1. The patient was admitted with exacerbation of congestive heart failure (CHF). Which of the following hemodynamic values would the nurse expect to see? Unlock & enrich document

2.The nurse is admitting a client diagnosed with acute renal failure (ARF). Which question is most important for the nurse to ask during the admission interview? Unlock & enrich document

3.The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which collaborative treatment should the nurse anticipate for the client? Unlock & enrich document

4.The nurse suspects a client has developed a flail chest based on which assessment data? Unlock & enrich document

5.The nurse is caring for a client who develops trachea shift, absence of breath sounds on the left side, and hypotension. A chest tube was inserted on the left side with 1800 mL of blood removed. Which surgical procedure should the nurse anticipate the client will have?

Solutions are as Below:

1. Hemodynamic Values in Congestive Heart Failure (CHF) Exacerbation

In patients with exacerbation of congestive heart failure (CHF), the nurse would typically expect to see the following hemodynamic values:

• Increased Central Venous Pressure (CVP): Reflects elevated right atrial pressure due to volume overload.
• Increased Pulmonary Artery Wedge Pressure (PAWP): Indicates left atrial pressure, often elevated in left-sided heart failure.
• Decreased Cardiac Output (CO) and Cardiac Index (CI): Due to impaired cardiac function.
• Increased Systemic Vascular Resistance (SVR): As a compensatory mechanism to maintain blood pressure.

Reference:

• Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … & Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.

2. Important Question for Acute Renal Failure (ARF) Admission Interview

The most important question for the nurse to ask during the admission interview of a client diagnosed with acute renal failure (ARF) is:

• “Have you been taking any nephrotoxic medications or substances?”

This question is crucial as it helps identify potential causes of ARF that could be related to medication or substance use, such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, or exposure to contrast dyes.

Reference:

• Nash, K., Hafeez, A., & Hou, S. (2002). Hospital-acquired renal insufficiency. American Journal of Kidney Diseases, 39(5), 930-936.

3. Collaborative Treatment for Hyperkalemia in ARF

For a client with acute renal failure (ARF) and a serum potassium level of 6.8 mEq/L, the nurse should anticipate the following collaborative treatments:

• Administration of Calcium Gluconate: To stabilize the cardiac membranes.
• Insulin and Glucose: To drive potassium into the cells.
• Sodium Bicarbonate: If metabolic acidosis is present.
• Kayexalate (Sodium Polystyrene Sulfonate): To remove potassium through the gastrointestinal tract.
• Dialysis: If the hyperkalemia is severe and refractory to medical management.

Reference:

• Palmer, B. F. (2004). Managing hyperkalemia caused by inhibition of the renin-angiotensin-aldosterone system. New England Journal of Medicine, 351(6), 585-592.

4. Assessment Data for Flail Chest

The nurse suspects a client has developed flail chest based on the following assessment data:

• Paradoxical Chest Movement: The affected segment moves inward during inspiration and outward during expiration.
• Severe Pain and Tenderness: At the site of the rib fractures.
• Dyspnea and Respiratory Distress: Due to compromised respiratory mechanics.
• Crepitus: A crackling sound over the rib fractures upon palpation.

Reference:

• Fowler, A. A., & Hamman, R. F. (1983). Flail chest: diagnosis and management. Chest, 83(4), 630-636.

5. Anticipated Surgical Procedure for Tracheal Shift and Hemothorax

In a client who develops tracheal shift, absence of breath sounds on the left side, and hypotension with 1800 mL of blood removed via chest tube, the nurse should anticipate the following surgical procedure:

• Thoracotomy: This procedure is necessary to explore the thoracic cavity, control hemorrhage, and repair the source of bleeding. Given the significant amount of blood loss, surgical intervention is essential to manage the injury and stabilize the patient.

Reference:

• Lee, Y. C. G., & Light, R. W. (2004). Management of pneumothorax and hemothorax. Chest, 127(1), 222-228.

These responses incorporate clinical guidelines and evidence-based practices, providing a comprehensive approach to each scenario.