Exam (elaborations)
NURS 4581 - Critical Care Final Review.
- Course
- NURS 4581
- Institution
- University Of Texas - Arlington
NURS 4581 - Critical Care Final Review/NURS 4581 - Critical Care Final Review.
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UTA NURS 4581 FinalUTA NURS 4581 Critical Care Final Review
Question Answer
bariatric surgery criteria guidelinesBMI ≥40 or a BMI ≥35 with one or more severe obesity-related medical complications (e.g., hypertension, type 2 diabetes mellitus, heart failure, or sleep apnea) AND documentation of three unsuccessful attempts at medically supervised weight loss programs
Benefits of restrictive bariatric surgery vs. malabsorptiveSince digestion is not altered, the risk of anemia
or cobalamin deficiency is low. Procedures can be performed using a laparoscopic approach, decreasing postoperative pain, hospital stays, and the rate of wound infection and hernia formation
Dumping syndromegastric contents empty too rapidly into the small
intestine, overwhelming its ability to digest nutrients
Nutritional therapy postgastrectomy dumping syndromedivide meals into 6 small feedings; fluids not taken with meals (at least 30-45 min before or after); avoid concentrated sweets; increase protein and fats (meat, cheese, and eggs); cobalamin injection monthly
General Adaptation Syndrome (GAS) stagesalarm reaction, stage of resistance, and stage of exhaustion
Respiratory acidosis causesChronic obstructive pulmonary disease, Barbiturate or sedative overdose, Chest wall abnormality (e.g., obesity), Severe pneumonia, Atelectasis, Respiratory muscle weakness (e.g.,
Guillain-Barré syndrome), Mechanical hypoventilation
Respiratory acidosis manifestationsDrowsiness, Dizziness, Headache, Disorientation→ Stupor & coma; ↓ Blood pressure, Ventricular fibrillation (related to hyperkalemia from compensation), Warm, flushed skin (related to peripheral vasodilation); Seizures; Hypoventilation and hypoxia
Respiratory acidosis managementidentify/treat cause (do not give bicarbonate) by
increasing ventilation and decreasing dead space (increase rate and volume of respiration);
for COPD it is normal for them to be in fully compensated acidosis and no treatment is necessary
Respiratory alkalosis causesHyperventilation (caused by hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, fever); Stimulated respiratory center caused by septicemia, encephalitis, brain injury, salicylate poisoning; Mechanical hyperventilation
Respiratory alkalosis manifestationsLethargy, Light-headedness, Confusion; Tachycardia, Dysrhythmias (r/t hypokalemia compensation); Nausea, Vomiting, Epigastric pain; hypocalcaemia manifestations (Tetany→ convulsions & unconsciousness); hyperventilation
Respiratory alkalosis managementslow ventilation, rebreather mask, increase dead space
Metabolic acidosis causesDiabetic ketoacidosis, Lactic acidosis, Starvation, Severe diarrhea, Renal tubular acidosis, Renal failure, Gastrointestinal fistulas, Shock, Poisoning
Metabolic acidosis manifestationsDrowsiness, Headache, Disorientation→coma; ↓ BP, Dysrhythmias (r/t hyperkalemia from compensation), Warm, flushed skin (related to peripheral vasodilation); Nausea, vomiting, diarrhea, abdominal pain; Kussmaul respirations (Deep, rapid)
Metabolic acidosis managementindentify/treat underlying cause; sodium bicarbonate (NaHCO3) if severe
Metabolic alkalosis causes Severe vomiting, Excess gastric suctioning, Diuretic therapy (increased excretion of H+), Potassium deficit, Excess NaHCO3 intake, Excessive mineralocorticoids
Metabolic alkalosis manifestationsDizziness, Irritability, Nervousness, confusion; n/v, Anorexia; hypokalemia (Tetany, Tremors, Tingling of fingers and toes, Muscle cramps, hypertonic muscles, Seizures); hypocalcemia (r/t increased calcium binding to proteins); Hypoventilation
Metabolic alkalosis managementtreat underlying cause, Diamox (acetazolamide)
volume ventilationa predetermined tidal volume (VT) is delivered with each inspiration, and the amount of pressure needed to deliver the breath varies based on the compliance and resistance factors
of the patient-ventilator system.
pressure ventilationthe peak inspiratory pressure is predetermined and the VT delivered to the patient varies based
on the selected pressure and the compliance and resistance factors of the patient-ventilator system.
Usual Tidal Volume Setting on Mechanical Ventilator6-10 mL/kg
Usual FIO2 setting on Mechanical Ventilatormay be set between 21% (essentially room air) and 100%; usually adjusted to maintain PaO2 level >60 mm Hg or SpO2 level >90%
Assist-Control (AC) or Assisted Mandatory Ventilation (AMV)The ventilator sensitivity is set so when the patient initiates a spontaneous breath, a full-
volume breath is delivered.
Intermittent Mandatory Ventilation (IMV) and Synchronized Intermittent Mandatory Ventilation (SIMV)In between “mandatory breaths,” patients can spontaneously breathe at their own rates and VT. With SIMV, the ventilator synchronizes the mandatory breaths with the patient's own inspirations.
Pressure Support Ventilation (PSV)Provides an augmented inspiration to a spontaneously breathing patient. When the patient initiates a breath, a high flow of gas is delivered to the preselected pressure level and pressure is maintained throughout inspiration.
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