PERFUSION NSG 252 EXAM QUESTIONS AND ANSWERS VRIFIED 100% CORRECT

PERFUSION NSG 252 EXAM QUESTIONS AND ANSWERS VRIFIED 100% CORRECT neurogenic shock nx interventions - Answer-maintain patent airway & assess breathing keep spine immobilized intubate & use mech vent PRN keep MAP btwn 85-90 mm Hg by giving fluids & vasopressors give *atropine* for low HR use rewarming devices to slowly bring up body's core temp insert foley cath prevent DVTs w compression socks, ROM, anticoag therapy anaphylactic shock causes - Answer-exposure to an allergen that creates a type I hypersensitivity reaction in the body anaphylactic shock risk factors - Answer-exposure to an allergen through- injection, inhalation, ingestion, skin contact common substances- certain foods, latex, certain meds, insect/animal venom, idiopathic reasons anaphylactic shock patho - Answer-type I hypersensitivity reaction that occurs rapidly and systemically after allergen exposure massive release of histamine from mast cells or basophils and causes damage to organs by decreased perfusion anaphylactic shock symptoms - Answer-headache dizziness paraesthesia feeling of impending doom pruritus angioedema erythema urticaria hoarsenss coughing wheezing stridor dyspnea tachypnea resp arrest hypotension dysrhythmias tachycardia cardiac arrest cramping abdominal pain nausea vomiting diarrhea anaphylactic shock tx - Answer-quick identification & admin of epinephrine teach pts to avoid allergen and carry EpiPen w them at all times anaphylactic shock nx interventions - Answer-maintain airway & O2 assess resp status begin CPR if indicated place pt in trendelenburg pos to promote venous return admin epinephrine admin IV fluids, albuterol, diphenhydramine and corticosteroids as indicated & prescribed teach pts to avoid allergens teach pts to have a medical allert bracelet on at all times & carry an EpiPen w then at all times MODS patho - Answer-during refractory stage of shock, cell death results in little O2 to vital organs of body. so much damage occurs that toxic metabolites and enzymes are released. this triggers more dead cells to open and release metabolites which trigger microthrombi to form. this blocks tissue perfusion and by default more cells b/cm damaged which continues the devastating cycle MODS risk factors - Answer-untreated/unmanaged sepsis any type of shock tissue hypoperfusion major trauma burns pancreatitis aspiration syndromes extracorporeal circulation (e.g. cardiac bypass) multiple blood transfusions ischemia- reperfusion injury autoimmune disease heat induced illness ecclampsia poisoning/toxicity MODS interventions - Answer-maximize O2 delivery & decrease O2 consumption provide mech vent central venous or PA cath or minimally invasive hemodynamic monitoring/arterial pressure monitoring replace volume to increase preload maintain a MAP >65 admin vasopressors EKG monitoring venous thromboembolism prophylaxis optimize cerebral blood flow & decrease O2 requirements admin CCB to prevent cerebral vasospasms continuous infusion of insulin and glucose to maintain BG level btwn 140-180 admin loop diuretics & provide continuous renal replacement therapy give antacids & PPI to prevent GI stress ulcers provide enteral feedings & monitor for abdominal distention provide mouth care frequently to stimulate mucosal activity avoid hepatotoxic drugs eval and assess for any types of bleeding use blood products to replace volume PRN insert central line to avoid trauma of frequent venipunctures and reduce intramuscular injections class I/ sodium channel blockers used for... - Answer-supraventricular tachycardia, V tach, V fib prevention class II/ beta blockers used for... - Answer-SVT, Afib, AF what arrhythmias is cardioversion used for? - Answer-a fib, VT, sinus tach, AF (if rhythm has been going on longer than 48 hours) cardioversion joules - Answer-50-200 when is cardioversion delivered? (synchronize/unsynchronized) - Answer-*synchronized- low shock* occurs w the R or right after in the QRS complex this delivery will NOT be delivered during the T wave pre cardioversion - Answer-pt's HR & rhythm, BP, RR, O2 levels monitored make sure O2 sat & suction is at bedside have pt on EKG monitor to be able to see the rhythm pts may have been told to take an anticoag for a few weeks before procedure if elective cardioversion, a TTE may be done beforehand to ensure there is not a clot in the heart intra cardioversion - Answer-intravascular med given to sedate pt post cardioversion - Answer-monitor pt for few hours, make sure rhythm states normalized, pt needs someone to drive them home, pt may have skin irritation from the shock anticoags may be given for a few weeks postop to prevent embolism what arrhythmias is defibrillation used for? - Answer-V fib (priority is to defibrillate STAT) V tach *NOT ventricular asystole!* defibrillation joules - Answer-monophastic= 360 J biphastic= 120-200 J when is defibrillation delivered? (synchronize/unsynchronized) - Answer-unsynchronized- high shock can fall anywhere in cardiac cycle usually used in *pulseless* rhythm (VT or VF) pre defibrillation - Answer-know the rhythm that pt is in determine # of J that the defibrillator needs to be set at intra defibrillation - Answer-make sure everyone is *CLEAR!* of the pt while shock is delivered