NSG 233 Med Surge 3 Final Exam – Questions With
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Terms in this set (58)
Chest Trauma- Complications Flail chest is frequently a complication of blunt chest
trauma, which may occur from a steering wheel
injury, motor vehicle crash involving a pedestrian or
cyclist, a significant fall onto the chest, or an assault
with a blunt weapon. As with rib fracture, treatment
of flail chest is usually supportive. Management
includes providing ventilatory support, clearing
secretions from the lungs, and controlling pain. For
mild-to-moderate flail chest injuries, the underlying
pulmonary contusion is treated by monitoring fluid
intake and appropriate fluid replacement while
relieving chest pain. Pulmonary physiotherapy
focusing on lung volume expansion and secretion
management techniques is performed. The patient is
closely monitored for further respiratory
compromise.
For severe flail chest injuries, ET intubation and
mechanical ventilation are required to provide
internal pneumatic stabilization of the flail chest and
to correct abnormalities in gas exchange.
,Shock Fluid At least two large-gauge IV lines are inserted to
establish access for fluid administration. Because the
goal of the fluid replacement is to restore
intravascular volume, it is necessary to administer
fluids that will remain in the intravascular
compartment to avoid fluid shifts from the
intravascular compartment into the intracellular
compartment. As discussed earlier, crystalloid
solutions such as lactated Ringer's solution or 0.9%
sodium chloride solution are commonly used to treat
hypovolemic shock, as large amounts of fluid must
be given to restore intravascular volume.
Hypovolemic Shock Hypovolemic shock, the most common type of
shock, is characterized by decreased intravascular
volume. Body fluid is contained in the intracellular
and extracellular compartments. Intracellular fluid
accounts for about two thirds of the total body water.
The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or
interstitial (surrounding tissues). The volume of
interstitial fluid is about three to four times that of
intravascular fluid. Hypovolemic shock occurs when
there is a reduction in intravascular volume by 15% to
30%, which represents an approximate loss of 750 to
1500 mL of blood in a 70-kg (154-lb) person
Cardiogenic Shock S&S Cardiogenic shock occurs when the heart's ability to
contract and to pump blood is impaired and the
supply of oxygen is inadequate for the heart and the
tissues. In cardiogenic shock, cardiac output, which is
a function of both stroke volume and heart rate, is
compromised. Patients in cardiogenic shock may
experience the pain of angina, develop arrhythmias,
complain of fatigue, express feelings of doom, and
show signs of hemodynamic instability.
, Hemorrhage- Shock If the patient is hemorrhaging, efforts are made to
stop the bleeding. This may involve applying pressure
to the bleeding site or surgical interventions to stop
internal bleeding. If the cause of the hypovolemia is
diarrhea or vomiting, medications to treat diarrhea
and vomiting are given while efforts are made to
identify and treat the cause. In older adult patients,
dehydration may be the cause of hypovolemic shock.
Shock Septic- Dopamine Dopamine, a naturally occurring precursor of
norepinephrine and epinephrine, functions as a
neurotransmitter. Dopamine is useful in hypovolemic
and cardiogenic shock. Adequate fluid therapy is
necessary for maximal pressor (increased blood
pressure) effect. Acidosis decreases the effectiveness
of the drug. If fluid therapy alone does not
effectively improve tissue perfusion, vasopressor
agents, specifically norepinephrine or dopamine,
may be initiated to achieve a MAP of 65 mm Hg or
higher
AAA- Tests The most important diagnostic indication of an
abdominal aortic aneurysm is a pulsatile mass in the
middle and upper abdomen. Most clinically
significant aortic aneurysms are palpable during
routine physical examination; however, the sensitivity
depends upon the size of the aneurysm, abdominal
girth of the patient (i.e., more difficult to find in the
patient with obesity), and the skill of the examiner. A
systolic bruit may be heard over the mass. Duplex
ultrasonography or CTA is used to determine the size,
length, and location of the aneurysm. When the
aneurysm is small, ultrasonography is conducted at
6-month intervals until the aneurysm reaches a size
so that surgery to prevent rupture is of more benefit
than the possible complications of a surgical
procedure. Some aneurysms remain stable over
many years of monitoring.
Expert Solutions
Save Groups
Terms in this set (58)
Chest Trauma- Complications Flail chest is frequently a complication of blunt chest
trauma, which may occur from a steering wheel
injury, motor vehicle crash involving a pedestrian or
cyclist, a significant fall onto the chest, or an assault
with a blunt weapon. As with rib fracture, treatment
of flail chest is usually supportive. Management
includes providing ventilatory support, clearing
secretions from the lungs, and controlling pain. For
mild-to-moderate flail chest injuries, the underlying
pulmonary contusion is treated by monitoring fluid
intake and appropriate fluid replacement while
relieving chest pain. Pulmonary physiotherapy
focusing on lung volume expansion and secretion
management techniques is performed. The patient is
closely monitored for further respiratory
compromise.
For severe flail chest injuries, ET intubation and
mechanical ventilation are required to provide
internal pneumatic stabilization of the flail chest and
to correct abnormalities in gas exchange.
,Shock Fluid At least two large-gauge IV lines are inserted to
establish access for fluid administration. Because the
goal of the fluid replacement is to restore
intravascular volume, it is necessary to administer
fluids that will remain in the intravascular
compartment to avoid fluid shifts from the
intravascular compartment into the intracellular
compartment. As discussed earlier, crystalloid
solutions such as lactated Ringer's solution or 0.9%
sodium chloride solution are commonly used to treat
hypovolemic shock, as large amounts of fluid must
be given to restore intravascular volume.
Hypovolemic Shock Hypovolemic shock, the most common type of
shock, is characterized by decreased intravascular
volume. Body fluid is contained in the intracellular
and extracellular compartments. Intracellular fluid
accounts for about two thirds of the total body water.
The extracellular body fluid is found in one of two
compartments: intravascular (inside blood vessels) or
interstitial (surrounding tissues). The volume of
interstitial fluid is about three to four times that of
intravascular fluid. Hypovolemic shock occurs when
there is a reduction in intravascular volume by 15% to
30%, which represents an approximate loss of 750 to
1500 mL of blood in a 70-kg (154-lb) person
Cardiogenic Shock S&S Cardiogenic shock occurs when the heart's ability to
contract and to pump blood is impaired and the
supply of oxygen is inadequate for the heart and the
tissues. In cardiogenic shock, cardiac output, which is
a function of both stroke volume and heart rate, is
compromised. Patients in cardiogenic shock may
experience the pain of angina, develop arrhythmias,
complain of fatigue, express feelings of doom, and
show signs of hemodynamic instability.
, Hemorrhage- Shock If the patient is hemorrhaging, efforts are made to
stop the bleeding. This may involve applying pressure
to the bleeding site or surgical interventions to stop
internal bleeding. If the cause of the hypovolemia is
diarrhea or vomiting, medications to treat diarrhea
and vomiting are given while efforts are made to
identify and treat the cause. In older adult patients,
dehydration may be the cause of hypovolemic shock.
Shock Septic- Dopamine Dopamine, a naturally occurring precursor of
norepinephrine and epinephrine, functions as a
neurotransmitter. Dopamine is useful in hypovolemic
and cardiogenic shock. Adequate fluid therapy is
necessary for maximal pressor (increased blood
pressure) effect. Acidosis decreases the effectiveness
of the drug. If fluid therapy alone does not
effectively improve tissue perfusion, vasopressor
agents, specifically norepinephrine or dopamine,
may be initiated to achieve a MAP of 65 mm Hg or
higher
AAA- Tests The most important diagnostic indication of an
abdominal aortic aneurysm is a pulsatile mass in the
middle and upper abdomen. Most clinically
significant aortic aneurysms are palpable during
routine physical examination; however, the sensitivity
depends upon the size of the aneurysm, abdominal
girth of the patient (i.e., more difficult to find in the
patient with obesity), and the skill of the examiner. A
systolic bruit may be heard over the mass. Duplex
ultrasonography or CTA is used to determine the size,
length, and location of the aneurysm. When the
aneurysm is small, ultrasonography is conducted at
6-month intervals until the aneurysm reaches a size
so that surgery to prevent rupture is of more benefit
than the possible complications of a surgical
procedure. Some aneurysms remain stable over
many years of monitoring.
