jchan0425

ok cool, i will give some more own opinion next time rather than leaving the question here coz that's what we usually do in skool forum.

not anything specific just nursing i am doing a RN course but what they are teaching is a post-graduate diploma ICU course content. we don't know the basic, how can we do the advance? They teach UWSD but never show us a real one even a bloody video, instead showing a empty bottle and tell us the mechnism of it... that's why i have a lot of questions i am sorry if i am making any trouble

mr fleming was admitted with multiple injuries following a mva including a haemopneumothorax which required the insertion of 2 chest drains, attached to an uwsd. when caring for mr fleming it is important to know the following: 1. the water in the uwsd tubing should be checked hourly for swinging. in an uwsd system vented to air on inspiration water will rise slightly; on expiration, water will swing down the tube. absence of swinging always means resolution of the pneumothorax. 2. attach a heimlich valve for 24 hours prior to removal to trial patient's tolerance without the uwsd system. 3. the following s/s signal a medical emergency. shift of the mediastinum to the opposite side, hypotension, severe breathlessness, tachycardia, reduced sao2, increased central venous pressure with distended neck vein and restlessness, pallor and diaphoresis. 4. if the chest drain comes out of the chest, the hole in the chest wall must be covered immediately so that it is air tight to prevent air getting into the pleural cavity. answer 1) wrong, not alwaysmeans a resolution i am choosing number 2 as my answer sounds no mistakes and good what do you think?

i am picking number 4 ans1) hysterectomy?? ans2) pt is not airway compromised why would we do that? pt's pain can be back without morphine ans3) she is already giving pain score 3/10, no reason to increase the dose at all ans4)do nothing is the best response

Number 2 is incomplete but you can't say it is wrong, Number 4 is complete but you can't say it is correct... sigh, the lecturers set up the questions without processing in the brain:madface:

yea, makes it more confusing

that's why i am struggling

mrs sachett 6 hours post op following hemicolectomy. she has a morphine infusion presently running as a background infusion of 2mg/hr and she describes her pain as 3/10 with respiratory rate of 14, sao2 97%, pulse 98 b/p 104/65 and although sleepy is easily roused. the order indicates she can have from 0-5 mg/hour with a bolus of 1mg twice per hour if necessary. what would you do? 1. decrease the rate of the infusion to 1 mg/hr and assess how she is feeling about her hysterectomy, teach her relaxation and breathing exercises to control the anxiety which is at this stage contributing to the experience of pain 2. stop the infusion and administer a dose of naloxone to reverse the effects of morphine 3. as pain is still present and the current amount is less than the maximum dose it would be appropriate to increase the infusion to 4mg/hr 4. keep the infusion at the current rate

i am choosing number 2

mrs sachett was returned to the ward following a hemicolectomy. a large bore ngt was insitu. there has been no naso-gastric tube drainage for 2 hrs and mrs sachett is also complaining of nausea. using an analysis of the literature and knowledge of post-op care for patient post hemicolectomy respond to each of the following: 1. check the patency of the ngt by instillation of 20ml of air into the ngt and listen for the 'swooshing' of air over the stomach with a stethoscope. 2. ensure the ngt drainage bag is below the bed frame, then check the patency of the ngt first by aspiration with a toomey syringe and testing the aspirate with litmus paper or ph strips. as you would expect around 50ml of fluid to build up in the stomach every hour. 3. lie mrs sachett down as post op blood pressure would be low and this combined with the morphine may be making her dizzy. following the determination of ngt patency the patient can then be administered iv tropisetron or stemetil. 4. administer maxolon which is always the first anti-emetic mediation orders on the post-operative nausea an d vomiting protocol.

assess for bleeding from the femoral vein isn't the procedure perform on a femoral artery?

if you were caring for mr meyer immediately post coronary angiogram, you would: 1. assess pt vitals signs, neurovascular obs on both legs, palpate femoral artery assessing for haematoma development, continuous cardiac monitoring, administer pain relief, position the patient in semi- recumberent position to facilitate breathing as he has had a general anaesthetic[jc1] . 2. assess pt vitals signs, neurovascular obs on both legs, position the patient supine, assess for bleeding from the femoral artery and ensure adequate fluid intake to facilitate excretion of dye. 3. assess pt vitals signs, neurovascular obs on leg of the femoral artery[jc2] used to insert pulmonary arterial catheter[jc3] , position the patient in supine position and assess for bleeding from the femoral artery. 4. assess pt vitals signs, neurovascular obs on both legs, position the patient supine, assess for bleeding from the femoral vein[jc4] , ensure adequate fluid intake to facilitate excretion of dye, continuous cardiac monitoring and administer pain relief prn. [jc1]usually not require [jc2]pulmonary arterial catheter insert into the femoral vein [jc3]its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs. [jc4]femoral artery this is a very tricky i am choosing number 2 as my answer am i correct?