Question1/6
Review all the pages of the electronic healthcare record (EHR).
Recognize Cues
Select the changes that indicate the client’'s condition has deteriorated since admission to the ICU. Be sure to review all tabs. Select all
that apply
Date/Time Nurses' Notes
4/23120YY Admitted from cardiac catheterization suite post acute myocardial infarction (AMI) and percutaneous
1120 coronary intervention (PCl); new stents in left anterior descending (LAD) and circumflex coronary
arteries; client experienced cardiac arrest during the procedure and was successfully resuscitated; skin is
cool and diaphoretic to touch; peripheral pulses 1+; capillary refill = 3 seconds; respiratory therapist at
bedside managing ventilator; telemetry and oxygen saturation monitor applied. Right radial arterial line
intact and secured: left (L) groin pressure dressing intact with no swelling or bruising noted.
4/23120YY
Responded to low blood pressure alarm , vital signs as noted;
1140
large bruise noted extending from L groin pressure dressing direct pressure applied . healthcare
provider notified.
, Question 216
Review the slectronic healheare record (EHR).
== [E== [e==r=]
DaterTime. Nurses Notes
423207Y | Admitted from cardiac catheterization suite post acute myocardia infarction (AMI) and percutaneous
120 coronary intervention (PCI); new stents in left anterior descending (LAD) and circumfiex coronary.
arteres; client experienced cardiac arrest during the procedure and was successfuly resuscitated: skinis
ool and diaphorefic o touch; peripheral pulses 1+; capillary refil > 3 seconds: espiratory therapist at
bedside managing ventiator; telemelry and oxygen saturation monitor applied. Right radial arterial ine
intact and secured; left (L) roin pressure dressing intact vith no swelling of buising noted.
423207 | Responded 1o low blood pressure alarm, vita signs as noted; large bruise noted extending from L groin
140 pressure dressing, direct pressure applied; healthcare provider nofified
Analyzing Cues
The ciientis at risk for developing which health alterations? Select al hat apply.
Hyperrefiexia
Ventiaton-perusion mismatch
Increased ammonia levels
Decreased lactate levels
Anasarc
Ischemia of ingers and foes
, Question 316
Review the slectronic healheare record (EHR).
== [E== [e==r=]
DaterTime. Nurses Notes
423207Y | Admitted from cardiac catheterization suite post acute myocardia infarction (AMI) and percutaneous
120 coronary intervention (PCI); new stents in left anterior descending (LAD) and circumfiex coronary.
arteres; client experienced cardiac arrest during the procedure and was successfuly resuscitated: skinis
ool and diaphorefic o touch; peripheral pulses 1+; capillary refil > 3 seconds: espiratory therapist at
bedside managing ventiator; telemelry and oxygen saturation monitor applied. Right radial arterial ine
intact and secured; left (L) roin pressure dressing intact vith no swelling of buising noted.
423207 | Responded 1o low blood pressure alarm, vita signs as noted; large bruise noted extending from L groin
140 pressure dressing, direct pressure applied; healthcare provider nofified
Prioritize Hypotheses
Use the drop-down options to choose the answer that best completes the sentence.
“The client i at highest rsk for developing [cardiogenic shock | teadingto [renal fature v