Essence Of Critical care Assessment Quiz

Effective communication is crucial in promoting a positive image of the nursing profession. Nurses interact with patients, their families, and other healthcare professionals on a daily basis. By communicating effectively, nurses can build trust, establish rapport, and provide quality care. Good communication skills also contribute to patient satisfaction and positive outcomes. Therefore, it is true that to promote a positive image of the nursing profession, effective communication is essential.

People’s perception of you can lead to a positive or negative relationship. This is because perception goes beyond just physical appearance and includes various factors such as attitude, affect, and tone of voice. These elements contribute to how others perceive and interpret your behavior and can ultimately determine the nature of your relationship with them. Therefore, all of the mentioned factors play a role in influencing people's perception of you and subsequently shaping the quality of your relationship with them.

The oxygen demand of the body can be influenced by various factors such as temperature, muscle activity (like shivering), agitation, and the work of breathing. These factors can increase the body's need for oxygen as they require more energy and metabolic activity. Therefore, all of the mentioned factors can affect the oxygen demand of the body.

Stewardship is a process that creates a collaborative environment where information is shared, people partner to learn and support each other, and ultimately leads to improved patient outcomes. This implies that stewardship goes beyond a professional ladder hierarchy and does not create an antagonistic environment. It emphasizes the importance of collaboration and support among individuals in order to enhance patient care. Therefore, the correct answer aligns with the concept of stewardship as a collaborative process.

The Gallop Poll shows that nurses have a strong reputation for patient customer relations, surpassing physicians, dentists, and members of the clergy. However, negative perceptions of nursing still persist. To combat this, nurses should focus on developing a positive self-image to project a better public image. Additionally, they should actively engage with the public to educate them about the role and responsibilities of nurses. Finally, nurses should strive to be role models in all aspects of their lives. Therefore, all of the above strategies can be effective in promoting nurses as key players in healthcare.

Conduction disturbances following open-heart surgery (OHS) may be related to the manipulation of the conduction system during the procedure, cardiac edema which can interfere with the normal conduction pathways, and electrolyte imbalances that can disrupt the electrical signals in the heart. Therefore, all of the above factors can contribute to conduction disturbances following OHS.

The correct answer is "checking regularly on the patient regarding 'pain, potty, and positioning'". This answer is correct because it accurately identifies the three important aspects of patient care that healthcare professionals should regularly monitor. Pain management, ensuring proper toileting needs, and maintaining a comfortable and safe position are crucial for providing comprehensive and effective care to patients. The other options listed in the question are not related to patient care or are not appropriate aspects to focus on in a healthcare setting.

The determinants of cardiac output include the heart's rate and rhythm, which refers to how fast and regular the heart beats. Preload and afterload are also determinants, with preload representing the amount of blood in the ventricles before contraction, and afterload representing the resistance the heart must overcome to pump blood out. Lastly, contractility refers to the strength of the heart's contractions. All of these factors contribute to determining the cardiac output, making the correct answer "All of the above."

The correct answer is A, B, and C because oxygen supply to the body is determined by multiple factors. Cardiac output refers to the amount of blood pumped by the heart per minute, which affects the delivery of oxygen to tissues. Hemoglobin concentration is the amount of oxygen-carrying protein in the blood, and oxygen saturation measures the percentage of hemoglobin that is bound to oxygen. All three factors play a role in determining the overall oxygen supply to the body.

Certification can enhance one's professional image and integrity because it provides credibility within the nursing profession. It signifies that the individual has met certain standards and possesses the necessary knowledge and skills in their field. This recognition and validation from peers and employers can boost one's self-image and confidence. Additionally, certification demonstrates a commitment to ongoing professional development and staying up-to-date with current practices, which further enhances credibility and professional value.

A nurse can evaluate the adequacy of cardiac output by assessing heart rate and blood pressure, as changes in these parameters can indicate changes in cardiac output. Additionally, peripheral pulses and skin temperature can also provide information about cardiac output, as decreased peripheral pulses and cool skin can suggest poor perfusion. Furthermore, urine output and acid-base balance can be indicators of cardiac output, as decreased urine output and imbalances in acid-base levels can be associated with decreased cardiac output. Therefore, all of the above assessments can help in evaluating the adequacy of cardiac output.

The patient's labs reveal a low hemoglobin level, indicating anemia, which may require a blood transfusion. The INR level is slightly elevated, indicating a potential issue with blood clotting, which may also require a transfusion of packed red blood cells. The platelet count is low, suggesting thrombocytopenia, which may require platelet transfusion. The low serum bicarbonate level indicates acidosis, which was addressed by giving sodium bicarbonate. The drainage of 360ml from the chest tubes suggests ongoing bleeding, further supporting the need for blood transfusion. Therefore, all of the above actions are appropriate.

The essence of critical care is the balance between oxygen supply and demand. This means that in critical care, the focus is on ensuring that patients receive enough oxygen to meet their body's demands. This balance is crucial for the proper functioning of vital organs and overall patient well-being. It involves closely monitoring oxygen levels, adjusting ventilation support, and providing necessary interventions to optimize oxygenation. Showing up for work every day and the balance between beer and kielbasa are not relevant to the essence of critical care.

The best course of action in this situation is to recruit help from colleagues, even if you have to go to the "front" to get it, get muscle relaxant from the Pyxis, ask the Operating Room to send someone from Anesthesia over, and once you get him quiet, gently pull back on the PA catheter 2-3 cm before flushing it. This is because Mr. Smith's sudden awakening and thrashing about in bed could potentially dislodge something or cause further bleeding. Getting help from colleagues and obtaining a muscle relaxant can help calm him down and prevent any further complications. Pulling back on the PA catheter before flushing it can also help ensure its proper placement and function.

The correct answer is "uncontrolled AF". AF stands for atrial fibrillation, which is an irregular and fast heart rhythm. In this scenario, Mr. Jones is experiencing symptoms of shortness of breath, dizziness, and a pounding heart, which are commonly associated with uncontrolled AF. Additionally, his blood pressure is low (90/70) and he is diaphoretic and anxious, which can be attributed to the irregular and fast heart rhythm. Therefore, uncontrolled AF is the most likely cause of his low blood pressure.

The mechanism that allows the patient's intrinsic activity to be recognized by the pacemaker is sensitivity. Sensitivity refers to the ability of the pacemaker to detect the patient's own heartbeats. It is set at a level that allows the pacemaker to recognize and respond to the patient's intrinsic activity, while still providing appropriate pacing when needed. By adjusting the sensitivity, the pacemaker can ensure that it does not interfere with the patient's natural heart rhythm and only provides pacing when necessary.

The appropriate initial actions for Mr. Smith include giving sodium bicarbonate and increasing the minute ventilation, administering volume (either 5% albumin or Lactated Ringers), and consulting the blood transfusion protocol and calling the cardiac surgeon. This is because Mr. Smith's chest tubes draining 360ml indicate potential bleeding, his low urine output suggests decreased renal perfusion, his elevated heart rate and low blood pressure may indicate hypovolemia, and his arterial blood gas showing a base excess of -4.5 suggests metabolic acidosis. Therefore, all of the above actions are necessary to address these potential issues and stabilize Mr. Smith's condition.

A patient should receive a blood transfusion when their hemoglobin drops below 7. This is because hemoglobin is responsible for carrying oxygen to the body's tissues, and a hemoglobin level below 7 indicates severe anemia. At this level, the patient may experience symptoms such as fatigue, shortness of breath, and weakness. Therefore, a blood transfusion is necessary to increase the hemoglobin level and improve oxygen delivery to the tissues.

The strip recorded in the CTICU showed normal sinus rhythm, left bundle branch block, and P-wave tracking pacing or DDD pacing mode. This means that the patient's heart was beating in a normal rhythm, but there was a delay in the electrical conduction in the left bundle branch. The pacemaker was set to track the P-waves and deliver pacing in the DDD mode, which means it was pacing both the atria and ventricles as needed. This mode ensures proper synchronization of the heart's chambers and helps maintain a normal heart rhythm.

The given symptoms and findings suggest that Charles Jenkins is experiencing a severe blockage of electrical signals between the atria and ventricles of his heart. This is indicated by the low heart rate (42 bpm) and the significant drop in blood pressure. Third degree heart block, also known as complete heart block, is a condition where there is a complete blockage of electrical signals between the atria and ventricles, resulting in a slow and irregular heartbeat. This condition can cause weakness, fatigue, and decreased exercise tolerance, which are consistent with Charles Jenkins' symptoms.

The correct answer is "Avoid all microwave ovens." After a permanent pacemaker insertion, patients and their families are educated about various aspects of care. This includes not scrubbing the insertion site to prevent infection and contacting the doctor if the patient has an elevated temperature, which could indicate an infection. However, avoiding all microwave ovens is not necessary or relevant to post-pacemaker care.

The correct answer is AAI. AAI is a type of pacemaker mode that stands for atrial pacing, atrial sensing, and inhibited ventricular pacing. In this mode, the pacemaker paces the atrium, senses the atrial activity, and inhibits ventricular pacing if the atrium is able to initiate a heartbeat. This mode is commonly used in patients with intact atrioventricular (AV) conduction but who have a slow heart rate or intermittent AV block.

Garlic, ginseng, and gingko have been associated with excessive bleeding when used as non prescription herbal supplements. These substances have anticoagulant properties, meaning they can thin the blood and increase the risk of bleeding. It is important to educate patients and their family members about the potential risks and side effects of using these supplements, especially if they are taking other medications or have underlying health conditions that may increase their risk of bleeding.

When a magnet is placed over a dual pacer generator, it triggers a magnet mode response. In this case, the pacing mode that is produced after applying the magnet is DOO. DOO stands for Dual-chamber pacing, with both the atrium and ventricle being paced asynchronously. This mode is typically used when the patient's natural heart rhythm is completely absent or unreliable.

After a myocardial infarction (MI), the heart's ability to pump blood is compromised. Decreasing preload (the amount of blood filling the heart) and afterload (the resistance the heart has to overcome to pump blood out) helps reduce the workload on the heart and improve its efficiency. Decreasing blood pressure (BP) is important to prevent strain on the heart and reduce the risk of further damage. Elevating myocardial oxygen demand (MVE delivery) is necessary to ensure adequate oxygen supply to the heart muscle. Therefore, decreasing preload, decreasing afterload, decreasing BP, and elevating MVE delivery are all beneficial in post-MI management.

Immediate cardioversion is considered in this case because the patient's heart rate continues at 128 and the onset of atrial fibrillation (AF) is less than 48 hours. Early cardioversion is often recommended for patients with recent-onset AF to restore normal sinus rhythm and prevent complications. Age and gender, lack of anticoagulation, and lack of adequate rate control with diltiazem are not specifically mentioned as reasons for immediate cardioversion in this scenario.

Nitroprusside is a drug that may cause intra coronary steal away from ischemic areas. Intra coronary steal refers to the redistribution of blood flow within the coronary arteries, away from areas of ischemia or inadequate blood supply. Nitroprusside is a vasodilator that acts by relaxing smooth muscles in blood vessels, including those in the coronary arteries. This relaxation can lead to increased blood flow to non-ischemic areas, potentially diverting blood away from areas with compromised blood supply.

DVI mode provides pacing in both the atria and ventricles, with a fixed atrial pacing rate. AOO mode provides pacing only in the atria, with a fixed atrial pacing rate. Therefore, both DVI and AOO modes will give the patient fixed atrial pacing.

Phenylephrine is the correct answer because it is a drug commonly used to treat post-operative hypotension and low cardiac output. Unlike epinephrine and ephedrine, phenylephrine does not have any inotropic effect, meaning it does not directly affect the force of contraction of the heart. This makes it a suitable choice for patients who do not require an increase in cardiac contractility but still need treatment for low blood pressure and cardiac output.

The correct answer is "Always wear gloves" because when caring for a patient with epicardial wires and pacer, it is important to maintain proper infection control measures. Wearing gloves helps to prevent the transmission of any potential pathogens and ensures the safety of both the patient and the healthcare provider.