Description CJSim™ Next Gen Quizzing Dashboard Pharmacology Sadrac Joicin 51-years-old Age: 5 ...
Description CJSim™ Next Gen Quizzing Dashboard Pharmacology Sadrac Joicin 51-years-old Age: 51 years Provider: P. Kolonich MD Allergies: atorvastatin, lisinopril, red dye, shellfish Code Status: Full Code Admit Wt: 190 lbs (86.2 kg) BMI: 26.5 Nursing Flowsheets Provider Lab & Diagnostics MAR Collaborative Care NURSING ASSESSMENT & NOTES2/19 1422 Neuro/Cognitive: Responsive to painful stimuli with flexion. Eyes fluttering open spontaneously. Pupils 3 mm PERRLA. GCS: 9. Cardiovascular: Wide irregular complex tachycardia. +palpable femoral and carotid pulses. No edema. Respiratory: 7.5 ET tube. +bilateral breath sounds via bag-mask ventilation. Equal chest rise and fall. Lung sounds clear bilaterally. Lines/Drains: 18-gauge R hand IV.2/19 1422Nursing Note: Client arrival via EMS post-cardiac arrest. Per wife, client out shoveling snow and came in with L sided chest pain radiating down arm and in L jaw. Witnessed collapse at approx 1345. Resuscitated after defibrillation x 2, epinephrine x 2. In wide complex irregular tachycardia. EKG completed, noted ST elevation in leads II, III, AVF, depression in lateral leads. Client reaching for endotracheal tube. Amiodarone infusion initiated. Cardiology paged and alerted catheterization lab.2/19 1432Nursing Note: Client becoming bradycardic in the 40s. Atropine 1 mg IVP administered.2/19 1437Nursing Note: Repeat 1 mg atropine IVP for bradycardia in the 40s.2/19 1440Nursing Note: Epinephrine drip infusing per MAR.2/19 1458Nursing Note: Client transported to catheterization lab on telemetry monitoring and accompanied by primary RN.2/20 0700Nursing Note: Report received from N. Pennapacker, RN. Family at bedside with client.2/20 0730 Neuro/Cognitive: Chemically sedated. Pupils 2 mm sluggish response. Respiratory: Lung sounds clear bilat. Mechanically ventilated. Cardiovascular: Normal sinus rhythm. S1 and S2 sound present. +apical murmur. +2 pitting edema feet to midcalf. +2 pedal pulses. Genitourinary: 16 F indwelling urinary catheter. 300 mL green urine drained from last shift Lines/Drains: 18-gauge R hand – heparin infusing, triple lumen central venous catheter – infusing propofol, dobutamine, epinephrine.2/20 0815Nursing Note: Dr. Kolonich made aware of lab values and to bedside to speak with family about plan of care. Family still agreeable to LVAD placement tomorrow. Question 3 Correct Mark 33.33 out of 33.33 Question text Before answering this question, review the client’s health information in the EHR. Identify indicators of client improvement. Select all that apply. Temperature Mean arterial pressure Cardiac rhythm Edema Urine output BNP level Potassium level Level of consciousness Feedback Your answer is correct. Debriefing: Overall the client’s condition is worsening and there are a variety of issues that should be addressed. The client’s cardiac rhythm has improved, and the mean arterial pressure is in the desired range because of cardiac medications. Consider: 1. What are the concerning findings in the EHR? 2. How do the client’s medications impact these findings? 3. How should the nurse interpret the arterial blood gas? The correct answers are: Cardiac rhythm Mean arterial pressure Nursing Flowsheets Provider Lab & Diagnostics MAR Collaborative Care VITAL SIGN TRENDDateTempHRRRBPSpO2O22/19 142296.9 °F (36.1 °C)1261288/42 (MAP 57)97%bag-valve ventilation2/20 091097.8 °F (36.6 °C)891494/48 (MAP 63)96%mechanic ventilator2/20 080097.5 °F (36.4 °C)6214108/68 (MAP 81)deferreddeferred Age: 51 years Provider: P. Kolonich MD Allergies: atorvastatin, lisinopril, red dye, shellfish Code Status: Full Code Admit Wt: 190 lbs (86.2 kg) BMI: 26.5 Nursing Flowsheets Provider Lab & Diagnostics MAR Collaborative Care PROVIDER PRESCRIPTIONS & NOTES2/19 1445Prescriptions: Labs: CBC, CMP, PT/INR, troponin, lactic acid EKG 1 view chest x-ray Start peripheral IV Amiodarone 150 mg/100 mL D5W now – infuse over 10 minutes EPINEPHRINE 4 MG/250 ML D5W IV CONTINUOUS – START 2 MCG/MIN – TITRATE 1-2 MCG/MIN EVERY 5-10 MINUTES FOR MAP>65 MMHG Propofol 1000 mg/100 mL IV continuous – start 5 mcg/kg/min, increase by 5-10 mcg/kg/min every 5-10 minutes goal sedation 2/20 0900Prescriptions: Dobutamine 500 mg/250 mL D5W IV continuous – infuse at 5 mcg/kg/min Furosemide 80 mg IV push twice daily Age: 51 years Provider: P. Kolonich MD Allergies: atorvastatin, lisinopril, red dye, shellfish Code Status: Full Code Admit Wt: 190 lbs (86.2 kg) BMI: 26.5 Nursing Flowsheets Provider Lab & Diagnostics MAR Collaborative Care LAB RESULTSDateLabNormalResult2/20 0810Na136-145 mEq/L136 K+3.5-5.0 mEq/L5.9 Cl98-106 mEq/L102 Glucose70-100 mg/dL91 BUN8-20 mg/dL38 Creatinine0.7-1.3 mg/dL2.8 BNP100 pg/mL18,500 ABG pH7.35.-7.457.25 ABG CO235-54 mmHg38 ABG O280-100 mmHg115 ABG HCO322-26 mEq/L17 Age: 51 years Provider: P. Kolonich MD Allergies: atorvastatin, lisinopril, red dye, shellfish Code Status: Full Code Admit Wt: 190 lbs (86.2 kg) BMI: 26.5 Nursing Flowsheets PROVIDER Lab & Diagnostics MAR Collaborative Care MEDICATION ADMINISTRATION RECORDMedication2/20 0910Medication: Dopamine Dosage: 500 mg/250 mL – 5 mcg/kg/min Route: IV Frequency: Continuous Parameters: Titrate to keep systolic blood pressure >100KMAMedication: Furosemide Dosage: 80 mg (40 mg/4 mL) Route: IV push Frequency: Once Parameters: N/AKMAMedication: Propofol Dosage: 35 mcg/kg/min (1000mg/100 mL) Route: IV Frequency: Continuous Parameters: Maintain moderate sedationKMAMedication: Epinephrine Dosage: 8 mcg/kg/min (4mg/250 mL) Route: IV Frequency: Continuous Parameters: Maintain MAP >65 mmHgKMAMedication: Heparin Dosage: 15 units/kg/hr (25,000 units/250 mL D5W) Route: IV Frequency: Continuous Parameters: PTT less than 40 – increase by 4 units/kg/hr PTT 40-49 – increase by 2 units/kg/hr PTT 50-74 – no change PTT 76-87 – decrease by 1 unit/kg/hr PTT 88-96 – Hold x 30 minutes, decrease by 2 units/kg/hr PTT greater than 96 – Hold x 1 hour, decrease by 3 units/kg/hr KMA Question 3 Correct Mark 33.33 out of 33.33 Question text Before answering this question, review the client’s health information in the EHR. Identify indicators of client improvement. Select all that apply. Temperature Mean arterial pressure Cardiac rhythm Edema Urine output BNP level Potassium level Level of consciousness Feedback Your answer is correct. Debriefing: Overall the client’s condition is worsening and there are a variety of issues that should be addressed. The client’s cardiac rhythm has improved, and the mean arterial pressure is in the desired range because of cardiac medications. Consider: 1. What are the concerning findings in the EHR? 2. How do the client’s medications impact these findings? 3. How should the nurse interpret the arterial blood gas?
