HESI MED SURG CRITICAL CARE NURSING EXAMS 2023/2024

Assessment of jugular venous pressure. Assessment of jugular venous pressure. Assessment of jugular venous pressure 13. Gastric bypass – MODS (multiple organ dysfunction syndrome) • Shock can progress to multiple organ dysfunction syndrome (MODS) unless compensatory mechanisms reverse the process or clinical interventions are successfully implemented. • Multiple organ dysfunction syndrome (MODS) is defined as the progressive physiological dysfunction of two or more organ systems where homeostasis cannot be maintained without intervention. It is initiated by illness, injury or infection and most commonly affects the heart, lungs, liver and kidneys. • Organ failure symptoms include low grade fever, tachycardia, and tachypnea in the first 24 hours. Within the following 24-72 hours, lung failure may set in. This can be followed by bacteremia, as well as renal, intestinal, and liver failure. • Multiple organ dysfunction syndrome (MODS) is caused by an overwhelming, uncontrolled systemic inflammatory response that is activated by a number of hostile stimuli including sepsis, hypovolemic shock, and severe trauma resulting in massive tissue injury. • Multiple organ dysfunction syndrome is well established as the final stage of a continuum: SIRS + infection sepsis severe sepsis Multiple organ dysfunction syndrome. • Stage 1: the patient has increased volume requirements and mild respiratory alkalosis which is accompanied by oliguria, hyperglycemia and increased insulin requirements. • Stage 2: the patient is tachypneic, hypocapnic and hypoxemic; develops moderate liver dysfunction and possible hematologic abnormalities. • Stage 3: the patient develops shock with azotemia and acid-base disturbances; has significant coagulation abnormalities. • Stage 4: the patient is vasopressor dependent and oliguric or anuric; subsequently develops ischemic colitis and lactic acidosis. • At present, there is no drug or device that can reverse organ failure that has been judged by the health care team to be medically and/or surgically irreversible (organ function can recover, at least to a degree, in patients whose organs are very dysfunctional, where the patient has not died and some organs, like the liver or the skin, can regenerate better than others),- with the possible exception of single or multiple organ transplants or the use of artificial organs or organ parts, in certain candidates in specific situations. Therapy, therefore, is usually mostly limited to supportive care, i.e. safeguarding hemodynamics, and respiration. Maintaining adequate tissue oxygenation is a principal target. Starting enteral nutrition within 36 hours of admission to an intensive care unit has reduced infectious complications QUESTION Example: The nurse is caring for a client who had gastric bypasssurgery yesterday. Which intervention is most important for the nurse to implement during the first 24 postoperative hours? Measure hourly urinary output. 14. Mechanical ventilation – wean 15. MODS – Hypotension 16. Parklandsformula 17. Burns – fluid replace 18. Drug action – primacor/interaction 19. ICU priority – CT transport 20. Mechanical vent.- extubation confusion 21. Pulselessfinding 22. Atrial Flutter 23. Chest Tube deep breathing QUESTION: In developing a care plan for the patient that has a chest tube and hemothorax the nurse should recognize that which intervention is essential? Encourage the client to breathe deeply and cough at frequent intervals 24. Ventilator disconnected 25. Trauma nose bleed 26. CVP Monitor ( Right atrium) QUESTION: Nursing care from a 58 year old client with postop complications include CVP monitoring. What is the most important consideration?? The zero point on the manometer must be level with the right atrium 27. Septic Shck – vasoconstrictor 28. Shock symptoms QUESTION: The nurse caring for a client who hemorrhaged postop and is in early stages of shock. Which cardiopulmonary symptoms are most indicative of progression into a state of shock? increased pulse rate lowered systolic pressure peripheral extremity mottling 29. Ventilator malfunction