Final Exam 4020
organ transplantation
The transfer of living organs, tissues, or cells from a donor to a recipient with the intention of maintaining the functional integrity of the transplanted tissue in the recipient.
What are the nutritional needs for a client with pancreatitis and when is nutrition contraindicated?
i. Nutritional support ii. Has shifted over last decade from resting pancreas to feeding patient. iii. Institute TPN only if patient has persistent vomiting, obstruction, or gastric distention.
a. What elements of education regarding pain can be communicated to the patient in acute pancreatitis
i. Severe epigastric pain, radiates to back, worse supine, pt may curl up with arms over abdomen to relive pain, pain unrelieved with vomiting ii. Pain Management iii. Major priority iv. Opiates may be necessary v. Patient position
A client received tPA for an ischemic stroke. That same patient can convert to a hemorrhagic stroke. True or false
true
Sickle Cell Pain Management
-Drink lots of fluids -Take over-the-counter (OTC) pain medication such as acetaminophen, aspirin, ibuprofen -Keep warm always, but avoid being too hot
labs of acute pancreatitis
-decreased Albumin -decreased Calcium -decreased potassium -increased Alkaline Phosphatase -increase bili, AST, LDH -increased glucose -increased hematocrit -increased amylase and lipase -increased WBC
Tetraology of Fallot
1. VSD, overriding aorta, pulmonary stenosis, & right ventricular hypertrophy 2. Needs surgical repair 3. "Tet spells", occur during the first two years of life a. Spontaneous cyanosis, respiratory distress, weakness, and syncope occur b. Last up to a few hours, followed by lethargy and sleep c. Place child in knee-chest position when tet spell occurs
A common teaching priority has to do with growth and development. What are some factors that need to be considered when educating a family?
?
Arrhythmia non-pharmacological management in infants
??
Medications for transplant: Calcineurin Inhibitors
Cyclosporine, Tacrolimus, Prograf a. Reduce the transcription of IL-2 gene, reduction in T-cell activation b. Side effects: Nephrotoxic, hypertension, Hyperlipidemia, hyperglycemia
Acute pancreatitis can be a silent disease as it does not cause any discomfort
False
Patients on low molecular weight heparin will never have incidence of H.I.T.
False
If one parent has sickle cell trait any child of that parent will develop sickle cell disease
False Would need both parents to have the trait for it to be true (1/4 chance with both)
Prostaglandin inhibitors
Give prostaglandins to keep PDA open until surgery
The nurse recognizes the importance of the burn pattern with a scald burn
Help identify a case of neglect
Which statement by a client with sickle cell disease demonstrates the need for additional education
I am excited to go back to the gym to get swoll § Athletes need to get sickle cell tested because there is a higher risk § Don't want them to hit it hard at the gym, just be active
Post op/ post procedure vascular assessment involves assessing the
Pulse distal to the vascular site Procedural/operative site HOB flat
Medications for transplant: Mammalian target of rapamycin (mTOR) inhibitors
Sirolimus, Everolimus a. Inhibits T-cell proliferation b. Side effects: leukopenia, thrombocytopenia, hyperlipidemia, delayed wound healing, rash, mouth ulcers
sickle cell pain crisis
Sludging of the sickled red blood cells in capillaries which cause severe pain in the arms legs chest and abdomen.
How do you know the amount of energy/joules a pediatric / infant patient will need during defibrillation?
The amount of joules delivered in a pediatric defibrillator can vary depending on the device and the child's size and age
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
atrial septal defect (ASD)
an opening in the septum separating the atria 1. Left to right shunting through hold in the artrial septum 2. Murmur 3. Many are asymptomatic 4. Commonly seen with Trisomy 21
How do complications from SS in early childhood impact the patient throughout their life?
i. Long term anemia ii. Pain or sickle crisis iii. Acute chest syndrome (permanent lung damage) iv. Splenic sequestration: sleep enlarged, blood pooling, may need splenectomy v. Strole if blood vessels are blocked vi. Infections: sickle cell puts kids at higher risk for infection vii. Painful erections
genetic risk factors of sickle cell
i. Autosomal recessive disorder ii. If both parents have the trait, each child will have a 1 in 4 likelihood of having the disease.
How are hemodynamics impacted in GI bleed
i. Blood loss 1. Bloody emesis, taryy stools, decreased CO, decreased BP, tachycardia, decreased pulses, confusion, anxiety, decrease urine output, increased urine concentration, hyperventilation 2. Hypovolemic shock: change in LOC< cool/clammy skin, decreased GI motility, decrease urine output, hypotension, tachycardia ii. Monitor HR, BP, RR iii. Anticipate Blood products iv. Observe for coagulopathy v. Hold antihypertensive meds
Causes and risks for developing an intraventricular hemorrhage (IVH)
i. Devasting neurological disease in the premature infant ii. Results in substantial mortality and morbidity iii. Bleeding into the brain iv. Premature infants are at increased risk of developing because their blood vessels are fragile and immature v. the smaller and more premature the baby, the greater the risk vi. Bleeding in the brain > increase ICP > severe, irreversible tissue damage
Education for sickle cell
i. Environment 1. Protect pt from infection, handwashing, proper rest, keeping warm ii. Fluid Intake 1. Adequate fluid and nutrition iii. Hydroxyurea 1. This drug is an antimetabolite. Cell cycle specific. The efficacy of hydroxyurea in the treatment of sickle cell disease is generally attributed to its ability to boost the levels of fetal hemoglobin. This lowers the concentration of Hb S within a cell resulting in less polymerization of the abnormal hemoglobin.
nonfunctional spleen complications
i. Sickle cells can block the blood vessels leading out of the spleen. When this happens, blood stays in the spleen instead of flowing through it. This causes the spleen to get bigger, and the blood counts to fall. This is called a splenic sequestration crisis, or simply "spleen crisis." ii. Can be treated with blood transfusion or Splenectomy ( if 2 or more spleen crisis)
Upper GI bleed s/s
i. Throwing up blood: hematemesis**main sign** ii. Hematochezia: blood in stools iii. Coffee ground looking, bright red iv. Mally Weiss tear: arterial hemorrhage in upper GI bleed from long term NSAID use or aspirin and excessive alcohol intake
Medications for transplant: Corticosteroids
methylprednisolone, prednisone a. Inhibits production of various cytokines and reduce immune response b. Side effects: Hypertension, hyperlipidemia, anxiety, insomnia, hyperglycemia, leukocytosis, osteoporosis
VSD (ventricular septal defect)
most common defect, a small/large opening between the ventricles 1. Left to right shunting via the opening in the ventricular septum 2. Audible murmur 3. Medical management or surgical repair
The client was admitted after a closed space fire. Aside from visible burn injury, what assessment if most important
o Airway § Look at the throat, swelling, burns internally, discoloration § Would hear wheezing and stridor
Strategies to decrease development of post intensive care syndrome
o Allow familiar to remain at bedside o Bring in familiar objects from home
Which of the following conditions would the nurse notice alterations in circulation
o Atrial septal defect o Tetralogy of Fallot o Patent ductus arteriosus o Coarctation of the aorta
o With GCS of 3 and family discussion of withdrawal of care, the nurse anticipates the potential for which of the following
o Calling OPO (Organ procurement organizations) to make referral § Don't talk to the family because we are supposed to remain neutral § The physician has to talk to the family first before deciding to go on comfort cares § We heed to have documentation that the person wants to give the gift of life, so that is why we need OPO first
A circumferential burn or crush injury to any extremity is at risk for which complication
o Compartment syndrome
Complications that occur secondary to electrical injuries include
o Damage to muscle tissue o Cardiac muscle alteration
What types of questions would you ask your patient to differentiate unstable versus stable angina
o Does it resolve with activity o Do you experience any other symptoms o What is happening at onset
Why is it important during a code to maintain individual roles
o Ensure clear communication o Ensure safe use of code equipment
Which of the following is true when applying principles of the Monro Kellie Doctrine
o If blood increase, the body needs to decrease CSF o The skull has no compliance § When you are a baby, your skull DOES have compliance o If unable to autoregulate pressure, a device to drain fluid may be needed
What differentiates HHS from DKA
o Insulin resistance o Presence of ketones
Which of the following conditions can put an infant at risk for IVH
o Less than 28 weeks gestation o Thin walled vasculature
Which of the following demonstrates inadequate CPP?
o MAP 65, ICP 9 § Normal CPP is 60-80
The correct meaning of the word hematemesis
o Puking blood
The client suffered an acute MI, what are the complications
o Rhythm alterations o Decrease in cardiac output o Ruptured papillary muscle
The nurse understands which patients are at risk of developing D.I.C.
o Septic patient o Post partum
Which of the following requires priority intervention? o CVP 8, SPO2 93%, HF NC (heart failure noncompliant)\ o Atrial line BP 88/50 with poor waveform, SPO2 98% 2L on NC, eating breakfast o Septic, UOP 40ml/hr for last two hours (weight 110kg), BP 90/52 o Cardiac index 2.3, SVR 840, SVO2 62%
o Septic, UOP 40ml/hr for last two hours (weight 110kg), BP 90/52
The nurse understands that brain perfusion can be calculated by
o Subtracting ICP from the MAP
Which of the following lab results would match criteria that could indicate sepsis
o Temperature of 96.4 o WBC 12.0 o Respiratory rate of 21
o How can the nurse assess the level of injury from a penetrating object
o The distance from which the penetrating object came § Ex: bullet, MVC, etc. § Would want to know the distance from things such as gunshot wounds, as that will affect the level of surrounding trauma in the body o Direct VS indirect mechanism of injury o The size of the penetrating object
In a code situation which of the rhythms are shockable
o Unstable Ventricular tachycardia o Ventricular fibrillation § If its ventricular its shockable
Patient admitted with vomiting for two days tell the nurse that she thew up coffee grounds, what is the diagnosis
o Upper GI bleed § When the blood gets digested but is still in the stomach, it is little particulates that look like grounds
Patient education on lifestyle post organ transplantation
rejection: take medications as instructed lifestyle: get approval before returning to activities may need to change diet/cut alcohol use
coartation of the aorta
severe narrowing of the descending aorta, a congenital heart defect 1. Narrowing of the vessel 2. BP of the upper extremities is greater than BP of lower extremities 3. Cool, pale, cyanotic lower extremities 4. Requires patient ductus arteriosus to preserve blood flow a. Give prostaglandins to get PDA open until surgery 5. Surgical intervention
