Q: A DNR order is signed and a patient has an implantable device. What should be the next step? Answer: implantable cardiac devices: -continuous pacing by a PPM or AICD -uses an LV AD these devices should be deactivated If a DNR order is signed or if a withdrawal of LST is desired by the patient and/or surrogate decision -maker. Q: DNRCC -Arrest Answer: DNR Comfort Care -Arrest orders (DNRCC -Arrest) permit the use of life -saving measures (such as powerful heart or blood pressure medications) before a person's heart or breathing stops. However, only comfort care may be provided after a person's heart or br eathing stops. -activates the DNR order when a cardiac or respiratory arrest occurs -All resuscitative therapies will be given before an arrest but not during an arrest. -Cardiac arrest occurs when there is no palpable pulse can be identified. -A respiratory arrest occurs when agonal breathing or no spontaneous breathing occurs. Q: DNRCC Answer: Final Exam: NR571/ NR 571 (2023/ 2024 Latest Update) Complex Diagnosis & Management in Acute Care Practicum Exam Review |W eeks 5-8 Covered| Questions and Verified Answers| 100% Correct- Chamberlain Do not resuscitate comfort care, no CPR -no resuscitative therapies will be undertaken from the time that the dnr order is signed -no chest compressions -no cardiac defibrillation or cardioversion -no insertion of an artificial airway -no resuscitative drugs (vasopressors, antiarrhythmics, etc.) Q: Do Not Intubate (DNI) Answer: a medical order that tells medical professionals not to place a breathing tube in a person. Q: DNR Reversal During Surgery Answer: -Any arrest during a surgery or endoscopy is considered to be potentially reversible. -DNR status should be addressed prior to any procedure that requires anesthesia including surgery or endoscopy. -If the patient or their surrogate decision maker rescinds the DNR order periopera - tively, a decision about when to reinstitute it upon arrival in the recovery room or at a specified time interval after surgery should be made prior to the procedure. -In some circumstances, a patient or their decision maker may decide that they do not wish to rescind the DNR perioperatively. -This decision must be documented in the surgical consent. If the patient expires in the OR, this would be characterized as an "expected death" meaning that a patient's demise is anticipated in a DNR situation. Q: Zeze is a 52 -year-old female with metastatic lung cancer to the brain who is admitted to the hospital with shortness of breath. A chest x -ray demonstrates a large pleural effusion. Initially, she is alert and conversant and is agreeable to the recommended procedure of a thoracentesis that is scheduled for the next day. Overnight, she becomes agitated and requires multiple doses of benzodiazepines. The following morning, she refuses thoracentesis and wants to be discharged from the hospital immediately. What is an important principle for the provider to consider in response to the patient's requests? A. Competence B. Advanced Directives C. Medical decision -making capacity D. Hospice consultation Answer: Medical decision -making capacity Rationale: Medical decision -making capacity may not be present in this patient who has had an abrupt change in mental status as well as an underlying neurological condition (brain metastasis). If there is a concern that the patient lacks the capacity for medical deci sion making, this should be formally evaluated before they allow the patient to refuse treatment. Q: A 76 -year-old male with a history of COPD and metastatic lung cancer has a DNRCC - Arrest order in place. He is admitted to a medical -surgical unit with pneumonia. He becomes progressively dyspneic and requires increasing oxygen requirements per nasal cannula. His heart rate was noted to be atrial fibrillation with rapid ven tricular rate in the 160s to 170s. His blood pressure is 96/62.Which of the following interventions would not be allowed under the DNRCC - Arrest order? A. Cardioversion B. Intubation with mechanical ventilation C. IV amiodarone D. None of the above Answer: None of the above Rationale: This patient has a DNRCC - Arrest order in place and is currently hemodynamically unstable but has not experienced a cardiac or respiratory arrest at this point, so full resuscitative attempts are permitted for this patient in the current clinical scenario. Q: A 32 -year-old male presents to the ED with multiple gunshot wounds to the head and chest. His blood pressure is undetectable with a blood pressure cuff nor does he have a palpable pulse. He is found to be in PEA arrest. Advanced cardiac life support is ini tiated, and the patient is eventually sta - bilized and taken to the Operating Room. Numerous people present to the hospital requesting information about the patient's condition. According to HIPAA privacy laws, who should information about the patient be r eleased to? A. The police B. The patient's best friend C. The patient's mother D. The police and patient's mother
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