A patient with a history of COPD is admitted with increasing dyspnea and fatigue. O2 is initiated via nasal cannula at 4 L/min with an O2 saturation of 99%. One hour later, the patient becomes lethargic. Which of the following is the most likely cause for the change in the patient's mental status?
Answer(s): C
A patient with COPD may have a chronically elevated PaCO2 and rely on hypoxia as the main stimulus for breathing. If the patient receives too much oxygen, this may reduce the hypoxic drive and cause respiratory depression, leading to lethargy and hypercapnia. O2 toxicity, absorption atelectasis, and decreased end-tidal CO2 are unlikely to occur with 4 L/min of O2 via nasal cannula in a short period of time.
Reference Guide for CCRN (Adult), page 14.Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?
A patient is admitted following a motor vehicle crash. A fluid challenge is initiated immediately after assessing a BP of 80/palpable. Fifteen minutes later,vital signs are as follows:BPHR 150RR 36The most appropriate action should be to
Answer(s): B
A patient presents with the following hemodynamics:MAP 40 mm HgPAD 6 mm HgPAOP 5 mm HgCI 1.8 L/min/m2SVR 875 dynes/sec/cm-5Which of the following is essential in the plan of care?
The patient has signs of hypovolemic shock, which is characterized by low MAP, low PAOP, low CI, and high SVR. The patient needs fluid resuscitation to restore intravascular volume and improve tissue perfusion. Loop diuretic, vasopressors, and whole blood are not indicated in this case.
Reference Guide for CCRN (Adult), page 14.Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online - Individual Purchase, Module 1:Cardiovascular, Part 1: Shock.
Which of the following is a sign of splenic injury and diaphragmatic irritation?
Left shoulder pain, also known as Kehr sign, is a sign of splenic injury and diaphragmatic irritation. It is caused by the irritation of the phrenic nerve, which innervates both the diaphragm and the shoulder, by blood or other fluids in the left upper quadrant. Tachypnea, flank pain, and hiccoughs are not specific signs of splenic injury or diaphragmatic irritation.
Splenic trauma | Radiology Reference Article | Radiopaedia.org Recognition and management of diaphragmatic injury in adults Reference Guide for CCRN (Adult), page 14.
A patient presents with fever and chills, is diaphoretic, and reports experiencing abdominal and intermittent left shoulder pain for the past week. An ultrasound shows an enlarged spleen. Vital signs are:BPHR 118RR 23T 101.2° F (38.4° C)When reviewing the lab report, which of the following findings is most significant to this presentation?
Answer(s): A
The patient's presentation is suggestive of splenic abscess, which is a rare but serious complication of splenomegaly. Splenic abscess is caused by bacterial or fungal infection of the spleen, usually from hematogenous spread or contiguous spread from adjacent organs. The most common symptoms are fever, chills, abdominal pain, and left shoulder pain (Kehr sign). The most significant laboratory finding is positive blood cultures, which indicate systemic infection and sepsis. Other laboratory findings may include leukocytosis, anemia, thrombocytopenia, elevated inflammatory markers, and abnormal liver function tests. However, these are nonspecific and may vary depending on the underlying cause of splenomegaly and the type of microorganism involved.
Splenic Abscess - Infectious Disease AdvisorCross-sectional imaging findings of splenic infections: is ... - Springer
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