All CCRN-Adult Test Inside AACN Questions

The laboratory values indicate hyperosmolar hyperglycemic state (HHS), characterized by high glucose levels, high osmolality, and dehydration. The primary management includes aggressive IV hydration to correct dehydration and improve circulation. Hemodialysis and intubation are not immediate priorities unless there are other indications, and osmotic diuresis is not appropriate in this context. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

The appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient’s condition and response to treatment.

References:

• Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that “Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what’s now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours.”
• Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that “Status asthmaticus is a severe asthma attack that doesn’t get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn’t help, you need medical care right away. If an attack comes on quickly and it doesn’t respond to regular treatment, it can lead to status asthmaticus.”
• Management of Status Asthmaticus | SpringerLink: This article states that “Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment. It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications.”

Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the leakage of the vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine should be administered intradermally around the site of extravasation as soon as possible, and the infusion should be stopped but the IV catheter should not be removed until some of the norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the absorption of norepinephrine, and lowering the extremity may increase the edema and pain. Removing the IV immediately may prevent the aspiration of norepinephrine and the administration of phentolamine.

References:

• Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold compress, lowering the extremity, and removing the IV.
• What are current recommendations for treatment of drug extravasation?: This article summarizes the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate topical therapy for norepinephrine extravasation.