Nursing Care for Deep Vein Thrombosis
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Questions and Answers

What is the confirmatory test for deep vein thrombosis (DVT)?

  • Duplex ultrasound (correct)
  • CT scan
  • Blood test
  • Homan’s test

    • Which method of administering insulin is not recommended due to the risk of cloudiness?

  • Intramuscular injection of insulin
  • IV administration of cloudy insulin (correct)
  • IV administration of regular insulin
  • Subcutaneous injection of NPH

    • What is the primary reason to avoid ambulation in a patient with an existing thrombus?

  • It can exacerbate swelling.
  • It can lead to pulmonary embolism. (correct)
  • It may cause muscle cramps.
  • It prevents proper blood circulation.

    • What is the correct calculation for drops per minute (gtts/min) if the order is for 100 units of insulin in 400 mL NSS to infuse at 4 units/hour?

    <p>5 gtts/min</p> Signup and view all the answers

    For DVT prevention, what is the recommended action for patients who are able to move?

    <p>Advise them to ambulate/walk.</p> Signup and view all the answers

    What is a common cardiovascular sign observed during the compensatory stage?

    <p>Increased heart rate</p> Signup and view all the answers

    Which organ systems receive reduced blood flow during the compensatory stage to prioritize vital organs?

    <p>Kidneys, skin, and gastrointestinal tract</p> Signup and view all the answers

    What laboratory findings indicate kidney impairment during the compensatory stage?

    <p>Increased BUN and creatinine levels</p> Signup and view all the answers

    How is renal failure classified during shock when it results from inadequate blood supply?

    <p>Pre-renal failure</p> Signup and view all the answers

    What is a potential mental status outcome due to impaired blood flow to the brain during the compensatory stage?

    <p>Deterioration in level of consciousness</p> Signup and view all the answers

    What is the maximum dosage for dobutamine IV infusion in a case of refractory heart failure?

    <p>20 mcg/kg/minute</p> Signup and view all the answers

    Why is dobutamine not useful in cases of ischemic heart disease?

    <p>It increases myocardial oxygen demand</p> Signup and view all the answers

    What is the correct starting infusion rate of Heparin for a 75 kg patient?

    <p>27 mL/hour</p> Signup and view all the answers

    What potential effect does Heparin have when administered with dobutamine?

    <p>Increases risk of bleeding</p> Signup and view all the answers

    How is the infusion rate of Heparin calculated from the total units in the IV bag?

    <p>Total units in IV bag / total volume (mL)</p> Signup and view all the answers

    What is a risk associated with Hydrocortisone when used with dobutamine?

    <p>Fluid retention and elevated blood pressure</p> Signup and view all the answers

    In what manner should Heparin be administered to minimize bleeding risks?

    <p>As a continuous infusion</p> Signup and view all the answers

    What is the anticipated effect of dobutamine on heart rate?

    <p>Increase heart rate</p> Signup and view all the answers

    What is a key characteristic of carfentanil compared to fentanyl?

    <p>It is 100-fold stronger than fentanyl.</p> Signup and view all the answers

    How does tolerance develop in relation to substance use?

    <p>The body adapts to the drug, requiring larger doses for the same effect.</p> Signup and view all the answers

    What is the primary use of carfentanil in veterinary practice?

    <p>For surgical procedures in large animals.</p> Signup and view all the answers

    Which of the following best describes drug dependence?

    <p>It can occur without drugs that cause addiction.</p> Signup and view all the answers

    What is NOT a symptom of drug abuse?

    <p>Experiencing withdrawal symptoms when stopping.</p> Signup and view all the answers

    Which statement best describes the effects of opioids like morphine?

    <p>They relieve pain without affecting consciousness.</p> Signup and view all the answers

    What typically occurs during withdrawal from addictive substances?

    <p>Manifestation of both physical and psychological symptoms.</p> Signup and view all the answers

    What is the primary mechanism through which opioids alleviate pain?

    <p>By depressing central nervous system and respiratory functions.</p> Signup and view all the answers

    What is a key indicator that blood is being shunted from the skin to vital organs?

    <p>Cold clammy skin</p> Signup and view all the answers

    Which condition could result from sluggish blood flow and metabolic acidosis?

    <p>Hypotension</p> Signup and view all the answers

    What might indicate worsening kidney function in a patient?

    <p>Oliguria</p> Signup and view all the answers

    Which of the following is NOT a common manifestation of reduced blood flow to the gastrointestinal tract?

    <p>Hyperactive bowel sounds</p> Signup and view all the answers

    What is the recommended initial intravenous fluid type for managing a patient in shock?

    <p>Isotonic solution</p> Signup and view all the answers

    In addition to monitoring blood pressure, which parameter shows an increase due to shock?

    <p>Respiratory rate</p> Signup and view all the answers

    Which of the following is a goal of medical management in a shock situation?

    <p>Support the pumping action of the heart</p> Signup and view all the answers

    What physiological condition can be indicated by decreased level of consciousness during shock?

    <p>Decreased cerebral perfusion</p> Signup and view all the answers

    What is the primary reason for decreased stroke volume during an intrauterine transfusion?

    <p>Reduced blood entering the heart</p> Signup and view all the answers

    Which procedure involves giving donor blood in the umbilical vein and obtaining waste blood in the umbilical artery?

    <p>Exchange transfusion</p> Signup and view all the answers

    What immediate action should be taken if a transfusion reaction is suspected?

    <p>Stop the procedure and check vital signs</p> Signup and view all the answers

    What is the normal total blood volume in a typical adult?

    <p>5 L</p> Signup and view all the answers

    After a transfusion reaction, which sample should be sent to the laboratory?

    <p>Blood from the arm opposite to the transfusion</p> Signup and view all the answers

    What does decreased cardiac output typically lead to during a transfusion procedure?

    <p>Decreased tissue perfusion</p> Signup and view all the answers

    What should be written following a transfusion reaction?

    <p>An incident report</p> Signup and view all the answers

    What is a potential consequence of hemorrhage during a transfusion?

    <p>Excess blood loss</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Emergency and High Alert Drugs

    • Crash carts contain equipment and medications needed for immediate medical emergencies within the first 30 minutes
    • Each cart will include similar equipment, but carts may vary depending on location
    • It is the charge nurse's responsibility to maintain the cart, checking before and after shifts
    • Two charge nurses should sign off on the crash cart use during codes
    • Medication carts are for medication and separate from crash carts for resuscitation
    • Crash carts should be present in all patient rooms

    High-Alert Medications

    • High-alert medications (HAM) have a higher risk of causing harm if used incorrectly
    • The medications include those that are dangerous if not administered properly due to patient rejection risk or other adverse reactions
    • Safety systems, such as independent double checks, are crucial for administration
    • Standardized order sets and medication charts should also be used
    • Medications include potassium (IV but never bolus), electrolytes, psychotropics, insulin, narcotics (morphine, opioids, sedatives), antimicrobials (antibiotics), and chemotherapy agents
    • Heparin and anticoagulants are also included
    • Opioids should be a last resort and should be preceded by non-opioids like acetaminophen
    • Key medications to be included in HAM: insulin, opiates/opioids, injectable potassium, IV anticoagulants, hypertonic fluids like sodium chloride 10%

    Crash Cart Contents

    • Drawer 1: Medications (aspirin, nitroglycerin, dextrose, naloxone, epinephrine, amiodorone, atropine, epi-pen, benadryl, adenosine, hydrocortisone)
    • Drawer 2: Breathing and airway equipment (oral and nasal airways, McGill forceps, King airway, nasal cannula, bag-valve mask, non-rebreather masks)
    • Drawer 3: Circulation and IV supplies (IV start packs, normal saline (1000 ml bags), IV tubing, angiocaths, syringes)
    • Drawer 4: Cardiac and chest procedures (Cardiac equipment, chest tubes)
    • Drawer 5: Special procedure trays
    • Drawer 6: apparatus, stethoscope, emergency check sheet

    Drugs in the Crash Cart

    • Aspirin, nitroglycerin, dextrose, naloxone, epinephrine, amiodarone, atropine, EpiPens, Benadryl, adenosine, and hydrocortisone are examples of frequently included medications
    • Dextrose 50% (25% for pediatrics) is an important emergency treatment for hypoglycemia
    • Naloxone (Narcan) is an antidote for opioid overdoses
    • Epinephrine is used for cardiac arrest and other emergencies
    • Amiodarone is for cardiac issues
    • Atropine is used for bradycardia, slowing down of heart-rate
    • EpiPens are for severe allergic reactions

    Reducing High-Alert Medication Errors

    • Standardized procedures, clearly marked medications, and minimal medication errors are vital
    • Error prevention strategies should focus on making mistakes obvious and lessening the consequences of errors

    During a Code

    • Physicians are the leaders of a code
    • Chest compressions are started without physician's order, followed 30 compressions and ventilations

    Oral Orders

    • Oral orders are accepted with a witness (nurse or credible person).
    • Repeat the order, confirm it, and administer the medication as soon as possible
    • The order should be written down in the correct medical forms.

    Emergency Drugs (Page 2)

    • Epinephrine is also known as adrenaline, a hormone secreted by the adrenal glands that increases cardiac output and blood sugar
    • Used to treat cardiac arrest, anaphylaxis, superficial bleeding, bronchospasm (asthma), and hypoglycemia

    Hydrocortisone (Solu-Cortef)

    • Is a corticosteroid used for inflammation of various body parts (like skin and joints) and several other conditions
    • Often used during shock and severe inflammation.

    Atropine Sulfate

    • Atropine blocks the vagus nerve action (cranial nerve 10 of the parasympathetic nervous system) leading to increase in heart rate.
    • It is used for bradycardia and as an antidote for pesticide poisoning.

    Amiodarone

    • Treats certain heart conditions (arrhythmias)
    • Important to use amber-coloured containers to protect from light and heat

    Sodium Bicarbonate

    • Used to neutralize excess acids and restore the body's buffering capacity
    • Indicated for metabolic acidosis, urinary or systemic alkalinization

    Dopamine

    • Is a hormone and neurotransmitter that affects a variety of bodily functions; especially involved in mood, movement, and motivation.

    Dobutamine

    • Is a sympathomimetic used for heart failure, primarily improving cardiac output

    Heparin

    • Used as an anticoagulant to prevent blood clots, used effectively before and after clot formation.
    • It's used to prevent blood clots in the veins and lungs (deep-vein thrombosis and pulmonary embolism)
    • Used in acute coronary syndrome, atrial fibrillation, and for conditions in which clots might form.

    Insulin

    • A hypoglycaemic agent, used to lower blood glucose levels
    • Subcutaneous administration is the normal practice, but regular insulin is the only IV option

    Additional Information

    • Fentanyl: A rapid-acting opioid for severe pain, often used post-surgery or for cancer patients.
    • Carfentanil: A strong opioid, primarily used in veterinary medicine.
    • Morphine: An opioid analgesic for severe pain.
    • Meperidine (Demerol) and Pethidine: Opioids for moderate to severe pain.

    IV Infusion Computations

    • Methods for calculating IV infusion rates are included
    • Formulas, examples, and detailed solutions of computations are presented

    Stages of Shock

    • 1. Compensatory (early) Stage: Body attempts to maintain circulation through mechanisms like increased heart rate.
    • 2. Progressive Stage: BP and other vital signs show rapid decline, organs are affected
    • 3. Irreversible Stage: Poor organs and body systems show complete failure.

    Types of Shock (pages 9-11)

    • Hypovolemic Shock: Caused by decreased blood volume
    • Cardiogenic Shock: Caused by heart's inability to pump effectively
    • Neurogenic Shock: Resulting from loss of sympathetic tone, leading to vasodilation.
    • Anaphylactic Shock: Triggered by a severe allergic reaction, causing a cascade of inflammatory responses, such as histamine release, which leads to severe vasodilation.
    • Septic Shock: Results from severe infections that trigger an overwhelming inflammatory response within the body.

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    Description

    This quiz covers essential nursing care aspects related to deep vein thrombosis (DVT), including confirmatory tests, insulin administration methods, ambulation risks, and calculations for infusion rates. Gain insights into best practices for DVT prevention and management in clinical settings.

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