critical care

Question 1

What are the FOUR foundations of Critical Nursing?

Answer 1

communication between team members and client
assessment of patient
review of patient needs and status
equipment & techniques to support patient need

Question 2

Absence of Deep Pain in a spinal cord injury for greater than 48 hours has which prognosis?

Answer 2

poor

Question 3

a Primary Neurologic Disease?

Answer 3

seizures due to brain tumor

Question 4

Therapy for cerebral edema would include:

Answer 4

elevate head
corticosteroids or mannitol IV
stop seizures with appropriate medication

Question 5

A dog with a spinal cord injury has a large urinary bladder which is difficult to express. This is consistent with

Answer 5

Upper Motor Bladder

Question 6

A dog with head trauma is growling at the stuffed animal (from home) in his cage. His mentation would be described as

Answer 6

disoriented

Question 7

You are caring for a Dachshund that is recovering from spinal cord surgery (IVDD) the day before. He is currently unable to walk in the rear legs, but has deep pain response. List thee specific criteria you will be monitoring to ensure that there is no unnoticed decline in his status. (Hint: always think of whole patient!)

Answer 7

Neuro Status:

Monitor deep pain (Withdrawal relex with brain recognition) q. 4 hr
Palpate urinary bladder q. 4 hr to assess function and prevent over-distension (express/place urinary catheter if needed)
(Monitoring for walking not specifically helpful for monitoring decline. He is not walking now, walking would be a sign of improvement).
Post-op:

TPR (evaluate for fever) q. 4 hr
Check incision line q. 4h
Pain score (evaluate for discomfort pain) q. 4 hr

Question 8

A 10-year-old cat presented in status epilepticus 2 hours ago and the emergency medications (Rx) stopped the seizure. List three “Must Haves” for his continued monitoring/nursing care.

Answer 8

a. IV catheter a must! (to treat next seizure, provide fluids/maintain blood pressure)

b. blood glucose level (is he a diabetic? )

c. continuous 24 hr in the room supervision

d. blood pressure checks q. 6 hr

Question 9

The Neurologic Exam involves a series of tests/reflex evaluations to localize the site of disease/injury in the nervous system. Name (or describe) one test to evaluate each region of the nervous system listed below.

a. Brain - cerebrum evaluation

b. Brain- cerebellum evaluation

c. Spinal cord evaluation

d. Cranial Nerve (any) evaluation

Answer 9

a. their mentation, QAR, BAR, disoriented, also could do the paw flip where u flip one paw and see the animal corrects it

b. eye exam see if they can follow an object, could also do wheelbarrow

c. pinching the toe seeing if they react , loss of pain

d. light shinning g in the eye to see if the eye reacts and both are the same er

Question 10

If a patient presents with a mild increase in skin tenting, normal blood pressure but mild tachycardia, and dry mucous membranes, his hydration status is:

Answer 10

7 %

Question 11

A dog presents with lethargy and anorexia. The DVM assesses him to be 5% dehydrated and he currently weighs 10 kg. If his dehydration is corrected over 24 hours and he is showing no excessive loss due to vomiting, diarrhea or urination; what should his fluid rate be set at for the next 24 hours? (use a maintenance rate of 60ml/kg/24 hr)

Answer 11

46 ml/hr

Question 12

Lactated Ringers Solution is

Answer 12

Isotonic

Question 13

0.45% normal saline is

Answer 13

hypotonic

Question 14

When performing phone triage, the LVT should

Answer 14

keep record of the phone call

Question 15

An owner carries a small dog into the lobby of an Emergency Service. The conscious dog is bleeding from the mouth and nose. His Triage score (1-5 system) is

Answer 15

2

Question 16

Colloid solutions include:

Answer 16

whole blood, plasma, Hydroxyethyl Starch (Hetastarch)

Question 17

three parameters of excellent intravenous catheter care.

Answer 17

check catheter site at level of skin at least every 24 hours for swelling, redness, discharge

b. keep catheter site, bandage and injection ports clean and dry at all times
c. change peripheral IV catheter (short) every 3 days

d. use aseptic technique to place catheter, disconnect/reconnect lines and utilize injection ports

Question 18

List three clinical signs of Over-hydration

Answer 18

wet lung sounds

weight gain

edema

Question 19

possible consequences of shock in the patient’s body.

Answer 19

brain damage, bleeding disorders, kidney failure

Question 20

When performing a thoracocentesis with the intention of removing free air, the animal should be positioned in

Answer 20

lateral recumbency, affected side up

Question 21

When collecting fluid from the pleural space,

Answer 21

the total volume of fluid from each side should be recorded

Question 22

A tracheostomy in veterinary medicine is utilized to treat

Answer 22

upper airway obstruction

Question 23

Clinical signs of upper airway obstruction include:

Answer 23

noisy breathing, slow deep breathing, extended head posture

Question 24

right-sided heart failure causes

Answer 24

fluid to accumulate in the pleural space or abdominal cavity

Question 25

a mean arterial pressure (MAP) of

Answer 25

60 is the minimum for organ perfusion

Question 26

Hypertrophic Cardiomyopathy

Answer 26

is an inherited disease in some breeds of cats is at risk for thromboembolism may be caused by hyperthyroidism

Question 27

Possible consequences to hypertension include:

Answer 27

vision loss or kidney damage

Question 28

Central Venous Pressure (CVP) measures pressure

Answer 28

of the right atrium

Question 29

Central Venous Pressure (CVP) measurements are indicated for patients at risk for

Answer 29

over-hydration or shock

Question 30

supportive care measures for a veterinary patient in heart failure.

Answer 30

provide oxygen b. minimize stress c. treat arrhythmias d. low sodium diet e. drugs to decrease preload and afterload (diuretics, nitroglycerin)

Question 31

clinical signs of a veterinary patient in heart failure

Answer 31

a. exercise intolerance b. dyspnea/tachypnea c. coughing (especially in morning or when lifted) d. syncope e. weakness f. mental confusion

Question 32

uses/functions of placing a central venous catheter (i.e. jugular) in a veterinary patient.

Answer 32

a. Measuring Central Venous Pressure (CVP) b. Blood sampling through catheter c. Administration of high osmotic therapy (i.e. IV Nutrition) d. Need for venous catheter more than 3 days, or risk of contamination in peripheral vein (i.e. Parvo Puppy)

Question 33

Easter lilies cause

Answer 33

acute kidney failure

Question 34

Sepsis is

Answer 34

systemic inflammatory response due to bacteria or toxins in bloodstream

Question 35

Hypodynamic Shock demonstrates

Answer 35

Mean Arterial Pressure (MAP) <60

Question 36

Name a common consequence of Gastric Dilatation Volvulus (GDV

Answer 36

heart arrhythmia, shock, disseminated intravascular coagulopathy (DIC)

Question 37

The most important initial therapy for GDV is

Answer 37

decompress the stomach by trocar or orogastric tube

Question 38

A diagnosis of Hemoabdomen can be made if

Answer 38

abdominocentesis yields non-clotting blood

Question 39

When reviving neonates recovered from a C-section

Answer 39

the umbilical cord is cared for after they are breathing well, gloves should be worn to protect them from nosocomial infections , vigorous rubbing with warm towels is extremely important

Question 40

Animals with urethral obstruction will die rapidly from

Answer 40

hyperkalemia (K+) causing cardiac arrest

Question 41

The one most diagnostic view for GDV is

Answer 41

right lateral abdomen

Question 42

A cat with urethral obstruction may have a history of

Answer 42

vocalizing when lifted by the abdomen and straining as if "constipated"

Question 43

List six recommended whelping supplies

Answer 43

warm towels, suction bulbs, dextrose, oxygen, heat source

Question 44

Describe the process of non-surgical correction of urethral obstruction in a male cat.

Answer 44

having the cat under anesthesia to place a urinary catheter lateral remembrance and assistant will hold/ hold outside of penis so it can be scrubbed underneath prepuce, this is a sterile procedure, penis is scrubbed, the catheter is lubed, sterile saline is injected, tom cat catheter is used and maybe an olive top if needed

Question 45

Clinical signs of an Addison Crisis (hypoadrenocorticism) are due to

Answer 45

dehydration hyponatremia hypoglycemia

Question 46

Hypercalcemia (when Ca x Ph >54) may cause

Answer 46

renal failure

Question 47

Diabetic Ketoacidosis (DKA) is potentially fatal due to

Answer 47

ketonemia acidosis dehydration

Question 48

The pathophysiology of myxedema is

Answer 48

Accumulation of mucopolysaccharides in the skin

Question 49

Blood pH is regulated by

Answer 49

lungs kidneys serum buffers (i.e. bicarbonate)

Question 50

If an animal has lung disease that leads to pH rising this is termed

Answer 50

Respiratory alkalosis

Question 51

Blood pH is usually linked to blood levels of

Answer 51

CO2

Question 52

You are monitoring anesthesia on a canine patient and the Et CO2 is 55, this indicates

Answer 52

the patient is not breathing often enough

Question 53

If the Et CO2 is 25, this will cause

Answer 53

Respiratory alkalosis

Question 54

To evaluate lung disease, the test of choice is

Answer 54

arterial blood gas

Question 55

The arterial blood gas sample is collected into

Answer 55

heparin

Question 56

A pulse oximetry reading of 94% hemoglobin saturation is an acceptable (normal) reading

Answer 56

no

Question 57

Potential danger(s) of transfusions of blood or blood products include

Answer 57

allergic reaction thromboemboli disease transmission

Question 58

Dog blood type "A-" (DEA 1.1 negative) is the

Answer 58

universal donor

Question 59

Fresh-frozen plasma is indicated for the treatment of

Answer 59

hypoalbuminemia systemic inflammatory conditions bleeding disorder of clotting factors

Question 60

possible clinical signs of a "transfusion reaction

Answer 60

fever, temp change by 1 degree vomiting facial swelling tachycardia, hives

Question 61

An adult dog has presented after HBC (hit by car), and cardiac arrest occurs prior to an IV catheter being placed. If an IV line (central or peripheral) is not available, the next best location for drug administration during CPR is

Answer 61

IT (intratracheal)

Question 62

When using the defibrillator,

Answer 62

It is most effective in normalizing the ventricular fibrillation arrhythmia

Question 63

When performing chest compressions during CPR, the sternum should go down

Answer 63

1/3 depth of chest

Question 64

The primary goal of performing CPR/Advanced Life Support is to generate

Answer 64

a spontaneous pulse

Question 65

Warning signs of an imminent cardiopulmonary arrest would include

Answer 65

hypothermia, hypotension, or changes in breathing pattern

Question 66

What will happen to the end-tidal CO2 if a heart beat is restarted after an arrest (ROSC)?

Answer 66

ET CO2 will rapidly rise to above 40 mmHg

Question 67

reasons an "Arrest Record" should be completed during the CPR/Advanced Life Support.

Answer 67

a. record of drugs given and timing b. record of all events and techniques associated with CPR (ET CO2, defibrillation, shock pants, etc) c. legal record d. post CPR care plan reference; e. team training post event (debriefing) (what was done well, what could be improved)

Question 68

Describe the current recommended CPR technique.

Answer 68

ventilation rate of 12-30 breaths per minute (q. 2-5 seconds) chest compression rate 120 bpm ET CO2 is best eval tool, but used in combination with femoral pulses and EKG