You are caring for a 24 year old female who was admitted following an
acetaminophen overdose. She admits to swallowing approximately 50 tablets 2 hours
ago but denies taking any other drugs. She is nauseated but alert, oriented, and has
no other symptoms so far. Initial lab values for liver and renal function, electrolytes,
and PT/aPTT are normal. Knowing the usual course of acetaminophen poisoning, you
anticipate which of the following actions/treatments within the next two hours:
A. Immediate intubation to prevent respiratory arrest.
B. Administration of acetylcysteine as an antidote.
C. Administration of phenytoin (Dilantin) for seizure prevention.
D. Immediate dialysis to remove acetaminophen and prevent renal failure.
Give this one a try later!
, B. Acetaminophen overdose usually results in acute liver failure within 72
hours. Within the first 24 hours, patients are often asymptomatic or have
nonspecific symptoms such as nausea, vomiting, diaphoresis, pallor, and
lethargy; and liver function labs are normal unless there is preexisting liver
disease. From 24 to 72 hours after ingestion, clinical and laboratory
evidence of hepatotoxicity (and often nephrotoxicity) appear: elevated
AST/ALT levels, prolonged PT, and elevated bilirubin. Liver function
abnormalities peak from 72 to 96 hours after ingestion, and patients
develop jaundice, confusion (hepatic encephalopathy), marked elevation in
hepatic enzymes, elevated ammonia levels, and bleeding. GI
decontamination with activated charcoal by mouth can be effective in
patients who present within four hours of acute ingestion. Acetylcysteine is
the antidote for acetaminophen poisoning and has the best outcome when
given within 8 hours of ingestion. Serious hepatotoxicity is uncommon and
death extremely rare if acetylcysteine is administered within eight hours
following acetaminophen ingestion. Chronic liver failure does not occur as
a result of acetaminophen overdose.
Respiratory arrest and seizures would not occur until very late in the course
of multiorgan dysfunction as a result of acetaminophen overdose.
Acute renal failure occurs in 10 to 25 percent of patients with significant
hepatotoxicity, and dialysis can be used to reduce acetaminophen levels if
treatment with acetylcysteine is not successful. However, dialysis is not the
initial treatment.
You are caring for a patient in the ICU who is intubated and on mechanical ventilation.
The patient was admitted 26 hours ago with pneumonia. The patient is
hemodynamically stable after initial treatment with fluids and antibiotics. The patient
has bowel sounds present in all four quadrants. The intensive care physician arrives on
the floor for daily rounds. What recommendations will be taken into consideration
when making decisions about nutrition for the patient:
A. Enteral nutrition is the preferred method for providing nutrition and should be
started 24 to 48 hours after admission in patients who have been adequately fluid
resuscitated.
B. The patient should remain NPO for the first 72 hours from admission and then
evaluated for the safe initiation of enteral feedings.
C. Parental nutrition is preferred over enteral nutrition in patients admitted with an
infectious process.
,D. Parental nutrition is recommended over enteral nutrition for patients who are
intubated and can be started immediately on admission to the intensive care unit.
Give this one a try later!
A. If the critically ill ICU patient is hemodynamically stable with a functional
gastrointestinal tract, then enteral nutrition (EN) is recommended over
parental nutrition (PN). Patients who receive EN experience less septic
morbidity and fewer infectious complications than patients who received
PN. If the critically ill patient is adequately fluid resuscitated, then EN
should be started within 24 to 48 hours following injury or admission to the
ICU. Early EN is associated with a reduction in infectious complications and
may reduce LOS.
All of the following put the patient at risk for the development of intra-abdominal
hypertension (IAH) or abdominal compartment syndrome (ACS) EXCEPT:
A. Increased abdominal wall compliance.
B. Increased peritoneal cavity contents.
C. Massive fluid resuscitation.
D. Increased intestinal intraluminal contents that may occur with such situations as an
ileus.
Give this one a try later!
, A. Decreased abdominal wall compliance can cause an increase in IAH and
ACS. Situations that can decrease intra-abdominal wall compliance include
acute respiratory failure with increased intrathoracic pressure, prone
position, abdominal surgery with primary fascial or tight closure.
Gastroparesis (delayed gastric emptying), ileus and colonic pseudo
obstruction can all result in increased intestinal intraluminal contents.
Increased peritoneal cavity contents occurs with hemoperitoneum,
pneumoperitoneum, or ascites.
Massive fluid resuscitation or capillary leak can may also result in IAH and
ACS. Some of the most common situations where this occurs includes:
massive transfusions (> 10 Units/24 hours), massive fluid resuscitations (>5
liters/24 hours), pancreatitis, sepsis, and burns.
You receive a 42 year old male patient from the Emergency Department who is being
admitted with suspected acute pancreatitis. You know the blood test most specific to
acute pancreatitis is:
A. Serum ammonia level.
B. Urine amylase Level.
C. Serum lipase Level.
D. Serum amylase level.
Give this one a try later!
C. Serum amylase level rises faster than serum lipase levels but serum
lipase is more specific to the pancreas than serum amylase. Therefore,
serum amylase is considered an early marker but serum lipase is a
confirmatory marker when elevated 3 times normal. Urine amylase will
often rise with pancreatitis but again, serum lipase is more specific to
pancreatitis.
A feeding tube is being placed at the bedside in a patient who is not fully alert.
Immediately after insertion the patient is coughing and his respirations appear more
labored. The appropriate response is:
A. Check the patient's oxygen saturation to confirm that placement is correct.
acetaminophen overdose. She admits to swallowing approximately 50 tablets 2 hours
ago but denies taking any other drugs. She is nauseated but alert, oriented, and has
no other symptoms so far. Initial lab values for liver and renal function, electrolytes,
and PT/aPTT are normal. Knowing the usual course of acetaminophen poisoning, you
anticipate which of the following actions/treatments within the next two hours:
A. Immediate intubation to prevent respiratory arrest.
B. Administration of acetylcysteine as an antidote.
C. Administration of phenytoin (Dilantin) for seizure prevention.
D. Immediate dialysis to remove acetaminophen and prevent renal failure.
Give this one a try later!
, B. Acetaminophen overdose usually results in acute liver failure within 72
hours. Within the first 24 hours, patients are often asymptomatic or have
nonspecific symptoms such as nausea, vomiting, diaphoresis, pallor, and
lethargy; and liver function labs are normal unless there is preexisting liver
disease. From 24 to 72 hours after ingestion, clinical and laboratory
evidence of hepatotoxicity (and often nephrotoxicity) appear: elevated
AST/ALT levels, prolonged PT, and elevated bilirubin. Liver function
abnormalities peak from 72 to 96 hours after ingestion, and patients
develop jaundice, confusion (hepatic encephalopathy), marked elevation in
hepatic enzymes, elevated ammonia levels, and bleeding. GI
decontamination with activated charcoal by mouth can be effective in
patients who present within four hours of acute ingestion. Acetylcysteine is
the antidote for acetaminophen poisoning and has the best outcome when
given within 8 hours of ingestion. Serious hepatotoxicity is uncommon and
death extremely rare if acetylcysteine is administered within eight hours
following acetaminophen ingestion. Chronic liver failure does not occur as
a result of acetaminophen overdose.
Respiratory arrest and seizures would not occur until very late in the course
of multiorgan dysfunction as a result of acetaminophen overdose.
Acute renal failure occurs in 10 to 25 percent of patients with significant
hepatotoxicity, and dialysis can be used to reduce acetaminophen levels if
treatment with acetylcysteine is not successful. However, dialysis is not the
initial treatment.
You are caring for a patient in the ICU who is intubated and on mechanical ventilation.
The patient was admitted 26 hours ago with pneumonia. The patient is
hemodynamically stable after initial treatment with fluids and antibiotics. The patient
has bowel sounds present in all four quadrants. The intensive care physician arrives on
the floor for daily rounds. What recommendations will be taken into consideration
when making decisions about nutrition for the patient:
A. Enteral nutrition is the preferred method for providing nutrition and should be
started 24 to 48 hours after admission in patients who have been adequately fluid
resuscitated.
B. The patient should remain NPO for the first 72 hours from admission and then
evaluated for the safe initiation of enteral feedings.
C. Parental nutrition is preferred over enteral nutrition in patients admitted with an
infectious process.
,D. Parental nutrition is recommended over enteral nutrition for patients who are
intubated and can be started immediately on admission to the intensive care unit.
Give this one a try later!
A. If the critically ill ICU patient is hemodynamically stable with a functional
gastrointestinal tract, then enteral nutrition (EN) is recommended over
parental nutrition (PN). Patients who receive EN experience less septic
morbidity and fewer infectious complications than patients who received
PN. If the critically ill patient is adequately fluid resuscitated, then EN
should be started within 24 to 48 hours following injury or admission to the
ICU. Early EN is associated with a reduction in infectious complications and
may reduce LOS.
All of the following put the patient at risk for the development of intra-abdominal
hypertension (IAH) or abdominal compartment syndrome (ACS) EXCEPT:
A. Increased abdominal wall compliance.
B. Increased peritoneal cavity contents.
C. Massive fluid resuscitation.
D. Increased intestinal intraluminal contents that may occur with such situations as an
ileus.
Give this one a try later!
, A. Decreased abdominal wall compliance can cause an increase in IAH and
ACS. Situations that can decrease intra-abdominal wall compliance include
acute respiratory failure with increased intrathoracic pressure, prone
position, abdominal surgery with primary fascial or tight closure.
Gastroparesis (delayed gastric emptying), ileus and colonic pseudo
obstruction can all result in increased intestinal intraluminal contents.
Increased peritoneal cavity contents occurs with hemoperitoneum,
pneumoperitoneum, or ascites.
Massive fluid resuscitation or capillary leak can may also result in IAH and
ACS. Some of the most common situations where this occurs includes:
massive transfusions (> 10 Units/24 hours), massive fluid resuscitations (>5
liters/24 hours), pancreatitis, sepsis, and burns.
You receive a 42 year old male patient from the Emergency Department who is being
admitted with suspected acute pancreatitis. You know the blood test most specific to
acute pancreatitis is:
A. Serum ammonia level.
B. Urine amylase Level.
C. Serum lipase Level.
D. Serum amylase level.
Give this one a try later!
C. Serum amylase level rises faster than serum lipase levels but serum
lipase is more specific to the pancreas than serum amylase. Therefore,
serum amylase is considered an early marker but serum lipase is a
confirmatory marker when elevated 3 times normal. Urine amylase will
often rise with pancreatitis but again, serum lipase is more specific to
pancreatitis.
A feeding tube is being placed at the bedside in a patient who is not fully alert.
Immediately after insertion the patient is coughing and his respirations appear more
labored. The appropriate response is:
A. Check the patient's oxygen saturation to confirm that placement is correct.
