEEP <5-8 cm
- PaO2/FiO2 should be 150-200

Vented patient is Asystole, don't know if he has DNR? - stop the code

High Pressure Alarm - - biting the tube
- mucus plug
- kinked tube
if you can't figure it out, bag patient and call an RT

Low Pressure Alarm - something is disconnected

Prepare you patient for weaning - tell patient breathing will be hard

Weaning is not working - - RR increases

,- HR increases
- O2 decreases
- low hemoglobins will not be successful

Patient is Tachy (150), hypotensive, signs of shock, heart failure... - - vagel maneuver first
- synchronized cardioversion

Patient is brady (35), hypotensive, diaphoresis, dizzy and SOB - transcutaneous pacing

Anxious on Ventilator - - sedate
- neuromuscular block (SEDATE FIRST)
- pressure ulcers are common as well as corneal abrasions (can't close eyes).

RASS - - agitation and sedation
- tells you if you need a neuro block
- 4 needs a neuro block
- 2 is typical

ALOC - - restless and irritable (WHY)
- typically not adequately oxygenated

Suction - - only when indicated
- hyperoxygenate before

Common Central Line Injury - pneumothorax

What is common to see with weaning? - - tachy
- agitated
- using accessory muscles

Patient w/ tachypnea, restlessness, getting worse, hypoxia... - ARDS

What is the first thing to do when patient alarms go off? - assess the patient

Coding Protocol - 100 compressions - 2 minutes - check pulse

Asystole - - start meds
- epi (1:10,000, 1 mg)

Heparin: preventive/ Therapeutic/ use - Preventive:
-SubQ (SC)
-5000 units BID/ TID

Therapeutic:
-IV
-weight based

, -units/Kg/ hr
-w/ loading dose

Use on Pt:
-(+) PE
-(+) VTE/ DVT
-off warfarin for impending procedure
ex: mechanical valve

Heparin: monitor Pt for - -platelets
-clot times (Q4H)
aptt/ ptt/ anti-Xa
-Hgb
baseline & drop

*H.I.T: Heparin induced thrombocytopoenia*

Enoxaparin: preventive/ therapeutic/ use - Preventive:
-SC 30 to 40 mg/ daily

Therapeutic:
-SC
-mg/Kg
-1.5 mg/ Kg/ daily or 1 mg BID

Ulcers: - Use:
-PPI
-H2 blockers

**PPI increase RF for C-diff**

Bundle of Care - A. Assessment of pain (CPOT)
B. SAT/ SBT (spontaneous awakening trial/ spontaneous breathing trial)
C. Choice of analgesics & sedation
D. Delirium (ICU psychosis)
E. early mobility
F. Family involvement

A: Assessment of pain - -regional anesthesia/ nonopioid adjuncts
-analgesia-based sedation tech. w/ fentanyl

B: Both SAT & SBT - -Daily linked SAT/ SBT
-multidisciplinary coordination of care
-faster liberation from mech. vent.

C: Choice of sedation - -targeted light sedation when sedation nec.

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