NSG 233 Med Surge 3 Final Exam Questions With Verified Solutions

NSG 233 Med Surge 3 Final Exam Questions With Verified Solutions 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. 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. 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 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. 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. 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 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. 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 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 occ