NURS 4626 Test Blueprint – Exam 3 Fall 2022
Alternate question types-8; Dosage Calculations-2 https://quizlet.com/_c7a6xd?x=1jqt&i=imkpf
Week Six:
19
●
CVAD
2 - central venous access device ○
Permit frequent continuous, rapid, or intermittent administration of fluids and medications ○
Allow for drugs that are vesicants to be given ○
Used for Blood/blood products and parenteral nutrition ○
No fluids until x-ray confirms placement**** ○
Centrally inserted Catheter: ■
Inserted in the chest or neck area (Subclavian or Jugular)funneled through to the heart at the
end of the vena cava ■
tip of catheter ends in SUPERIOR vena cava ■
Dacron cuf f anchors and prevents infection ■
up to 3 lumens (types Hickman, Broviac, Groshong) ○
Peripherally Inserted Central catheter: ■
Cephalic or Basilic veins in the arm ■
1 week - 6 months ■
Can't use arm for BP or blood draw ■
T
his has lower infection rate and cost ○
Nursing management: ■
Inspect site, assess for pain ■
change dressing and clean according to hospital policy (chlorhexidine cleaning agent) ■
Change injection caps (patient to turn head opposite side, valsalva if no clamp) ■
flushing is important (saline, 10mL or more,
push-pause
technique
) ●
Complications: Catheter occlusion (tip against wall, clamped/kinked, thrombosis,
buildup), Embolism (catheter breaking, dislodged thrombus, entry of air) , Infection
(contamination, immunosuppressed), Pneumothorax (perforation of visceral pleura),
Catheter migration (bad suturing, trauma, spontaneous) ●
Differ entiate the differ ent types of acute blood transfusion r eactions.
1 ○
Hemolytic: ■
Infusion of
incompatible blood, RBCs
, or at least
10mL of RBCs, antibodies attach to the added blood antigens causing destruction ■
S/S (occur within 15 mins):
Fever
with or without
chills,
back/abdominal/chest/flank pain
, infusion site pain
, tachycardia,
dyspnea, tachypne
a,
hypotension, hemoglobinuria, acute jaundice, dark urine, bleeding, AKI, shock, cardiac arrest, DIC, death ■
Management: Treat any complication that occurs, draw blood samples slowly , insert foley and monitor output and send of f urine specimen, maintain BP with IV colloid solutions, and give diuretics to help with urine output, do not give more blood till tests have been done ○
Febrile: ■
sensitization to
donor WBCs (most common), platelets,
or plasma pr oteins ■
S/S:
Sudden chills,
rigors, and
fever (rise in temperatur e
>1degr ee celsius
), HA, vomiting ■
Management: Give antipyretics
(acetaminophen
), Do
not restart transfusion unless HCP orders ○
Aller gic: ■
Sensitivity to donor plasma protein ■
Mild reaction: ●
S/S: Facial flushing, hives (urticaria), rash Pruritus ●
Management: Give antihistamine, corticosteroid, epinephrine ■
Severe: ●
S/S: Anxiety , abdominal pain, urticaria, dyspnea, wheezing, progressing to cyanosis, bronchospasms, hypotension, shock, cardiac arrest ●
Management: CPR, give o2, epinephrine, maybe antihistamines and B-blockers ●
Describe the nursing management of the patient r eceiving transfusions of blood and blood
components who develop acute blood transfusion r eactions.
2
○
IN ORDER:
■
Stop transfusion
■
maintain patient line with saline
■
notify HCP and Blood bank
■
Reidentify tags and bags
■
Monitor VS and urine
■
Implement providers orders
■
Save tubing/bags to send back to blood bank
■
Collect blood blood/urine specimens
■
document incident
●
Discuss the principles, interpr ofessional car e, and nursing management of the patient r eceiving hemodynamic monitoring, specifically arterial and CVP (central venous pr essur e) lines.
3 ○
Arterial Line: ■
Identify the Phlebostatic Axis- 4th intercostal space, and in line with the heart → CRIMSON CHIN ■
Before insertion do the Allen test (ulnar and radial artery blood flow test, <6 seconds is good) ■
Keep pressure bag inflated to 300 mmHg, Flush bags of normal saline are changed q96 hr or
PRN ■
All lines must have rigid non-compliant tubing ■
Immobilize site ■
keep visible ( no bandage on art line)
■
normal Cardiac Output (CO) is 2.2-4 L/Min
■
MAP calc =𝑆𝐵𝑃 + (2𝑥𝐷𝐵𝑃)3 ■
Pulse pressure = SBP-DBP (normal =30-50) ○
Central Venous Pressure (CVP): ■
PICC or Central Line used ■
Measures the Preload, and best measurement of fluid status in distributive shocks (septic,
neurogenic, anaphylactic)
■
no fluids pushed until CXR r eceived ■
2-8 mmHg ■
Hypovolemic goal: 8-12 mmHg ■
Cardiogenic goal: <8 mmHg ●
Differ entiate the clinical manifestations, interpr ofessional car e including drug therapy , and nursing
management of patients with: Table completed
○
Cardiogenic Shock
2
■
MI, HF , CAV, etc; want to restore blood flow → stent, revascularization, drug to reduce work
of heart
■
heart not strong enough to perfuse body- or gan malperfusion → or gan failure
■
keep CVP <8
■
tachycardia, hypotension, edema, crackles in lungs
■
infuse fluids with caution → fluid overload
■
treatment: increase bp (fluids NS) (vasopressors if unresponsive), O2
Alternate question types-8; Dosage Calculations-2 https://quizlet.com/_c7a6xd?x=1jqt&i=imkpf
Week Six:
19
●
CVAD
2 - central venous access device ○
Permit frequent continuous, rapid, or intermittent administration of fluids and medications ○
Allow for drugs that are vesicants to be given ○
Used for Blood/blood products and parenteral nutrition ○
No fluids until x-ray confirms placement**** ○
Centrally inserted Catheter: ■
Inserted in the chest or neck area (Subclavian or Jugular)funneled through to the heart at the
end of the vena cava ■
tip of catheter ends in SUPERIOR vena cava ■
Dacron cuf f anchors and prevents infection ■
up to 3 lumens (types Hickman, Broviac, Groshong) ○
Peripherally Inserted Central catheter: ■
Cephalic or Basilic veins in the arm ■
1 week - 6 months ■
Can't use arm for BP or blood draw ■
T
his has lower infection rate and cost ○
Nursing management: ■
Inspect site, assess for pain ■
change dressing and clean according to hospital policy (chlorhexidine cleaning agent) ■
Change injection caps (patient to turn head opposite side, valsalva if no clamp) ■
flushing is important (saline, 10mL or more,
push-pause
technique
) ●
Complications: Catheter occlusion (tip against wall, clamped/kinked, thrombosis,
buildup), Embolism (catheter breaking, dislodged thrombus, entry of air) , Infection
(contamination, immunosuppressed), Pneumothorax (perforation of visceral pleura),
Catheter migration (bad suturing, trauma, spontaneous) ●
Differ entiate the differ ent types of acute blood transfusion r eactions.
1 ○
Hemolytic: ■
Infusion of
incompatible blood, RBCs
, or at least
10mL of RBCs, antibodies attach to the added blood antigens causing destruction ■
S/S (occur within 15 mins):
Fever
with or without
chills,
back/abdominal/chest/flank pain
, infusion site pain
, tachycardia,
dyspnea, tachypne
a,
hypotension, hemoglobinuria, acute jaundice, dark urine, bleeding, AKI, shock, cardiac arrest, DIC, death ■
Management: Treat any complication that occurs, draw blood samples slowly , insert foley and monitor output and send of f urine specimen, maintain BP with IV colloid solutions, and give diuretics to help with urine output, do not give more blood till tests have been done ○
Febrile: ■
sensitization to
donor WBCs (most common), platelets,
or plasma pr oteins ■
S/S:
Sudden chills,
rigors, and
fever (rise in temperatur e
>1degr ee celsius
), HA, vomiting ■
Management: Give antipyretics
(acetaminophen
), Do
not restart transfusion unless HCP orders ○
Aller gic: ■
Sensitivity to donor plasma protein ■
Mild reaction: ●
S/S: Facial flushing, hives (urticaria), rash Pruritus ●
Management: Give antihistamine, corticosteroid, epinephrine ■
Severe: ●
S/S: Anxiety , abdominal pain, urticaria, dyspnea, wheezing, progressing to cyanosis, bronchospasms, hypotension, shock, cardiac arrest ●
Management: CPR, give o2, epinephrine, maybe antihistamines and B-blockers ●
Describe the nursing management of the patient r eceiving transfusions of blood and blood
components who develop acute blood transfusion r eactions.
2
○
IN ORDER:
■
Stop transfusion
■
maintain patient line with saline
■
notify HCP and Blood bank
■
Reidentify tags and bags
■
Monitor VS and urine
■
Implement providers orders
■
Save tubing/bags to send back to blood bank
■
Collect blood blood/urine specimens
■
document incident
●
Discuss the principles, interpr ofessional car e, and nursing management of the patient r eceiving hemodynamic monitoring, specifically arterial and CVP (central venous pr essur e) lines.
3 ○
Arterial Line: ■
Identify the Phlebostatic Axis- 4th intercostal space, and in line with the heart → CRIMSON CHIN ■
Before insertion do the Allen test (ulnar and radial artery blood flow test, <6 seconds is good) ■
Keep pressure bag inflated to 300 mmHg, Flush bags of normal saline are changed q96 hr or
PRN ■
All lines must have rigid non-compliant tubing ■
Immobilize site ■
keep visible ( no bandage on art line)
■
normal Cardiac Output (CO) is 2.2-4 L/Min
■
MAP calc =𝑆𝐵𝑃 + (2𝑥𝐷𝐵𝑃)3 ■
Pulse pressure = SBP-DBP (normal =30-50) ○
Central Venous Pressure (CVP): ■
PICC or Central Line used ■
Measures the Preload, and best measurement of fluid status in distributive shocks (septic,
neurogenic, anaphylactic)
■
no fluids pushed until CXR r eceived ■
2-8 mmHg ■
Hypovolemic goal: 8-12 mmHg ■
Cardiogenic goal: <8 mmHg ●
Differ entiate the clinical manifestations, interpr ofessional car e including drug therapy , and nursing
management of patients with: Table completed
○
Cardiogenic Shock
2
■
MI, HF , CAV, etc; want to restore blood flow → stent, revascularization, drug to reduce work
of heart
■
heart not strong enough to perfuse body- or gan malperfusion → or gan failure
■
keep CVP <8
■
tachycardia, hypotension, edema, crackles in lungs
■
infuse fluids with caution → fluid overload
■
treatment: increase bp (fluids NS) (vasopressors if unresponsive), O2
