Carlos Adams was involved in a motor vehicle crash and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg.
His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.
The following prescriptions are written for the patient: . Place two large-bore IVs and infuse 0.9% NS at 125 ml/hr/line Obtain complete blood count, serum electrolytes • Oxygen at 2 L/min via nasal cannula Type and cross for 4 units of blood . Flat plate of the abdomen STAT (Learning Objectives 4 and 5) ..
Describe the pathophysiologic sequence of events seen with hypovolemic shock.
b. What are the major goals of medical management in this patient? What is the rationale for placing two large- bore IVS?
c. What are advantages of using 0.9% NS in this patient?
d. What is the rationale for placing the patient in a modified Trendelenburg position?
Multiple Organ Dysfunction Case St…
1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments.
The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg.
His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep Sao, greater than 90%.
The patient responded to 2 L of oxygen per nasal cannula with an sao, of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL.
The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg.
A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy.
(Learning Objectives 4, 6 and 7) What predisposed the patient to develop septic shock? What potential findings would suggest that the patient’s septic shock is worsening from the point of admission? The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS).
Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?
Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? Explain the importance for nutritional support for this patient and which type of nutritional support should be provided? 27
Select the best answer for the question
1. A fellow coworker tells you that she accidently gave a patient the incorrect medication. The coworker has realized that she made the mistake and has checked on the patient. What else does your coworker need to do right away?
A. Report the error immediately to the provider and document the error once letting the patient go home.
B. Report the error immediately to the provider and follow the provider’s order for correcting the error
C. Let the patient go home and document what happened.
D. Report the error immediately to the provider and follow the provider’s orders but don’t tell the patient that an error occurred.
2. Which of the following statements best describes a nebulizer?
A. It’s a way to measure an asthmatic’s inspiratory volume.
B. It’s a device that changes medications from a powder form into a mist.
C. It’s a way to measure a patient’s oxygen level.
D. It’s a device that changes medication from a liquid form into a mist.
4. Which one of these items is not mandated by OSHA?
A. Employees must partake in Standard Precautions.
B. Employees must practice engineering/work practice controls.
C. Employees must purchase their own PPE to use while at work.
D. Employees must receive Hepatitis B vaccine.
6. A medication error can occur when
A. the drug is administered to the correct patient.
B. a drug is administered via an incorrect route.
C. the correct drug is given.
D. the correct dose is administered.
Which one of the following is not part of the Seven Rights of Medication Administration?
A. Right Time
B. Right Route
C. Right Dose
D. Right Brand
The microorganisms that live in our intestinal tract are often referred to as
A. normal fauna.
C. normal viruses.
D. normal flora.
Transmission-Based Precautions are
A. another term for Standard Precautions.
B. precautions that only the physicians need to follow.
C. used when a patient is suspected of or diagnosed with a highly contagious disease.
D. only used in the inpatient setting.
An example of a dry powdered inhaler is
If a person is exposed to a body fluid, what should be the first thing that he or she should do?
A. Immediately wash flush the exposed area with water and soap or mouthwash, if appropriate, then report the incident to supervisor for documentation
B. Leave work immediately and go straight to the nearest emergency room
C. Keep working and wash/flush the area later. Tell the supervisor when he or she gets the chance.
D. Keep working and don’t say anything because it might cause problems with the employer.
When getting ready to administer an MDI inhaler,
A. document the administration of the inhaler when checking the “three befores.”
B. make sure that the inhaler is well-shaken prior to administering.
C. make sure that the inhalers are only given when a patient is in respiratory distress.
D. never shake the inhalers because they may break.
When providing patient education on the use of an inhaler, instruct the patient
A. that exhaling while activating the inhaler is when the medication is released.
B. to rinse their mouth and mouthpiece after using the inhaler to prevent potential microorganism growth.
C. that inhalers really don’t have any side effects to worry about
D. to use the inhaler whenever they need it.
The prescription label is just a guideline to follow.
Oxygen is ordered as
A. liters per minute.
B. levels per minute.
C. milliliters per minute.
D. liters per millisecond.
Which fact about fingernails in the clinical setting is true?
A. Fingernails don’t matter as long as hands are thoroughly washed.
B. Long nails that are artificial or real make it easier to type and enter data when using a keyboard.
C. Artificial nails should not be worn in the clinical setting because they can harbor bacteria.
D. Artificial nails do not harbor bacteria because they’re fake and not made of organic matter.
When charting the administration of a medication, which of the following information should be documented?
A. Patient’s name, name of the drug, the route, the shape of the pill, the color of the pill, any complications, any necessary vital signs, and signature and date
B. Patient’s name, date and time of administration, name of the drug, route, any unusual reactions, any complications, any necessary vital signs, and signature and date
C. Name of the drug, route, any unusual reactions, any complications, any necessary vital signs, signature and date, the shape of the pill, and the color of the pill
D. Patient’s name, name of the drug, route, any unusual reactions, any complications, and how busy the office was while trying to complete the patient care
Finish the following sentence regarding one of the “three befores”: Double-check the medication
A. on returning the medication container to storage or before discarding the empty container.
B. just before removing it from the container,
C. when the medication is taken from the storage area.
D. as you hand it to the patient.
John has T cells that can respond to an Antigen S1 (SARS-CoV-2 spike protein). John’s friend Harry has been exposed to antigen S1, and John offers to have some of his T cells transfused to Harry so that he will not come down with an infection. You overhear their conversation.
Based on what you have learned about of the binding of T cell to either Class I or Class II HLA in chapter 22, do you think such a transfusion would or would not work? Why? – IF E Module 03 Discussion Board For this discussion board you are asked to write a reflection regarding the following story.
• You are asked to provide an initial reflection post containing at least 150 words. To start, click on the “Reply” button below. You may choose to type your post in a word processing document separately and copy/paste the text into the dialogue box. .
Please also respond to at least one classmate with thoughtful posts of at least 150 words each. When finished, click on the “Post Reply” button This discussion board is worth up to 15 points. Here is the story to review for this discussion: John has T cells that can respond to an Antigen S1 (SARS-CoV-2 spike protein).
John’s friend Harry has been exposed to antigen S1, and John offers to have some of his T cells transfused to Harry so that he will not come down with an infection.
You overhear their conversation. Based on what you have learned about of the binding of T cell to either Class I or Class II HLA in chapter 22, do you think such a transfusion would or would not work? Why? .
Description: Shenya Jones, 34-year-old female, arrives at the office with swelling and a red pustule on her face. She states that the problem started 2 days ago as a small pimple near her nose. It became irritated, and then extremely swollen and painful overnight.
This morning, she noticed yellow drainage at the lesion site and the swelling has increased. The area of drainage is approximately 1 cm in diameter.
Her upper lip, side of the face, and nose are all swollen.The examination and treatment areas need to be prepared before you bring her to the back office.
1. What needs to be done before Shenya is brought back into the exam room?
2. Shenya is diagnosed with community-acquired MRSA (a highly contagious microorganism). What measures should you take to ensure there is no transfer of infection?
3. After Shenya’s examination, you will need to use an ultrasonic cleaner for sanitization. Describe how you would proceed and what source you would use if you had questions about the cleaner you are using. P.S: Please answer all 3 questions individually. Thank you.
Status epilepticus is when: seizures that continue without interruption for at least ten minutes seizures that continue without interruption for at least five minutes o intermittent seizures occurring over at least 30 minutes O grand mal seizures leading to respiratory arrest
A patient with gout has an accumulation of urate crystals in subcutaneous tissue causing formation of white nodules are called: o tophi o heberden nodes o bouchard nodes o pseudogout
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