Comprehensive HESI Review Exit Test Bank 2022/2023 (Over 2000 Questions and Answers)

Comprehensive HESI Review Exit Test Bank 2022/2023 (Over 2000 Questions and Answers) Acute Respiratory Distress Syndrome (ARDS) The exchange of oxygen for carbon dioxide in the lungs is inadequate for oxygen consumption and carbon dioxide production within the body's cells Characteristics of ARDS Hypoxemia that persists even when 100% oxygen is given; decreased pulmonary compliance; dyspnea; non-cardiac associated bilateral pulmonary edema; dense pulmonary infiltrates on X-ray ARDS No abnormal breath sounds are present in this disorder on auscultation because the edema occurs first in the interstitial spaces and not the airways. ARDS Unexpected, catastrophic pulmonary complication occurring in a person with no pervious pulmonary problems. ARDS Common laboratory finding is a lowered pO2; not responsive to high concentrations of oxygen and often need intubation and mechanical ventilation with PEEP PEEP Positive end-expiratory pressure The instillation and maintenance of small amounts of air into the alveolar sacs to prevent then from collapsing each time the client exhales; amount of pressure can be set and is usually around 5-10cm of water Nursing Assessment of ARDS Dyspnea, hyperpnea; intercostals retractions; cyanosis, pallor; hypoxemia; diffuse pulmonary infiltrates seen on chest radiograph as "white-out" appearance; verbalized anxiety, restlessness Hypoxemia PO2 50mmHg with FiO2 60% Common causes of respiratory failure COPD; pneumonia; tuberculosis; contusion; aspiration; inhaled toxins' emboli; drug OD; fluid overload; DIC; shock Suction When providing care to a patient with ARDS, only do this when secretions are present 7.35-7.45 PH normal value 35-45 mmH PCO2 normal value 22-26 mEq HCO3 normal value 80-100mm PO2 normal value 95-100% O2 normal value Allen Test Perform this test before drawing an ABG from the radial artery Common cause of respiratory failure in children Congenital heart disease; respiratory distress syndrome; infection, sepsis; neuromuscular diseases; trauma and burns; aspiration; fluid overload and dehydration; anesthesia and narcotic OD Nursing assessment of child in respiratory failure Kid just "looks bad;" very slow or very rapid RR, dyspnea, apnea, gasping; tachycardia; cyanosis, pallor, or mottled color; irritability and lethargy; retractions, nasal flaring, poor air movement; hypoxemia, hypercapnia, respiratory acidosis Respiratory Failure PCO2 45 or PO2 60 on 50% O2; a child in severe distress should be on 100% O2 Shock Widespread, serious reduction of tissue perfusion which, if prolonged, leads to generalized impairment of cellular functioning System Hypotension Marked reduction in either cardiac output or peripheral vasomotor tone, without a compensatory elevation in the other results in this Early signs of shock Agitation and restlessness that results from cerebral hypoxia Hypovolemic Shock Related to external or internal blood or fluid loss Cardiogenic Shock Related to ischemia or impairment in tissue perfusion resulting from MI, serious arrhythmia, or HF; all cause decrease CO Vasogenic Shock Related to allergens, spinal cord injury, or peripheral neuropathies, all resulting in venous pooling and decreased blood return to the heart, which decreases cardiac output over time Septic Shock Related to endotoxins released by bacteria, which cause vascular pooling, diminished venous return, and reduced CO High fowler position with legs down Position to reduce venous return in order to decrease further venous return to the left ventricle Medical treatment for shock Rapid infusion of volume-expanding fluids such as whole blood, plasma, plasma substitutes; isotonic, electrolyte IV solutions; CVP artery catheters; CVP measurements, urine output, HR, clinical and mental state; immediate attendtion to improvement of perfusion; administration of drugs is withheld until circulating volume has been restores; O2 administration Pulmonary edema If shock is cardiogenic in nature, the infusion of volume-expanding fluids may result in this Cardiac Function When treating a patient with shock, the restoration of what should take priority Increase Cardiac Contractility Administration of cardiotonic drugs such as digitalis does what? Dopamine and digitalis Increases the contractility Dopamine (Dopram) and norepinephrine (Levophed) Vaso-constricting agents that may be used in cardiogenic shock Nursing Assessment of patient in shock Tachycardia, tachypnea, decrease in BP (systolic 80mmHg) ; mental status changes; cool, clammy skin; diaphoresis, paleness; urine output decreases; CVP 4cm of H2O; urine SG 1.020 Hypovolemia Urine SG 1.020 indicates? Early shock mental status changes Restless, hyper-alert Late shock mental status changes Decreased alertness, lethargy, coma Patient in shock Maintain a urine output of at least 30ml/hr and notify health care provider if it drops below this CVP Administer prescribed fluids until designated ?? is reached in patients with shock CVP When a patient is in shock, this number is usually elevated to 16-19 cm of H2O as compensation for decreased cardiac output Patient in shock Place this patient in Trendelenburg position (feet up 45 degrees, head flat IM or Subcutaneous route Do not administer medications via these routes to a patient in shock until perfusion improves to the muscles and subcutaneous tissues Vasopressors or adrenergic stimulants When administering these medications to a patient in shock, they must be administered via a volume-controlled pump; monitor BP q 5-15 min; watch IV site carefully for extravasation and tissue damage; ask about the target mean systolic BP Vasopressors or adrenergic stimulants used in shock patients Epinephrine (Bronkaid). Dopamine (Dopram), Dobutamine (Dobutrex), norepinephrine (Levophed), isoproterenol (Isuprel) Vasodilators used in shock patients Hydralazine (Apresoline), nitroprusside (Nipride), labetalol hydrochloride (Normodyne, Trandate) Vasopressor and vasodilator drugs Potent drugs used in shock patients; dangerous and require that the client be weaned onto and off them. Don't change both infusions rates simultaneously. Vasodilator; Vasopressor If drop in BP occurs, decrease ?? infusion rate first, then increase ?? rate Vasopressor; Vasodilator If BP increases, decrease ?? rate first, then increase the rate of the ?? Stage 1 of hypovolemic shock Initial stage; blood loss of less than 10%; compensatory mechanisms triggered; apprehension and restlessness; increased HR; cool, pale skin; fatigue; arteriolar constriction; increased production of ADH; arterial pressure maintained; CO normal; reduction in blood flow to the skin and muscle beds Stage 2 of Hypovolemic Shock Compensatory stage; blood volume reduced by 15%-25%; decompensation begins; flattened neck veins and delayed venous filling time; increased HR&RR; pallor, diaphoresis and cool skin; decreased UP; sunken soft eyeballs; confusion; marked reduced in CO; arterial pressure decline; massive adrenergic compensatory response; decrease cerebral perfusion massive adrenergic compensatory response Tachycardia, tachypnea, cutaneous vasoconstriction and oliguria Stage 3 of Hypovolemic shock Progressive stage; edema; increased blood viscosity; excessively low BP; dysrhythmia, ischemia, and MI; weak, thread, or absent peripheral pulses; rapid circulatory deterioration; decreased CO; decreased tissue perfusion; reduced blood volume Stage 4 of Hypovolemic shock Irreversible stage; profound hypotension that is unresponsive to vasopressor drugs; severe hypoxemia that is unresponsive to O2; anuria, renal shut down; HR slows, BP falls with consequent cardiac and respiratory arrest; cell destruction so severe that death is inevitable; multiple organ system failure Severe shock Leads to widespread cellular injury and impairs the integrity of the capillary membranes Fluid and osmotic proteins Seep into the extravascular spaces, further reducing CO Mean arterial pressure Normal value in adults 100mmHg Mean arterial pressure Level of pressure in the central arterial bed measured indirectly by BP; measured directly through arterial catheter insertion MAP calculation CO x total peripheral resistance = systolic BP + 2/3 Cardiac Output Volume of blood ejected by the left ventricle per unit of time Cardiac output Normal value is 4-6L/min CO calculation Stroke volume (amount of blood ejected per beat) x HR Peripheral resistance Resistance to blood flow offered by the vessels in the peripheral vascular bed. Central venous pressure