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Examen

Nur2115 Exam 2 Questions & 100% Correct Answers

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how to calculate cardiac output :~~ CO = SV x HR Mean Arterial Pressure (MAP) :~~ MAP= SBP + 2(DBP) / 3 Normal= 70-105mmHg Needs to be >65mmHg to perfuse ONLY the vital organs. THIS IS NOT NORMAL Use A line to measure Pulmonary Artery Catheter Pressures :~~ PA pressures- (distal port) PAS= 15-30mmHg PAD 8-15mmHg SIRS :~~ systemic inflammatory response syndrome. does not have to be associated with an infection. 2 | P a g e | © copyright 2024/2025 | Grade A+ Master01 | September, 2024/2025 | Latest update SIRS criteria :~~ need 2 or more s/s -temp >100.4, temp <96.8 -HR >90bpm -RR >20 and /or PCO2 <32 (rapid breathing) -WBC >12,000 or <4,000 WOTF is not criteria s/s for dx SIRS 1. RR > 20 2. HR <60 3. Temp >100.4 4. PaCO2 <32 :~~ 2. HR <60 ANSWER DIC :~~ disseminated intravascular coagulation DEATH IS COMING NO PERFUSION They will have an increased D Dimer 3 | P a g e | © copyright 2024/2025 | Grade A+ Master01 | September, 2024/2025 | Latest update DIC clinical presentation :~~ Acute bleeding from multiple sites. Bleeding from everywhere. Organ dysfunction, Thrombosis. DIC nursing management :~~ 1. Occult blood testing of all fluids 2. avoid puncturing the pt. 3. Apply pressure 10-15 MIN for arterial puncture. 5MIN for venous puncture. 4. paper tape 5. No BP cuff. NEED AN A LINE 6. No rectal temp 7. gentle personal care 8. dec. pressure points 9. monitor pupils for changes- Could be cerebral bleed. WOTF lab value is indicative of DIC 1. dec PTT 2. inc Platelet 3. dec INR 4. inc FDP (fibrin degradation product) 4 | P a g e | © copyright 2024/2025 | Grade A+ Master01 | September, 2024/2025 | Latest update :~~ 4. inc FDP (fibrin degradation product) ANSWER hypovolemic shock :~~ TANK PROBLEM inadequate fluid volume in the space cardiogenic shoc

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Institución
NUR2115
Grado
NUR2115

Información del documento

Subido en
9 de septiembre de 2024
Número de páginas
32
Escrito en
2024/2025
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Examen
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1 | P a g e | © copyright 2024/2025 | Grade A+




Nur2115 Exam 2 Questions & 100%
Correct Answers
how to calculate cardiac output

✓ :~~ CO = SV x HR




Mean Arterial Pressure (MAP)

✓ :~~ MAP= SBP + 2(DBP) / 3

✓ Normal= 70-105mmHg

✓ Needs to be >65mmHg to perfuse ONLY the vital organs. THIS IS NOT

NORMAL

✓ Use A line to measure




Pulmonary Artery Catheter Pressures

✓ :~~ PA pressures- (distal port)

✓ PAS= 15-30mmHg

✓ PAD 8-15mmHg




SIRS

✓ :~~ systemic inflammatory response syndrome.

does not have to be associated with an infection.




Master01 | September, 2024/2025 | Latest update

, 2 | P a g e | © copyright 2024/2025 | Grade A+




SIRS criteria

✓ :~~ need 2 or more s/s

-temp >100.4, temp <96.8

-HR >90bpm

-RR >20 and /or PCO2 <32 (rapid breathing)

-WBC >12,000 or <4,000




WOTF is not criteria s/s for dx SIRS

1. RR > 20

2. HR <60

3. Temp >100.4

4. PaCO2 <32


✓ :~~ 2. HR <60 ANSWER




DIC

✓ :~~ disseminated intravascular coagulation

DEATH IS COMING

NO PERFUSION

They will have an increased D Dimer




Master01 | September, 2024/2025 | Latest update

, 3 | P a g e | © copyright 2024/2025 | Grade A+


DIC clinical presentation

✓ :~~ Acute bleeding from multiple sites. Bleeding from everywhere. Organ

dysfunction, Thrombosis.




DIC nursing management


✓ :~~ 1. Occult blood testing of all fluids

2. avoid puncturing the pt.

3. Apply pressure 10-15 MIN for arterial puncture. 5MIN for venous puncture.

4. paper tape

5. No BP cuff. NEED AN A LINE

6. No rectal temp

7. gentle personal care

8. dec. pressure points

9. monitor pupils for changes- Could be cerebral bleed.




WOTF lab value is indicative of DIC

1. dec PTT

2. inc Platelet

3. dec INR

4. inc FDP (fibrin degradation product)




Master01 | September, 2024/2025 | Latest update

, 4 | P a g e | © copyright 2024/2025 | Grade A+


✓ :~~ 4. inc FDP (fibrin degradation product) ANSWER




hypovolemic shock


✓ :~~ TANK PROBLEM

inadequate fluid volume in the space




cardiogenic shock

✓ :~~ PUMP PROBLEM

Coronary- problem with heart itself, cant move blood.

Non-Coronary- physical obstruction into or out of heart




circulatory (distributive) shock

✓ :~~ PIPE PROBLEM ---> EXTREME VASODILATION

septic shock- inflammatory response due to invasion of organism

anaphylactic- antigen-antibody response




shock initially

✓ :~~ Dont see anything at first. will just have a lactic acid buildup.




Compensatory stage




Master01 | September, 2024/2025 | Latest update
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