CRITICAL CARE HESI EXAM QUESTIONS WITH COMPLETE SOLUTIONS VERIFIED GRADED A+
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Course
HESI
Institution
HESI
CRITICAL CARE HESI EXAM QUESTIONS WITH COMPLETE SOLUTIONS VERIFIED GRADED A+
spinal cord injury at the scene
Nursing interventions are focused on stabilization of the spine, preserving the airway and respiratory status and preventing complications associate with SCI. Assessment of respiratory a...
CRITICAL CARE HESI EXAM QUESTIONS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A+
spinal cord injury at the scene
Nursing interventions are focused on stabilization of the spine, preserving the airway
and respiratory status and preventing complications associate with SCI. Assessment of
respiratory and neurological status is first priority, might need to be tubed. If in
neurogenic shock, they cannot regulate body temperature
teaching for ICD
site care and symptoms of complications, hematoma at the site is common, wear a
medic alert bracelet, when device fires the patient will feel either tingling or discomfort or
wont even know it went off. avoid strong magnetic fields (MRI), keep cell phones 6
inches from ICD, may fire when tachycardic, avoid driving for 6 months if hx of cardiac
arrest, teach family CPR
ventilator alarms
can be caused by biting tube, kinks, need suctioned or trying to talk
ARDS and lung trauma
Refractory hypoxemia: hallmark sign of ARDS. FiO2 could be 100% but Pao2 is <60%.
only intervention is ECMO which is difficult because adults need anticoagulation
therapy.
Bilateral patchy infiltrates: patches of white on a lung x ray
Noncompliance of the lung: it will not expand, need to be sedated
-initial ABGs show low CO2 because of hypervention then it flips to metabolic acidosis
- lungs clamp down so it is difficult to breath, capillary membrane damage)
Treatment: ventilator, lung protective strategies (low TV, FiO2 at nontoxic levels ~60%,
unconventional vent settings i.e. RR 300-420 BPM)
VAP
, main cause is aspiration, poor oral hygiene, contaminated equipment.
strategies to reduce VAP: - elevated HOB 30-45 degrees, hand hygiene and gloves
when suctioning, suction above cuff before deflation, oral hygiene Q2!!!!
documentation of pneumothorax breath sounds
they are absent
tension pneumothorax and trauma
tension pneumo can be caused by mechanical ventilation. pressurized air enters the
pleural space and continues to accumulate which causes an increase in pressure,
increasing amount of alveoli collapse and pressure on the heart and great veins.
immediate insertion of a chest tube is needed and removed from vent
chest tube assessment
splint insertion site to facilitate coughing and deep breathing. do not milk the tube, do
not clamp the tube
mechanical ventilator and respiratory acidosis
If the ventilator is set at a low RR (e.g., 2 to 6 breaths per minute) and the patient does
not have an adequate drive to initiate additional breaths, respiratory acidosis may occur.
Ideally the VT and RR are set to achieve a VE that ensure a normal PaCO2 level
first action with a PE
anticoagulation with heparin. venous preventions-- is NOT oxygen first, anticoag first
patient safety and ICU confusion
Acute delirium is common in critically ill patients; more than 70% to 80% of patients
develop some form of delirium, resulting in longer duration of mechanical ventilation and
longer ICU stay than those without delirium.
Non restraints and pharmacologic measures are taken first. If pulling at drains then they
may be restrained. Haloperidol is the drug of choice to calm patients
restraint intervention
must be repositioned, and the areas where the restraints are applied are assessed for
perfusion and sensation at least every hour
aortic aneurysm repair
Post op: VS Q1 hour (watch for tachycardia and hypotension). Peripheral pulses.
Monitor for hemorrhage.
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