NSG 233 Med Surge 3 Final Exam -
LauraRuth28 (questions with answers)
Chest Trauma- Complications - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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.
Shock Septic- Dopamine - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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.
LauraRuth28 (questions with answers)
Chest Trauma- Complications - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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.
Shock Septic- Dopamine - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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 - ....🔰VERIFIED ANSWERS.... ✔✔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.
