CJSim™ Next Gen Quizzing

Dashboard

Pharmacology

Sadrac Joicin 51-years-old

1. Age: 51 years

Provider: P. Kolonich MD

1. Allergies: atorvastatin, lisinopril, red dye, shellfish

Code Status: Full Code

1. 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?

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.