NR 574 EXAM PREP LATEST ACUTE CARE PRACTICUM I ANSWERED 2026/2027 (16pages)

1. What are the three main components of the ABCDE assessment for critically ill patients? How would you perform each component? - The three main components are airway, breathing and circulation. To perform the airway component, you would assess the patient's ability to speak, cough and protect their airway, and intervene if needed with suctioning, positioning or advanced airway management. To perform the breathing component, you would assess the patient's respiratory rate, effort, oxygen saturation and chest movement, and intervene if needed with oxygen therapy, ventilation or chest tube insertion. To perform the circulation component, you would assess the patient's heart rate, blood pressure, capillary refill and peripheral pulses, and intervene if needed with fluid resuscitation, vasopressors or cardiac pacing. 2. What are the common causes and signs of increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI)? How would you monitor and manage increased ICP? - The common causes of increased ICP in patients with TBI are cerebral edema, hemorrhage, contusion or hydrocephalus. The signs of increased ICP are headache, nausea, vomiting, altered level of consciousness, pupillary changes, Cushing's triad (hypertension, bradycardia and irregular breathing) and herniation. To monitor ICP, you would use an invasive device such as a ventriculostomy or an intraparenchymal catheter, and keep the ICP below 20 mmHg. To manage increased ICP, you would elevate the head of the bed to 30 degrees, maintain normothermia and normoglycemia, avoid hypoxia and hypercapnia, administer osmotic diuretics or hypertonic saline, and consider sedation, analgesia or neuromuscular blockade. 3. What are the indications and contraindications for initiating extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS)? What are the potential complications and nursing care considerations for patients on ECMO? - The indications for initiating ECMO in patients with ARDS are refractory hypoxemia or hypercapnia despite optimal mechanical ventilation, a PaO2/FiO2 ratio below 100 mmHg or a pH below 7.2. The contraindications for initiating ECMO in patients with ARDS are irreversible lung disease, severe multiorgan failure, active bleeding or coagulopathy, or futility of care. The potential complications of ECMO are hemorrhage, infection, thrombosis, embolism, hemolysis or mechanical failure. The nursing care considerations for patients on ECMO are monitoring the circuit function and anticoagulation status, maintaining adequate perfusion and oxygenation, preventing infection and bleeding, providing nutrition and hydration, and supporting the patient's psychological needs.