Comprehensive HESI Review Exit exam 2023, Over 2000 Questions And Correct Answers. 100% Verified Solution
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HESI
Comprehensive HESI Review Exit exam 2023, Over 2000 Questions And Correct Answers. 100% Verified Solution
Acute Respiratory Distress Syndrome (ARDS)
The exchange of oxygen for carbon dioxide in the lungs is inadequate for oxygen consumption and carbon dioxide production within the body's cells
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Comprehensive HESI Review Exit exam
2023, Over 2000 Questions And Correct
Answers. 100% Verified Solution
Acute Respiratory Distress Syndrome (ARDS)
The exchange of oxygen for carbon dioxide in the lungs is inadequate for oxygen
consumption and carbon dioxide production within the body's cells
Characteristics of ARDS
Hypoxemia that persists even when 100% oxygen is given; decreased pulmonary
compliance; dyspnea; non-cardiac associated bilateral pulmonary edema; dense
pulmonary infiltrates on X-ray
ARDS
No abnormal breath sounds are present in this disorder on auscultation because the
edema occurs first in the interstitial spaces and not the airways.
ARDS
Unexpected, catastrophic pulmonary complication occurring in a person with no
pervious pulmonary problems.
ARDS
Common laboratory finding is a lowered pO2; not responsive to high concentrations of
oxygen and often need intubation and mechanical ventilation with PEEP
PEEP Positive end-expiratory pressure
The instillation and maintenance of small amounts of air into the alveolar sacs to
prevent then from collapsing each time the client exhales; amount of pressure can be
set and is usually around 5-10cm of water
Nursing Assessment of ARDS
Dyspnea, hyperpnea; intercostals retractions; cyanosis, pallor; hypoxemia; diffuse
pulmonary infiltrates seen on chest radiograph as "white-out" appearance; verbalized
anxiety, restlessness
Hypoxemia
PO2 < 50mmHg with FiO2 >60%
Common causes of respiratory failure
COPD; pneumonia; tuberculosis; contusion; aspiration; inhaled toxins' emboli; drug OD;
fluid overload; DIC; shock
Suction
When providing care to a patient with ARDS, only do this when secretions are present
7.35-7.45
PH normal value
35-45 mmH
PCO2 normal value
22-26 mEq
,HCO3 normal value
80-100mm
PO2 normal value
95-100%
O2 normal value
Allen Test
Perform this test before drawing an ABG from the radial artery
Common cause of respiratory failure in children
Congenital heart disease; respiratory distress syndrome; infection, sepsis;
neuromuscular diseases; trauma and burns; aspiration; fluid overload and dehydration;
anesthesia and narcotic OD
Nursing assessment of child in respiratory failure
Kid just "looks bad;" very slow or very rapid RR, dyspnea, apnea, gasping; tachycardia;
cyanosis, pallor, or mottled color; irritability and lethargy; retractions, nasal flaring, poor
air movement; hypoxemia, hypercapnia, respiratory acidosis
Respiratory Failure
PCO2 > 45 or PO2 < 60 on 50% O2; a child in severe distress should be on 100% O2
Shock
Widespread, serious reduction of tissue perfusion which, if prolonged, leads to
generalized impairment of cellular functioning
System Hypotension
Marked reduction in either cardiac output or peripheral vasomotor tone, without a
compensatory elevation in the other results in this
Early signs of shock
Agitation and restlessness that results from cerebral hypoxia
Hypovolemic Shock
Related to external or internal blood or fluid loss
Cardiogenic Shock
Related to ischemia or impairment in tissue perfusion resulting from MI, serious
arrhythmia, or HF; all cause decrease CO
Vasogenic Shock
Related to allergens, spinal cord injury, or peripheral neuropathies, all resulting in
venous pooling and decreased blood return to the heart, which decreases cardiac
output over time
Septic Shock
Related to endotoxins released by bacteria, which cause vascular pooling, diminished
venous return, and reduced CO
High fowler position with legs down
Position to reduce venous return in order to decrease further venous return to the left
ventricle
Medical treatment for shock
Rapid infusion of volume-expanding fluids such as whole blood, plasma, plasma
substitutes; isotonic, electrolyte IV solutions; CVP artery catheters; CVP measurements,
urine output, HR, clinical and mental state; immediate attendtion to improvement of
perfusion; administration of drugs is withheld until circulating volume has been restores;
O2 administration
,Pulmonary edema
If shock is cardiogenic in nature, the infusion of volume-expanding fluids may result in
this
Cardiac Function
When treating a patient with shock, the restoration of what should take priority
Increase Cardiac Contractility
Administration of cardiotonic drugs such as digitalis does what?
Dopamine and digitalis
Increases the contractility
Dopamine (Dopram) and norepinephrine (Levophed)
Vaso-constricting agents that may be used in cardiogenic shock
Nursing Assessment of patient in shock
Tachycardia, tachypnea, decrease in BP (systolic <80mmHg) ; mental status changes;
cool, clammy skin; diaphoresis, paleness; urine output decreases; CVP <4cm of H2O;
urine SG >1.020
Hypovolemia
Urine SG >1.020 indicates?
Early shock mental status changes
Restless, hyper-alert
Late shock mental status changes
Decreased alertness, lethargy, coma
Patient in shock
Maintain a urine output of at least 30ml/hr and notify health care provider if it drops
below this
CVP
Administer prescribed fluids until designated ?? is reached in patients with shock
CVP
When a patient is in shock, this number is usually elevated to 16-19 cm of H2O as
compensation for decreased cardiac output
Patient in shock
Place this patient in Trendelenburg position (feet up 45 degrees, head flat
IM or Subcutaneous route
Do not administer medications via these routes to a patient in shock until perfusion
improves to the muscles and subcutaneous tissues
Vasopressors or adrenergic stimulants
When administering these medications to a patient in shock, they must be administered
via a volume-controlled pump; monitor BP q 5-15 min; watch IV site carefully for
extravasation and tissue damage; ask about the target mean systolic BP
Vasopressors or adrenergic stimulants used in shock patients
Epinephrine (Bronkaid). Dopamine (Dopram), Dobutamine (Dobutrex), norepinephrine
(Levophed), isoproterenol (Isuprel)
Vasodilators used in shock patients
Hydralazine (Apresoline), nitroprusside (Nipride), labetalol hydrochloride (Normodyne,
Trandate)
Vasopressor and vasodilator drugs
, Potent drugs used in shock patients; dangerous and require that the client be weaned
onto and off them. Don't change both infusions rates simultaneously.
Vasodilator; Vasopressor
If drop in BP occurs, decrease ?? infusion rate first, then increase ?? rate
Vasopressor; Vasodilator
If BP increases, decrease ?? rate first, then increase the rate of the ??
Stage 1 of hypovolemic shock
Initial stage; blood loss of less than 10%; compensatory mechanisms triggered;
apprehension and restlessness; increased HR; cool, pale skin; fatigue; arteriolar
constriction; increased production of ADH; arterial pressure maintained; CO normal;
reduction in blood flow to the skin and muscle beds
Stage 2 of Hypovolemic Shock
Compensatory stage; blood volume reduced by 15%-25%; decompensation begins;
flattened neck veins and delayed venous filling time; increased HR&RR; pallor,
diaphoresis and cool skin; decreased UP; sunken soft eyeballs; confusion; marked
reduced in CO; arterial pressure decline; massive adrenergic compensatory response;
decrease cerebral perfusion
massive adrenergic compensatory response
Tachycardia, tachypnea, cutaneous vasoconstriction and oliguria
Stage 3 of Hypovolemic shock
Progressive stage; edema; increased blood viscosity; excessively low BP; dysrhythmia,
ischemia, and MI; weak, thread, or absent peripheral pulses; rapid circulatory
deterioration; decreased CO; decreased tissue perfusion; reduced blood volume
Stage 4 of Hypovolemic shock
Irreversible stage; profound hypotension that is unresponsive to vasopressor drugs;
severe hypoxemia that is unresponsive to O2; anuria, renal shut down; HR slows, BP
falls with consequent cardiac and respiratory arrest; cell destruction so severe that
death is inevitable; multiple organ system failure
Severe shock
Leads to widespread cellular injury and impairs the integrity of the capillary membranes
Fluid and osmotic proteins
Seep into the extravascular spaces, further reducing CO
Mean arterial pressure
Normal value in adults 100mmHg
Mean arterial pressure
Level of pressure in the central arterial bed measured indirectly by BP; measured
directly through arterial catheter insertion
MAP calculation
CO x total peripheral resistance = systolic BP + 2/3
Cardiac Output
Volume of blood ejected by the left ventricle per unit of time
Cardiac output
Normal value is 4-6L/min
CO calculation
Stroke volume (amount of blood ejected per beat) x HR
Peripheral resistance
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