Rasmussen College :NUR 2755 MDC4 – Examination Blueprint – Exam 2_LATEST 2022,100% CORRECT

Rasmussen College :NUR 2755 MDC4 – Examination Blueprint – Exam 2_LATEST 2022 Burns • Assessment – Expected laboratory values – stages - • Treatment – Fluids - skin grafts - Fluid overload S&S • Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase • Total body surface area (TBSA) – Rule of Nines • Depth of burns • Parkland Formula • Urine Output 0.5ml/kg/hr • Carbon monoxide poisoning • Complication-eschar, burn shock, stridor, Infection, Curling Ulcers: treatment escharotomy Respiratory Diseases (Assessment, Nursing interventions) • Acute respiratory distress syndrome (ARDS) – Stridor – Risk Factors o Clinical manifestations:….refractory hypoxemia, non-cardiac pulmonary edema o Treatment: Prone, PEEP • Hypoxemia • Pulmonary embolism – Laboratory Values – Thrombophlebitis - Medications • Pulmonary edema • Pneumonia – Aspiration Pneumonia • Flail chest - Paradoxical respiration – paralysis of the diaphragm – respiratory failure • Pneumothorax – Signs and symptoms o Chest tube management (watch Respiratory SR lecture) • Treatment - endotracheal tube – tracheostomy - mechanical ventilation - bag-valve-mask device - pulse oximeter, Chest Tubes • Mechanical Ventilators: o Settings o Complications o Nursing interventions o Low pressure and high-pressure alarms o Ventilator Acquired Pneumonia (VAP) Protocol • ABG Interpretation Shock • Hemodynamics: Central Venous pressure, Wedge pressure • Meant Arterial Pressure Calculation MAP={SBP + 2(DBP)}/3. Usual Range 70-110 • Types, Cause, Risk factors o Hypovolemic o Cardiogenic o Neurogenic o Septic o Anaphylactic • Stages Progression • Assessment/Clinical Manifestations/Labs and Diagnostics • Interventions: o ABC o Specific interventions • Client teaching/prevention • Complications: o DIC o MODS o ARDS o SIRS Medications: (Therapeutic Effect, Uses, Side effects, Nursing Considerations) Drug Class: Anticoagulant Heparin Clopidogrel Warfarin Ticlopidine Enoxaparin Drug Class: Anticoagulant antidote • Protamine Sulfate • Vitamin K Antiulcer Medication: Proton Pump Inhibitors-prazole: omeprazole lansoprazole esomeprazole pantoprazole Histamine blockers: -dine: famotidine ranitidine cimetidine Drug Class: Antibiotics Vancomycin Ciprofloxacin Silver sulfadiazine Penicillin V Drug Class: Thrombolytic Alteplase Urokinase Reteplase Streptokinase Meds for anaphylaxis Epinephrine Drug Class: • Antihistamines • Corticosteroids Drug Class: Corticosteroids Methylprednisolone Hydrocortisone Prednisone Cortisone Fludrocortisone Drug Class: Inotropes Dobutamine Digoxin Volume Replacement Normal Saline Lactated Ringers Blood Products • Consent, 20G, 2RNs, 4 hours max Clotting Factors Drug Class: Diuretic Furosemide Hydrochlorothiazide Spironolactone Drug Class: Vasopressors Dopamine Norepinephrine (Levophed) Vasopressin Drug Class: Vasodilators (afterload Reducers) Nitroglycerine Nitroprusside Laboratory Values (Highlighted-MUST KNOW) pH 7.35 – 7.45 mmol/L Pa02 80 – 100 mm Hg PaCO2 35-45 mm Hg HCO3 22-26 mEq/L SaO2 95% D-dimer 0.5 mg/l of blood or 500 ng/ml of blood Lactic Acid (lactate) 3-7 mg/dL 0.3-0.8 mmol/L WBC 5,000-10,000 cells/mcl Hemoglobin (Hgb) Men 14-18 g/100 ml, Women 12-16 g/100 mL Hematocrit (Hct) Men 42-52%, Women 37-47% Sodium 136-145 mEq/L Potassium 3.5-5 mEq/L Laboratory Value Interpretation Burns Resuscitative High K+ Hyponatremia Increase WBC Acute Low K+ Hyponatremia Increase WBC Hypoxemia Low Pa02 Pulmonary embolism High D-Dimer High CO2 Low PaO2 Infection High WBC Increase temp Fluid volume excess Decreased Serum Sodium 136 Decreased Urine Specific Gravity Bounding pulse, Increase BP Hypovolemic Shock H/H high- dehydration H/H low-bleeding Increased Lactic Acid Increased K Dosage and Calculation – (Know how to work these calculations.) 1. A client needs to receive vancomycin 500mg IV to treat pneumonia. The medication is supplied in a 100ml IV piggyback that is to be given over 1 hour. What rate in ml/hr should the nurse program into the IV pump? mL/hr 2. Calculate the IV flow rate in drips per minute using a drip rate. Administer 2500ml Lactated Ringer's over 16 hours using a tubing with a drip factor of 15 drops/ml. Provide the answer in a whole number gtt/min 3. Determine the infusion rate in milliliters per hour: The client has a vasoactive medication ordered to infuse at 5mcg/kg/min. The client is 188 lbs and the medication supply is 400mg in 250ml. The correct rate is mL/hr 4. The order is to infuse Heparin 1000 u/hr from a solution of 20,000 u in 500 mL of D5W. What is the ml/hr flow rate? mL/hr 5. Order: diltiazem 30 mg PO BID. Available: diltiazem 60 mg per tablet. Dose: Tablets 6. Order: diphenhydramine 25 mg IM now. Available: diphenhydramine 50 mg/ml in a 10 ml vial. How much will you give? mL Calculate the Mean Arterial Pressure (MAP) for a client with a BP of 90/48. Rule of 9s 1. The client has his entire left arm burnt, all of his front torso and the front of both legs. % 2. The client has his entire head burnt, entire back and back of the left leg. % Parkland Formula 1. The client weighs 200 pounds and has burns to both his legs: % 2. Using the Parkland Formula determine the following: a. Total fluid for the first 24 hours: mL b. Fluid administered the first 8 hours mL. c. How many mLs per hours will that be? mL/hr d. IV rate for the next 16 hours: mL/hr e. What would the IV rate be if the client waited 3 hours to come to the ED? mL/hr f. Urine output: What would the minimum urine output be for the above client? mL/hr Answers: 1. 100 2. 39 3. 16 4. 25 5. 0.5 6. 0.5 MAP=62 Rule of 9s 1. 45 2. 36 Parkland Formula 1. 36 a. 13,104 b. 6552 c. 819 d. 409.5 e. 1310.4 f. 45.5