Adult-Gerontology Acute Care Nursing Flashcards

A patient with ARDS is on mechanical ventilation. Which ventilator strategy reduces ventilator-induced lung injury?

Answer: Low tidal volume ventilation (6 mL/kg ideal body weight)

Low tidal volume ventilation (6 mL/kg ideal body weight) is the evidence-based lung-protective strategy for ARDS. The ARDSNet trial demonstrated significant mortality reduction compared to 12 mL/kg tidal volumes.

When caring for a patient post-CABG, which finding requires immediate intervention?

Answer: Mediastinal chest tube output of 250 mL/hr for two consecutive hours

Chest tube output greater than 200 mL/hr for 2 consecutive hours post-CABG indicates excessive bleeding requiring immediate surgical re-exploration.

A patient with acute liver failure and hepatic encephalopathy needs management of cerebral edema. Which nursing intervention is the priority?

Answer: Elevate head of bed to 30 degrees and minimize stimulation

Elevating the head of bed to 30 degrees promotes venous drainage and reduces intracranial pressure. Minimizing stimulation reduces ICP spikes.

According to the Surviving Sepsis Campaign, what is the recommended fluid resuscitation target within the first 3 hours of septic shock?

Answer: At least 30 mL/kg crystalloid

The Surviving Sepsis Campaign recommends at least 30 mL/kg intravenous crystalloid fluid within the first 3 hours of sepsis-induced hypoperfusion or septic shock.

Which intervention is most supported by evidence to prevent and treat ICU delirium?

Answer: Early mobilization, sleep protocol, and reorientation using the ABCDEF bundle

The ABCDEF bundle (Assess, Both SAT/SBT, Choice of analgesia/sedation, Delirium assessment, Early mobility, Family engagement) is the evidence-based framework for preventing and treating ICU delirium.

A patient with TBI has ICP of 28 mmHg and MAP of 85 mmHg. What is the CPP and is it within the recommended range?

Answer: CPP = 57 mmHg; below the recommended minimum of 60-70 mmHg

CPP = MAP minus ICP = 85 minus 28 = 57 mmHg. The Brain Trauma Foundation recommends CPP of 60-70 mmHg. A CPP of 57 mmHg is below the minimum and requires intervention.