NRNP6566 KNOWLEDGE CHECK WEEK 8
QUESTION 1
1. A 77 year old man fell and suffered a laceration across his upper right lip. The APRN
decides to utilize a block for pain control which suturing the laceration. What type of
block and what medication would be appropriate for this patient?
For upper lip laceration, an infraorbital nerve block can be used. The anesthetic of choice is plain
lidocaine but if there are profuse bleeding externally, epinephrine can be added for better
hemodynamic control. Once anesthesia is achieved, irrigate the area with saline. Lidocaine 2%
should be used as nerve blocks for intraoral and superficial procedures. Adding epinephrine
produces vasoconstriction. The dose for lidocaine with epinephrine is 7mg/kg with a maximum
dose of 500 mg
QUESTION 2
1. A 13 year old girl is evaluated in urgent care for a large wound on her left forearm. She
complains of severe pain, is crying, and is rocking on the bed due to pain. The APRN is
planning on how to repair the laceration and is considering utilizing ketamine for
procedural sedation. What are the benefits and risks of this drug? What monitoring would
be indicated if utilized?
Ketamine has several advantages over other sedatives for procedural sedation. According to
Buck (2016), the use of ketamine results in only minimal respiratory depression with preserved
or exaggerated pharyngeal and laryngeal reflexes. It also results to normal or slightly increased
muscle tone with minor increase in BP, heart rate and cardiac output (Buck, 2016). Additionally,
it is rapid acting as an anesthetic with analgesic properties. Some potentially life-threatening
adverse effects have been associated with ketamine, although rare. These include laryngospasm,
apnea, impaired cardiac function, increased intracranial pressure and diabetes insipidus so the
patients should be carefully monitored for these (Buck, 2016).
Reference
Buck, M. L. (2016). Ketamine infusions for pediatric sedation and analgesia. Pediatric
Pharmacotherapy, 22(6). https://med.virginia.edu/pediatrics/wp-
content/uploads/sites/237/2015/12/June16_Ketamine_PedPharmaco.pdf
QUESTION 3
1. A 66 year old women in the ICU is diagnosed with delirium. What would be the best
approach to treating her delirium?
, Barkley and Myers (2018), treating the underlying medical condition is crucial to resolving
delirium as failure to do so may lead to long-term cognitive impairment. Although sedatives and
antipsychotics may be administered, efforts must be made to reduce anxiety and agitation by
keeping them comfortable, maintaining normal sleep patterns, and frequent reorientation
(Barkley & Myers, 2018). Acute psychotic medications like lorazepam, olanzapine, and Haldol
can be ordered for those with dementia (Barkley & Myers, 2018). If patient is lucid, oral
quetiapine, olanzapine, risperdone, and haloperidol can be given in low doses (Barkley & Myers,
2018). Medical, neurologic and psychiatric consultations should be made as well.
Reference
Barkley, T. W., & Myers, C. M. (2015). Practice considerations for the adult-gerontology acute
care nurse practitioner (2nd ed.). West Hollywood, CA: Barkley & Associates.
QUESTION 4
1. A 66 year old man is admired to the ICU with respiratory distress and bilateral
pneumonia. He has a history of a CVA 2 years ago with right hemiplegia and aphasia.
Current vitals signs are T 98.8 HR 115 BP 170/99. RR 32. Oxygen saturation is 90% on
a nonrebreather mask. The patient weighs 70 kg. The NP decides to perform a rapid
sequence intubation. What medications and doses would be appropriate for this patient?
For rapid sequence intubation, induction agent that could be used is etomidate 0.3mg/kg IV
(20mg for this patient). The neuromuscular blocking agent that could be used is rocuronium 1-
1.2 mg/kg IV (70 mg for this patient). Succinylcholine is not indicated for those with history of
stroke over 72 hours.
QUESTION 5
1. A patient receiving propofol for bronchoscopy in the ICU becomes unresponsive to
verbal or tac-tile stimulation. His pulse oximeter reads 85%. What action should the NP
take to improve the patient’s oxygenation?
Propofol is short acting. When respiratory depression occurs as shown by decreased level
of consciousness and decreased oxygen saturation, discontinue the drip and provide ventilatory
assistance through a bag valve mask.
2. In treating propofol toxicity, the first step to prevent worsening conditions is to
discontinue the propofol infusion. If the patient still requires sedation in the due to other
factors another class of sedative should be substituted. The patient should then be
hemodynamically stabilized. In severe cases, patients may require advanced
cardiorespiratory like this patient, support such as extracorporeal membranous
QUESTION 1
1. A 77 year old man fell and suffered a laceration across his upper right lip. The APRN
decides to utilize a block for pain control which suturing the laceration. What type of
block and what medication would be appropriate for this patient?
For upper lip laceration, an infraorbital nerve block can be used. The anesthetic of choice is plain
lidocaine but if there are profuse bleeding externally, epinephrine can be added for better
hemodynamic control. Once anesthesia is achieved, irrigate the area with saline. Lidocaine 2%
should be used as nerve blocks for intraoral and superficial procedures. Adding epinephrine
produces vasoconstriction. The dose for lidocaine with epinephrine is 7mg/kg with a maximum
dose of 500 mg
QUESTION 2
1. A 13 year old girl is evaluated in urgent care for a large wound on her left forearm. She
complains of severe pain, is crying, and is rocking on the bed due to pain. The APRN is
planning on how to repair the laceration and is considering utilizing ketamine for
procedural sedation. What are the benefits and risks of this drug? What monitoring would
be indicated if utilized?
Ketamine has several advantages over other sedatives for procedural sedation. According to
Buck (2016), the use of ketamine results in only minimal respiratory depression with preserved
or exaggerated pharyngeal and laryngeal reflexes. It also results to normal or slightly increased
muscle tone with minor increase in BP, heart rate and cardiac output (Buck, 2016). Additionally,
it is rapid acting as an anesthetic with analgesic properties. Some potentially life-threatening
adverse effects have been associated with ketamine, although rare. These include laryngospasm,
apnea, impaired cardiac function, increased intracranial pressure and diabetes insipidus so the
patients should be carefully monitored for these (Buck, 2016).
Reference
Buck, M. L. (2016). Ketamine infusions for pediatric sedation and analgesia. Pediatric
Pharmacotherapy, 22(6). https://med.virginia.edu/pediatrics/wp-
content/uploads/sites/237/2015/12/June16_Ketamine_PedPharmaco.pdf
QUESTION 3
1. A 66 year old women in the ICU is diagnosed with delirium. What would be the best
approach to treating her delirium?
, Barkley and Myers (2018), treating the underlying medical condition is crucial to resolving
delirium as failure to do so may lead to long-term cognitive impairment. Although sedatives and
antipsychotics may be administered, efforts must be made to reduce anxiety and agitation by
keeping them comfortable, maintaining normal sleep patterns, and frequent reorientation
(Barkley & Myers, 2018). Acute psychotic medications like lorazepam, olanzapine, and Haldol
can be ordered for those with dementia (Barkley & Myers, 2018). If patient is lucid, oral
quetiapine, olanzapine, risperdone, and haloperidol can be given in low doses (Barkley & Myers,
2018). Medical, neurologic and psychiatric consultations should be made as well.
Reference
Barkley, T. W., & Myers, C. M. (2015). Practice considerations for the adult-gerontology acute
care nurse practitioner (2nd ed.). West Hollywood, CA: Barkley & Associates.
QUESTION 4
1. A 66 year old man is admired to the ICU with respiratory distress and bilateral
pneumonia. He has a history of a CVA 2 years ago with right hemiplegia and aphasia.
Current vitals signs are T 98.8 HR 115 BP 170/99. RR 32. Oxygen saturation is 90% on
a nonrebreather mask. The patient weighs 70 kg. The NP decides to perform a rapid
sequence intubation. What medications and doses would be appropriate for this patient?
For rapid sequence intubation, induction agent that could be used is etomidate 0.3mg/kg IV
(20mg for this patient). The neuromuscular blocking agent that could be used is rocuronium 1-
1.2 mg/kg IV (70 mg for this patient). Succinylcholine is not indicated for those with history of
stroke over 72 hours.
QUESTION 5
1. A patient receiving propofol for bronchoscopy in the ICU becomes unresponsive to
verbal or tac-tile stimulation. His pulse oximeter reads 85%. What action should the NP
take to improve the patient’s oxygenation?
Propofol is short acting. When respiratory depression occurs as shown by decreased level
of consciousness and decreased oxygen saturation, discontinue the drip and provide ventilatory
assistance through a bag valve mask.
2. In treating propofol toxicity, the first step to prevent worsening conditions is to
discontinue the propofol infusion. If the patient still requires sedation in the due to other
factors another class of sedative should be substituted. The patient should then be
hemodynamically stabilized. In severe cases, patients may require advanced
cardiorespiratory like this patient, support such as extracorporeal membranous
