A 65years old female with diagnosis of AKI,Dehydration, secondary diagnosis Dm,HTN,Hypothyroidism, Appendectomy, Right Great toe amputation. Full code, 5ft 8inches, weighs 170lbs. Admitted to Medical Surgical floor. Syncope and dizziness during shower.Allergy: NKDA.
Blood sugar check QAC + QHS Diet: Carib Control cardiac diet.Labs CBC with differential, Chem 7 in am.
1.What at is the full meaning of AKI?
Answer:
A.AKI stands for Acute Kidney injury.
B.Accurate Knowledge information
C.A and B.
D.All of the above.
Correct answer A
2.The doctor orders carb control cardiac diet. What does the nurse understands about this?
Answer:
A.The patient is diabetic and Hypertension, so the doctor considers the patient condition when ordering diet.
B.Carb control cardiac diet is the same as regular diet.
C.This is the same as keto diet
D.B and C.
Correct answer A.
Rationale :Since patient is hypertensive and diabetic, the doctor orders food that is low in sodium and sugar which is carb control cardiac diet. Diabetes contributes substantially to morbidity and mortality with diabetic foot complications being among the most serious and costly complications of diabetes. Foot ulceration often lead to amputation.
3.List three comorbidities for this patient.
Answer:
A.Hypertension, diabetes ,hypothyroidism.
B.Great toe amputation, and age.
C.Age with chronic condition.
C.None of the above .
Correct answer A.
Rationale: Diabetes,hypertension and hypothyroidism are comorbidity. B,C, D are not.
Mr. Y J.74 years Male brought into the Emergency room by his daughter, because of confusion for the past two days.Diagnosis: Hyponatremia ( Sodium 125), Sepsis. Secondly Diagnosis: High Cholesterol, Diabetes, Dementia, Hypertension.Allergy: Morphine, Vancomycin. Diet :Cardiac Heart health diet.Generalized rashes( reaction to antibiotic – Vancomycin)Bilateral upper Extremity skin tears.Tegaderm to skin tear.Voiding well using the urinal.Had bowel movements × 2 today.Normal Saline(0.9NS) at 75ml/hours left hand.
Lab: Sodium level check Q8hours × 24 hrs. Chem 7 in am.
(Normal sodium levels in the blood is 135 to 145mEq/L)
Blood Sugar check: QAC + (QHS.
Medications:
Sodium 1gm Q8hrs.
Calamine lotion Qhs.
Benadryl 25mg iv/PO Q6hours itching.
PLAN: Discharge home when medically stable.
Continue home medications per doctor discharge orders.
Follow up with your primary care physician in one week. Patient family are very good with his care. Case manager saw and evaluated patient. The daughter said that they have enough supplies at home including his medications.
(Normal sodium level is 135mEq/L to 145mEq/L.
There are two types of hypertension crisis.
4.What is Hypertensive Emergency?
Answer :This is a severe increase in blood pressure that can lead to a stroke. It can damage blood vessels’ 180/120, uncontrolled.
It can lead to organ damage.
What is Hypertensive urgency? Blood pressure is remarkably high with minimal or no symptoms.
EKG is an electrocardiogram test of the heart. It is simple and very painless. It measures the electric signal of your heart. Each time that your heart beats this signal will travel across your heart. EKG tells if your heart is strong and beating at a normal rate or abnormal rate. EKG can reveal an arrhythmia that is abnormal heart rate .Is your heart getting enough oxygen, it can tell your doctor that. Is the heart enlarged, or did you have a heart attack in the past.EKG will disclose all of that.
Heart Sounds.
S1 This is associated with the closing of the AV Valves.It is loudest at Apex and the beginning of systole.
S2 Is known as the closure of semi lunar valves. It is usually very loud at the base.
S3 In older adult is associated with ventricular gallop. This is due to fluid overload, or CHF. It is normal in children and young adult.
S4: Can occur with no cardiac disease. But it can be an indication of hypertension, CAD ,or heart failure.
Age/Sex 60years ,male. Admitted with CHF.
CHF is the failure of the heart to pump blood effectively to meet metabolic demands. Because of that failure, there is excessive amount of fluid in the heart, lungs and tissues
The left sided failure the blood will back up into the lungs causing pulmonary edema manifestations. When the right side of the heart fails blood backs up into the venous and portal system manifestations.
Signs/Symptoms of CHF are dyspnea, orthopnea, weight gain, Pulmonary edema, distended neck veins, crackles.
Treatment:
Oxygen at 2 Liter Nasal Canula.Digoxin, dopamine, diuretics (Lasix)Digoxin 0.125mg PO dailyLasix 20mg IV BID.
Nurses responsibilities:
Place patient in high Fowler’s position.
Assess vital signs Q4hours.
Lung sounds.
Monitor Intake and output.
Check peripheral pulses
Provide good skin care.
The nurse formulates a plan of care for a patient with left sided CHF. An appropriate nursing diagnosis would be an alteration in gas exchange secondary to increased in Capillary hydrostatic pressure.
Questions:
5.Why is patient placed on low sodium diet?.
Answer:
A.Patient came in due to congestive heart failure. Since the heart is not pumping well extra sodium will lead to fluid retention.
B.It is what it is.Heart not pumping.
C.Fluid restriction is good enough.
Well patient is breathing.
Correct answer A.
6.What is the rationale for potassium supplements?
Answer:
A.Patient is on Lasix and Lasix deplete potassium.
B.Our body need some electrolytes.
C.Potassium is good for you.
DWhy not, it is one of the electrolytes of the body..
Correct answer A.
Rationale: When given Lasix, it decrease fluid by making the patient to urinate a lot ,and it takes potassium as you urinate. So you get potassium if your potassium is low. But if you are a dialysis patient. The nurse should call the doctor so that it will be taken care of during dialysis.
7.The nurse is preparing to begin a dopamine infusion on a client. Before beginning the infusion the nurse?
Answer:
A.Should assess for the Patency of IV.
B.Assess if patient can swallow.
C.Check the doctor order again.
D.Check patient room number.
Correct answer: A.
Rationale: It is very important ,to assess for iv potency.
Case Scenario of left sided CHF.
A 68years old man is admitted to the hospital for the treatment of left sided CHF. While the nurse is assessing the patient, she should identify that dyspnea is an early sign of left sided heart failure. Identify the key word “early ” and left sided. As a way to differentiate left versus right sided CHF. Think of cars on a highway. If a car cannot get onto a highway because of traffic congestion, it remains on the entrance ramp. If blood can’t get into the heart due to congestion, it remains where it is .Blood attempting to get into the right side of the heart remains in the vessel of systemic circulation.
Dyspnea because the lungs vital capacity is reduced when air is displaced by fluid. Left sided failure signs and symptoms are dyspnea, orthopnea, crackles, tachycardia, diaphoresis, confusion
But the Right Sided Heart signs and symptoms weight gain,edema,distended neck vein, increased CVP.
8.A 45years old man is admitted for the treatment of heart disease ( CHF).The doctor orders an IVF of 0.9NS at 125ml/hour and the CVP readings Q4hours. 16hours after admission the CVP readings is 3cmH20.
9.What is the evaluation of patient’s fluid status if made by the nurse is accurate?
Answer:
A.The patient need more fluid because the normal level is 3 – 8cm, and patient fluid status indicates hypovolemia.
B.Patient is not hypovolemic.
C.Fluid volume is normal.
D.0.9NS at 125ml/hour is too much.
Correct answer A.
10.A 65years old woman is admitted to the hospital with a diagnosis of Myocardial infarction. Morphine sulfate is ordered by the doctor for the relief of pain. In addition to providing pain relief, the nurse knows that Morphine sulfate will provide what effect?
Answer:
A.Decreased blood return to the right side of the heart; decreased peripheral resistance. Decreased preload and after load pressure. Morphine sulfate is the drug of choice for an MI because it reduces the preload and after load pressure, also provides relief for anxiety. Dilaudid is used if patient is allergic to morphine or sensitive to respiratory depression.
B.Increase blood return to the right side of the heart.
C.Put the patient to sleep and relaxation.
D.Morphine is often the drug of choice.
Correct answer A.
Rationale: Decreased preload and after load pressure. Morphine sulfate is the drug of choice for an MI because it reduces the preload and after load pressure, also provides relief for anxiety. Dilaudid is used if patient is allergic to morphine or sensitive to respiratory depression. So morphine is very effective.
11.The nurse plans of care for of a patient diagnosed with an acute myocardial infarction. An appropriate nursing diagnosis would be. A potential for alteration in cardiac output secondary to what?.
Answers:
A.The heart is compromised.
B.This is a serious cardiac issue.
C.A& B
D.Ventricular dysrhythmia . TGV(Transportation of the great vessels) has reduce the efficiency of the heart, which is common after myocardial infarction.
Correct answer D.
12.A 23 years old female comes to the Emergency room with a possible Pneumothorax. Based on the nurse’s knowledge about the respiratory patterns of a patient with a Pneumothorax. The nurse should assess the patient for the development of?
Answer:
A.Tachypnea.
B.Asthma
C.Bradycardia.
D.Pneumothorax.
Correct answer A.
Rationale: Tachypnea (Fast shallow breathing) is a condition that involves rapid breathing. The normal breathing rate for an average adult is between 12 to 20 breath per minute.
13.The nurse cares for a 48years old man who sustained a Pneumothorax in an automobile accident. The patient has a chest tube attached to three chamber water seal drainage system (Pleur evac) connected to suction. When assessing the functioning of the chest tube the nurse should be most concerned if?
Answer:
A.There is continuous bubbling during both inspiration and expiration in the water seal chamber Pleur- evac has three chamber water seal drainage system First Chamber collect drainage. Second Chamber act as water seal.
B.No changes noted.
C.Inspirational and expiration bubbling is what we want.
D.B & C.
Correct answer A.
Rationale: Should fluctuate (tidal) with respiration. If it stops fluctuating the lungs has re- expanded or tubes are obstructed.
Continuous bubbling is an indication of Air leak
Third Chamber is the Suction control. Alters the amount of suction delivered to pleural Space. And should bubble gently and continuously.
There are various types of chest tube.
Pleura-vac combine wet and dry into one drainage system.
Dry chest tube.
Dry suction system allows you to do more than 20cm suction, can go up to 40cm.
Sizes: Adult 24 to 40 FR.
Children 18 FR.
Chest Tube Drainage System.
This chest tube is connected to the patient. Look at it very well. What is your observation?
What are the indication for Chest Tube?
Pneumothorax air enters into pleural space due to trauma or spontaneously.
Hemothorax blood enters pleural space due to trauma ,tuberculosis, blood clotting issue.
14.What Are The Landmark For Chest Tube Placement.
Mid-axillary between the 4th and 5th intercostal space for the removal of air and fluid.
Sometimes Anterior chest 2nd intercostal space, midclavicular line for air removal.
Coagulopathy.
If pneumothorax is < 10 -15%.
Skin infection over site.
Diaphragmatic hernia.
Adhesions in pleural space.
Bleeding.
Infection.
Sub-Q emphysema.
Air leak bubbling in the seal chamber.
Re-expansion pulmonary edema.
Use the attached sterile water to establish a water seal.
What Is The Importance Of Chest Tube Insertion?
A chest tube can help drain air,blood,or fluid from the pleural space. The pleural space surrounds your lungs.
Continuous wall suction set between 80 to 100 will assure adequate suction. Orange bellowin chamber indicates that a seal/suction is applied.
Never clamp a chest tube because it will generate extreme negative pressure and can lead to tension pneumothorax. Also avoid extreme stripping or milking because it can generate extreme negative pressure as well.
If tube gets dislodged at the insertion set immediately place occlusive Vaseline gauze over the chest tube site and notify the doctor immediately. Please keep a bottle of sterile water at bedside to create water seal if the system is dislodged or broken.
Dressing change should be done daily ,if no longer dry and intact or signs of infection,redness,swelling ,exudates.
Chest x ray daily, orders by the doctor to evaluate the lung status.
Must Keep Occlusive Dressing In Place For 24 To 48 Hours After Chest Tube Is Removed.
Drainage >150 to 200ml/hour is dangerous. Notify the doctor.
>1500 ml/hour is massive hemorrhage. Need to be reported immediately.
15.A 44years old man returns to his room following a Cardiac Catheterization. Which assessment if made by the nurse would justify calling the doctor?
Answer:
A.Absence of a pulse distal to the catheter insertion site.
B.Check blood pressure first.
C. Check respiration and pulse.
D.Check saturation level.
Correct answer A.
16.A 50years old man is admitted to the hospital for evaluation of cardiac disease. He is scheduled to have cardiac Catheterization. Three hours before the procedure. He said to the nurse, “I don’t want this procedure to be done on me”. Which of the following responses by the nurse will be the best.
Nurses You Move Me 
Big thank you.
LikeLike