NSG 233 MED SURGE 3 FINAL EXAM - QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW!!
Chest Trauma- Complications - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 - (ANSWER)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.
, NSG 233 MED SURGE 3 FINAL EXAM - QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW!!
Shock Septic- Dopamine - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 occur
because of manipulations with sheaths and catheters with the aortic lumen, although the exact etiology
is unknown. The symptoms are thought to be related to the activation of cytokines. They can be
managed with a mild analgesic (e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g.,
ibuprofen [Motrin]) and usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients can
resume their pre-proce
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW!!
Chest Trauma- Complications - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 - (ANSWER)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.
, NSG 233 MED SURGE 3 FINAL EXAM - QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW!!
Shock Septic- Dopamine - (ANSWER)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 - (ANSWER)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 - (ANSWER)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 occur
because of manipulations with sheaths and catheters with the aortic lumen, although the exact etiology
is unknown. The symptoms are thought to be related to the activation of cytokines. They can be
managed with a mild analgesic (e.g., acetaminophen [Tylenol]) or an anti-inflammatory agent (e.g.,
ibuprofen [Motrin]) and usually subside within a week.
Because of the increased risk of hemorrhage, the primary provider is also notified of persistent
coughing, sneezing, vomiting, or systolic blood pressure greater than 180 mm Hg. Most patients can
resume their pre-proce
