Summary ADVANCED CLINICAL CONCEPTS HESI HINTS DOCUMENT

ADVANCED CLINICAL CONCEPTS HESI HINTS DOCUMENT Trendelenburg because the weight of the lower organs restricts breathing). • Epinephrine: 1:1000, 0.2 to 0.5ml subq for mild • Epinephrine: 1:10,000, or 5ml IV for severe • Volume expanding fluids are usually given to clients in shock. However, if the shock is cardiogenic, pulmonary edema may result. • Drugs of choice for shock - Digitalis preparations: Increase the contractility of the heart muscle - Vasoconstrictors (Levophed, Dopamine): Generalized vasonconstriction to provide more available blood to the heart to help maintain cardiac output. • A common volume-expanding substance is plasma and possibly whole blood. • You are caring for a woman who was in severe automobile accident several days ago. She has several fractures and internal injuries. The exploratory laparotomy was successful in controlling the bleeding. However, today you find that this client is bleeding from her incision, short of breath, has a weak thready pulse, has cold and clammy skin, and hematuria. - What do you think is wrong with the client, and what would you expect to do about it? - These are typical signs and symptoms of DIC crisis. Expect to administer IV heparin to block the formation of thrombin (Coumadin does not do this). However, the client described is already past the coagulation phase and into the hemorrhagic phase. Her management would be administration of clotting factors along with palliative treatment of the symptoms as they arise. (Her prognosis is poor). • NCLEX-RN questions on CPR often deal with prioritization of actions. Question: What actions are required for each of the following situations? - A 24-year old motorcycle accident vistim with a ruptured artery if the leg is pulseless and apneic. - A 36-year old first time pregnant woman who arrests during labor. - A 17-year old with no pulse or respirations who is trapped in an overturned car, which is starting to catch fire. - A 40-year old businessman who arrests two days after a cervical laminectomy. • WHEN TO SEEK EMERGENCY MEDICAL SERVICE (EMS) - The American Heart Association recommends that those with known angina pectoris seek emergency medical care if chest pain is NOT relieved by three nitroglycerin tablets 5 minutes apart over a 150minute period. - A person with previously unrecognized coronary disease experiencing chest pain persisting for 2 minutes or longer should seek emergency medical treatment. • It is important for the nurse to stay current with the American Heart Association’s guidelines for Basic Life Support (BLS) by being certified every two years as required.