Pulmonary, Cardio and Sepsis

Question 1

Pulm: Discuss the rationale of performing high quality oral care for mechanically ventilated patients

Answer 1

Oral care should be performed using a suction toothbrush at least every 12 hours on patients who are mechanically ventilated in order to prevent Ventilator Acquired Pneumonia.

Question 2

ABG: analyze the following ABG
pH- 7.25
PaCO2- 29
HCO3- 14

Answer 2

Partially Compensated Metabolic Acidosis

Question 3

ABG: analyze the following ABG
pH- 7.50
PaCO2- 36
HCO3- 18

Answer 3

Uncompensated Respiratory Alkalosis

Question 4

Pulm: Describe the expected finding of a chest tube suction control chamber and water seal chamber

Answer 4

Gentle, continuous bubbling of the suction control chamber is normal and expected. Bubbling in the water seal chamber during exhalation or coughing indicates that air is being pulled from the pleural space. The bubbling should not be excessive or continuous. If it does, there is an air leak somewhere in the chest tube

Question 5

Pulm: Describe why a patient with a spontaneous pneumothorax is at risk of developing a tension pneumothorax

Answer 5

Air in the pleural space compresses the vessels in the chest cavity and compromises blood return to the heart. As more air accumulates, there is greater risk of displacing the trachea (tension pneumothorax). This is an emergency

Question 6

Cardio: Describe why Amiodarone is the treatment of choice for a patient who converts into ventricular tachycardia but has a pulse

Answer 6

Ventricular tachycardia with a pulse is not defibrillated nor is CPR started. Pacing is not indicated. The rhythm will be treated with antiarrhythmics

Question 7

Cardio: Explain why defibrillation takes priority over any other intervention when a patient is in ventricular fibrillation

Answer 7

The greatest risk to the client is death from a lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular fibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular fibrillation into a sustainable rhythm

Question 8

Cardio: Explain the difference between V. Tach with a pulse and pulseless V. Tach

Answer 8

V. Tach with a pulse is typically intermittent and the patient should be observed and treated for symptoms. Pulseless V. Tach is a shockable rhythm and defibrillation is the priority action

Question 9

Cardio: State the arrhythmias that are shockable and describe why defibrillation is the priority action

Answer 9

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

Both of these are incompatible with life because there is virtually no cardiac output due to the left ventricle not squeezing efficiently

Question 10

Cardio: Describe vagal maneuvers and why you would use them

Answer 10

Vagal maneuvers refer to actions that stimulate the vagus nerve and causes the heart rate to slow down. Things like baring down and carotid stimulation are considered vagal maneuvers and are used for patients with stable supraventricular tachycardia (SVT)

Question 11

Describe the priority nursing action for a patient in asystole and why

Answer 11

A patient in asystole should be given high-quality CPR as a priority. Defribrillation is not indicated for asystole because there is no electrical activity

Question 12

State proper delivery of adenosine for tachycardic arrhythmias

Answer 12

Adenosine must be delivered in a controlled environment such as an ICU setting where advanced cardiac life support resources are readily available

Question 13

Describe the rationale for using IV amiodarone

Answer 13

Amiodarone is used as an antiarrhythmic for maintenance of normal rhythms

Question 14

Describe why a nurse might use an ambu bag to manage a patient on mechanical ventilation

Answer 14

A nurse may use an ambu bag to mainain an artifical airway of a patient with mechanical ventilation when they are transporting to another department and when a ventilator malfunctions and a respiratory therapist is preparing an alternative ventilator for the patient

Question 15

Cardiac: Describe the mechanism of action for Atropine and what is is used for

Answer 15

Atropine increases the sympathetic nervous system drive and depresses the parasympathetic drive thereby increasing the heart rate. Atropine can be used to treat symptomatic bradicardia

Question 16

Cardiac: Describe the mechanism of action for Adenosine and what it is used for

Answer 16

Adenosine slows the conduction through the AV and SA nodes, thereby disrupting erratic cardiac electrical activity. It is used in the treatment of SVT that is unresponsive to other methods of conversion. Adenosine must administered with consent from the patient, a physician at the bedside, and defibrillation pads in place

Question 17

Discuss the relationship between cardiac arrhythmias and tissue perfusion

Answer 17

Cardiac arrhythmias can impact cardiac output due to the fast or slow rate or the disrupted electrical conduction

Question 18

Sepsis: Describe early signs of sepsis

Answer 18

Recent infection
Elevated temperature
Tachycardia
Tachypnea
Elevated WBC
Elevated Lactate

Question 19

Sepsis: Describe the priority nursing actions when sepsis is suspected

Answer 19

Fluid resuscitation (30ml/kg)
Obtain blood cultures BEFORE administering antibiotics
Begin vasopressors
Administer broad-spectrum antibiotics