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NR 574 EXAM PREP LATEST ACUTE CARE PRACTICUM I ANSWERED
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NR 574 EXAM PREP LATESTACUTE CARE PRACTICUM I
ANSWERED
2023/2024
,1. What are the three main components of the ABCDE assessment for critically ill patients?
How would you perform each component?
- The three main components are airway, breathing and circulation. To perform the airway
component, you would assess the patient's ability to speak, cough and protect their airway, and
intervene if needed with suctioning, positioning or advanced airway management. To perform
the breathing component, you would assess the patient's respiratory rate, effort, oxygen
saturation and chest movement, and intervene if needed with oxygen therapy, ventilation or
chest tube insertion. To perform the circulation component, you would assess the patient's
heart rate, blood pressure, capillary refill and peripheral pulses, and intervene if needed with
fluid resuscitation, vasopressors or cardiac pacing.
2. What are the common causes and signs of increased intracranial pressure (ICP) in patients
with traumatic brain injury (TBI)? How would you monitor and manage increased ICP?
- The common causes of increased ICP in patients with TBI are cerebral edema, hemorrhage,
contusion or hydrocephalus. The signs of increased ICP are headache, nausea, vomiting,
altered level of consciousness, pupillary changes, Cushing's triad (hypertension, bradycardia
and irregular breathing) and herniation. To monitor ICP, you would use an invasive device such
as a ventriculostomy or an intraparenchymal catheter, and keep the ICP below 20 mmHg. To
manage increased ICP, you would elevate the head of the bed to 30 degrees, maintain
normothermia and normoglycemia, avoid hypoxia and hypercapnia, administer osmotic
diuretics or hypertonic saline, and consider sedation, analgesia or neuromuscular blockade.
3. What are the indications and contraindications for initiating extracorporeal membrane
oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS)? What are
the potential complications and nursing care considerations for patients on ECMO?
- The indications for initiating ECMO in patients with ARDS are refractory hypoxemia or
hypercapnia despite optimal mechanical ventilation, a PaO2/FiO2 ratio below 100 mmHg or a
pH below 7.2. The contraindications for initiating ECMO in patients with ARDS are irreversible
lung disease, severe multiorgan failure, active bleeding or coagulopathy, or futility of care. The
potential complications of ECMO are hemorrhage, infection, thrombosis, embolism, hemolysis
or mechanical failure. The nursing care considerations for patients on ECMO are monitoring
the circuit function and anticoagulation status, maintaining adequate perfusion and
oxygenation, preventing infection and bleeding, providing nutrition and hydration, and
supporting the patient's psychological needs.
, 4. What are the types and causes of shock in critically ill patients? How would you differentiate
between them based on clinical manifestations and laboratory findings?
- The types of shock in critically ill patients are hypovolemic, cardiogenic, obstructive and
distributive. The causes of hypovolemic shock are fluid loss due to hemorrhage, dehydration or
burns. The causes of cardiogenic shock are impaired cardiac function due to myocardial
infarction, arrhythmia or cardiomyopathy. The causes of obstructive shock are mechanical
obstruction of blood flow due to pulmonary embolism, cardiac tamponade or tension
pneumothorax. The causes of distributive shock are vasodilation due to sepsis, anaphylaxis or
neurogenic injury. To differentiate between them based on clinical manifestations and
laboratory findings,
you would look at the following parameters:
| Parameter | Hypovolemic | Cardiogenic | Obstructive | Distributive |
|-----------|-------------|-------------|-------------|--------------|
| Heart rate | Increased | Increased | Increased | Increased |
| Blood pressure | Decreased | Decreased | Decreased | Decreased |
| Central venous pressure | Decreased | Increased | Increased | Decreased |
| Pulmonary artery wedge pressure | Decreased | Increased | Increased | Decreased |
| Cardiac output | Decreased | Decreased | Decreased | Increased |
| Systemic vascular resistance | Increased | Increased | Increased | Decreased |
| Urine output | Decreased | Decreased | Decreased | Decreased |
| Skin temperature | Cool | Cool | Cool | Warm |
| Lactate level | Increased | Increased | Increased | Increased |
5. What are the indications and principles of therapeutic hypothermia in patients with cardiac
arrest? How would you implement and monitor therapeutic hypothermia in your practice?
Know the populations at risk for alterations in thermoregulation and why they are at risk. What
individual factors place clients at risk?
- Infants and older adults
- INFANTS- no heat-conserving capacity, they don’t shiver, greater body surface
area to weight, less subq fat, blood vessels are closer to the skin, inability to take
preventative measures.
- OLDER ADULTS- slower circulation, decreased vasoconstrictor response,
decrease sweat production, decreased heat production, decreased shivering
response, reduced perception of environmental temperature.
- INDIVIDUAL RISK FACTORS- impaired cognition (dementia, stroke, substance
use), medical condition (autoimmune disorder, Bruns, hypothalamic disorders,
thyroid disorders, obesity, infection), occupation and recreation (outdoor
occupations, heat generating manufacturing environments, athletes, strenuous
exercise)
Know the difference between heat stroke and heat exhaustion.
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