HOMEOSTATIS, EMERGENCY AND CRITICAL CARE NURSING MSN SYN.

📘 Topic: Stress

🔹 1. Definition:

Stress is the body’s nonspecific response to any demand or threat (real or perceived), which disrupts its homeostasis.

✅ Selye’s Definition: “Stress is the nonspecific response of the body to any demand for change.”

🔹 2. Types of Stress:

Stress can be broadly categorized into:

Eustress – Positive, motivating stress (e.g., exams, new job).
Distress – Negative stress that causes anxiety or depression.
Acute Stress – Short-term, immediate reaction to a threat.
Chronic Stress – Long-term stress due to ongoing situations.
Emotional Stress – Arising from personal feelings or emotions.
Physical Stress – Due to physical illness, trauma, or fatigue.
Psychological Stress – Due to thoughts, mental pressure.

🔹 3. Causes / Stressors:

Stressors can be:

Physical: Injury, illness, noise, pollution.
Emotional: Fear, anger, sadness, anxiety.
Social: Peer pressure, conflict, isolation.
Environmental: Workload, unemployment, exams.
Psychological: Negative thinking, perfectionism.

🔹 4. Pathophysiology:

Stress activates the Hypothalamic–Pituitary–Adrenal (HPA) axis:

Stressor → Hypothalamus releases CRH
CRH stimulates Pituitary to release ACTH
ACTH triggers Adrenal glands to release Cortisol (stress hormone)
Cortisol prepares body: ↑ blood sugar, ↑ BP, ↑ heart rate
Chronic cortisol exposure → immune suppression, anxiety, fatigue

🔹 5. Signs and Symptoms:

Physical: Headache, muscle tension, fatigue, insomnia
Emotional: Irritability, anxiety, depression, restlessness
Cognitive: Poor concentration, forgetfulness, negative thoughts
Behavioral: Over/under eating, substance abuse, withdrawal

🔹 6. Diagnostic Evaluation:

History and physical examination
Psychological stress scales (e.g., Holmes-Rahe Stress Scale)
Cortisol levels (in chronic stress)
Observation of behavior and coping skills

🔹 7. Management:

🔸 A. Medical Management:

Anxiolytics: Benzodiazepines (e.g., lorazepam)
Antidepressants: SSRIs (e.g., fluoxetine)
Cognitive Behavioral Therapy (CBT)

🔸 B. Non-Pharmacological:

Relaxation Techniques: Deep breathing, yoga, meditation
Time Management
Counseling & Support groups
Exercise & Proper Sleep
Avoidance of caffeine, alcohol, tobacco

🔸 C. Nursing Management:

Assess stress level and coping strategies
Provide emotional support
Encourage relaxation methods
Involve family support
Educate on healthy lifestyle

🔹 8. Complications:

Hypertension
Heart disease
Depression and anxiety
Substance abuse
Gastrointestinal disorders
Weakened immune system

🔹 9. Nurse’s Role:

Early identification of stress symptoms
Provide patient-centered counseling
Refer for psychological help if needed
Promote stress management education
Create a therapeutic environment

🔹 10. Golden One-Liners:

“Stress is a silent killer.”
“Eustress motivates; distress debilitates.”
“Cortisol is the primary hormone of stress.”
“Chronic stress impairs immunity and promotes illness.”

🔹 11. MCQs for Practice:

Q1. Which hormone is primarily released during stress response?
A. Insulin
B. Cortisol
C. Glucagon
D. Prolactin
Answer: B. Cortisol
Rationale: Cortisol is secreted by the adrenal cortex under stress via the HPA axis.

Q2. Which of the following is a positive type of stress?
A. Chronic stress
B. Acute stress
C. Eustress
D. Distress
Answer: C. Eustress
Rationale: Eustress is beneficial and motivates performance.

Q3. Which of the following is a physical symptom of stress?
A. Happiness
B. Sweating and palpitations
C. Calmness
D. Laughter
Answer: B. Sweating and palpitations
Rationale: Physical signs of stress include autonomic symptoms like sweating and rapid heartbeat.

Q4. Which system is involved in the stress hormone release?
A. Respiratory
B. Renal
C. HPA Axis
D. Cardiovascular
Answer: C. HPA Axis
Rationale: The hypothalamic-pituitary-adrenal (HPA) axis controls stress hormone release.

Q5. One of the best non-pharmacological interventions for stress relief is:
A. Watching TV
B. Yoga and deep breathing
C. Overeating
D. Excess sleeping
Answer: B. Yoga and deep breathing
Rationale: Relaxation techniques like yoga help regulate stress response effectively.

📘 General Adaptation Syndrome (GAS)

🔹 1. Definition:

General Adaptation Syndrome (GAS) is a three-stage physiological response developed by Hans Selye to describe how the body reacts to stress.

✅ “GAS is the body’s predictable response pattern to any kind of stressor—physical, emotional, or environmental.”

🔹 2. Stages of GAS:

🟩 Stage 1: Alarm Reaction Stage

The body identifies the stressor.
Fight or Flight response is activated.
Sympathetic nervous system gets stimulated.
Hormones released: Adrenaline & Cortisol
Changes: ↑ Heart rate, ↑ BP, ↑ blood glucose

✅ Goal: Prepare the body to respond to the stressor.

🟨 Stage 2: Resistance Stage

Body tries to adapt to the stressor.
Stress hormones remain elevated.
Body appears normal but is using high energy.
Immune system may begin to weaken.

✅ Goal: Cope with the stressor and restore balance (homeostasis).

🟥 Stage 3: Exhaustion Stage

Occurs when the stress continues for a long time.
Body’s resources are depleted.
Fatigue, burnout, anxiety, depression may appear.
Increased risk for illness (e.g., ulcers, HTN, infection).

✅ Outcome: Recovery (if stress removed) or death (if prolonged without intervention).

🔹 3. Physiological Involvement:

Endocrine System: HPA axis – releases cortisol
Autonomic Nervous System: Triggers fight-or-flight
Immune System: Suppressed in prolonged stress

🔹 4. Examples of Triggers (Stressors):

Physical injury or illness
Exams or job pressure
Financial problems
Loss of loved one
Long-term caregiving or emotional trauma

🔹 5. Clinical Significance:

Explains why chronic stress leads to diseases.
Helps nurses understand patient reactions to illness or trauma.
Basis for stress management interventions.

🔹 6. Nurse’s Role:

Identify which stage of stress the patient is in.
Provide physical and emotional support.
Teach relaxation and coping strategies.
Encourage healthy lifestyle: nutrition, sleep, exercise.
Refer to counseling if needed.

🔹 7. Golden One-Liners:

“GAS was proposed by Hans Selye in 1936.”
“Stages of GAS: Alarm → Resistance → Exhaustion.”
“If stress continues without relief, exhaustion sets in.”
“Cortisol is the major hormone involved in GAS.”

🔹 8. MCQs for Practice:

Q1. Who proposed the General Adaptation Syndrome?
A. Walter Cannon
B. Hans Selye
C. Florence Nightingale
D. Sigmund Freud
Answer: B. Hans Selye
Rationale: Hans Selye introduced the concept of General Adaptation Syndrome in 1936.

Q2. What is the first stage of General Adaptation Syndrome?
A. Resistance
B. Exhaustion
C. Alarm Reaction
D. Recovery
Answer: C. Alarm Reaction
Rationale: This is the immediate response to a stressor and initiates the fight-or-flight mechanism.

Q3. Which hormone is primarily involved in the resistance stage of GAS?
A. Insulin
B. Cortisol
C. Oxytocin
D. Adrenaline
Answer: B. Cortisol
Rationale: Cortisol remains elevated during resistance to help the body cope with prolonged stress.

Q4. What happens during the exhaustion stage of GAS?
A. Energy levels are high
B. Body returns to normal
C. Immune system is strong
D. The body can no longer resist the stressor
Answer: D. The body can no longer resist the stressor
Rationale: Prolonged stress depletes body reserves, leading to fatigue, illness, or even death.

Q5. What is the main goal of the resistance stage in GAS?
A. Eliminate the stressor
B. Adapt to the stressor
C. Ignore the stressor
D. Fight against the stressor
Answer: B. Adapt to the stressor
Rationale: The body tries to maintain homeostasis by adapting to the stressor during the resistance stage.

📘 Shock

🔹 1. Definition:

Shock is a life-threatening medical condition where there is inadequate tissue perfusion and oxygenation, leading to cellular dysfunction and organ failure.

✅ “Shock is a state of acute circulatory failure that impairs the delivery of oxygen and nutrients to vital organs.”

🔹 2. Classification / Types of Shock:

🟩 A. Hypovolemic Shock

Due to loss of blood or fluids.
Causes: Hemorrhage, burns, diarrhea, vomiting.

🟨 B. Cardiogenic Shock

Due to heart’s inability to pump blood effectively.
Causes: Myocardial infarction, heart failure, arrhythmias.

🟥 C. Distributive Shock (Vasodilatory Shock)

Abnormal vasodilation and redistribution of blood.
Types:
- Septic Shock – Infection-induced vasodilation
- Anaphylactic Shock – Allergic reaction
- Neurogenic Shock – Spinal cord injury

🟦 D. Obstructive Shock

Caused by physical obstruction of blood flow.
Causes: Pulmonary embolism, cardiac tamponade, tension pneumothorax.

🔹 3. Etiology / Causes:

Severe trauma
Internal or external bleeding
Myocardial infarction
Sepsis or severe infection
Spinal cord injury
Severe allergic reaction (anaphylaxis)

🔹 4. Pathophysiology:

Initial ↓ tissue perfusion → ↓ oxygen delivery
Shift to anaerobic metabolism → ↑ lactic acid
Cell membrane dysfunction → organ damage
Prolonged state → multi-organ failure → death

🔹 5. Stages of Shock:

Initial Stage:
- Mild hypoperfusion
- No visible signs, ↓ oxygen at cellular level
Compensatory Stage:
- SNS activation → ↑ HR, vasoconstriction
- Signs: Tachycardia, cool skin
Progressive Stage:
- Failing compensation
- Signs: Hypotension, confusion, weak pulse
Irreversible Stage:
- Severe hypoxia
- Cell death, organ failure, death likely

🔹 6. Clinical Manifestations:

Cold, clammy skin
Rapid weak pulse
Tachypnea
Hypotension
Confusion or altered sensorium
Decreased urine output
Cyanosis (late sign)

🔹 7. Diagnostic Evaluation:

Vital signs: BP, HR, RR
CBC, electrolytes, ABG, lactate
ECG (for cardiogenic shock)
Blood cultures (for septic shock)
Chest X-ray, echocardiogram, ultrasound

🔹 8. Management:

🔸 A. General Measures:

Ensure airway, breathing, circulation (ABCs)
Position: Supine with legs elevated (Trendelenburg)
IV fluids – crystalloids like NS or RL
Monitor vitals, urine output

🔸 B. Type-Specific Treatment:

Type of Shock	Treatment
Hypovolemic	IV fluids, blood transfusion
Cardiogenic	Inotropes (e.g., dopamine), diuretics
Septic	Antibiotics, vasopressors (e.g., norepinephrine)
Anaphylactic	Epinephrine, antihistamines, steroids
Neurogenic	Vasopressors, atropine
Obstructive	Remove obstruction (e.g., surgery, chest tube)

🔹 9. Nursing Management:

Maintain airway and oxygenation
Monitor fluid status and vitals closely
Insert and monitor Foley catheter
Administer prescribed medications promptly
Provide emotional support to patient and family
Educate about prevention of causes (infection, allergy)

🔹 10. Complications:

Multi-organ failure
Respiratory distress (ARDS)
Acute kidney injury
Disseminated intravascular coagulation (DIC)
Death if untreated

🔹 11. Golden One-Liners:

“Shock is a state of inadequate tissue perfusion.”
“First sign of shock is tachycardia.”
“Septic shock is the most common type in ICU settings.”
“Hypotension and cold extremities are key features of shock.”
“Irreversible shock leads to organ failure and death.”

🔹 12. MCQs for Practice:

Q1. Which is the most common type of shock in ICU settings?
A. Hypovolemic
B. Cardiogenic
C. Septic
D. Neurogenic
Answer: C. Septic
Rationale: Septic shock due to infection is the most frequently seen shock in critical care.

Q2. What is the first compensatory mechanism in shock?
A. Bradycardia
B. Vasodilation
C. Tachycardia
D. Sweating
Answer: C. Tachycardia
Rationale: The body increases heart rate to maintain perfusion.

Q3. Which hormone is administered in anaphylactic shock?
A. Insulin
B. Cortisol
C. Epinephrine
D. Norepinephrine
Answer: C. Epinephrine
Rationale: Epinephrine is the first-line drug in anaphylactic shock due to its bronchodilatory and vasoconstrictive effects.

Q4. Which of the following is a late sign of shock?
A. Warm skin
B. Anxiety
C. Cyanosis
D. Restlessness
Answer: C. Cyanosis
Rationale: Cyanosis occurs due to prolonged hypoxia and is a late sign.

Q5. In hypovolemic shock, which treatment is most urgent?
A. Antibiotics
B. IV fluids
C. Vasodilators
D. Blood thinners
Answer: B. IV fluids
Rationale: Volume replacement is critical in hypovolemic shock to restore perfusion.

📘 Topic: Edema

🔹 1. Definition:

Edema is the abnormal accumulation of fluid in the interstitial spaces of tissues, leading to swelling.

✅ “Edema results from an imbalance in forces regulating the movement of fluid between vascular and interstitial compartments.”

🔹 2. Types of Edema:

🟩 A. Based on Cause:

Localized Edema: Limited to one area (e.g., sprained ankle, inflammation)
Generalized Edema: Affects the entire body (e.g., heart failure, nephrotic syndrome)

🟨 B. Based on Location:

Peripheral Edema: Legs, ankles, feet
Pulmonary Edema: Lungs (life-threatening)
Cerebral Edema: Brain
Macular Edema: Retina of eye
Ascites: Fluid in peritoneal cavity
Anasarca: Severe, widespread generalized edema

🔹 3. Mechanisms (Pathophysiology):

Edema occurs due to any of the following mechanisms:

↑ Capillary Hydrostatic Pressure
- e.g., Congestive heart failure
↓ Plasma Oncotic Pressure (Hypoproteinemia)
- e.g., Nephrotic syndrome, malnutrition
↑ Capillary Permeability
- e.g., Inflammation, burns
Lymphatic Obstruction (Lymphedema)
- e.g., Cancer, parasitic infections
Sodium and Water Retention
- e.g., Renal failure

🔹 4. Causes of Edema:

System	Common Causes
Cardiovascular	CHF, DVT
Renal	Nephrotic syndrome, CKD
Hepatic	Cirrhosis, portal hypertension
Endocrine	Hypothyroidism
Allergic	Anaphylaxis
Nutritional	Kwashiorkor, protein deficiency
Medications	NSAIDs, corticosteroids, antihypertensives

🔹 5. Signs and Symptoms:

Swelling or puffiness (esp. in limbs)
Stretched or shiny skin
Pitting on pressure (pitting edema)
Increased weight
Decreased urine output
Dyspnea (in pulmonary edema)
Headache/confusion (in cerebral edema)

🔹 6. Diagnostic Evaluation:

Physical examination (check for pitting vs. non-pitting)
Daily weight monitoring
Serum albumin levels
Urinalysis (protein loss)
Renal and liver function tests
Chest X-ray (for pulmonary edema)
ECG/Echo (for cardiac cause)

🔹 7. Management:

🔸 A. General Measures:

Elevate affected limbs
Low sodium diet
Fluid restriction (in CHF, renal failure)
Monitor I/O and weight

🔸 B. Medications:

Diuretics: Furosemide, spironolactone
Albumin infusion (in hypoalbuminemia)
Antihypertensives (if BP-related)
Corticosteroids (in inflammatory causes)

🔸 C. Treat Underlying Cause:

Heart failure → Inotropes, diuretics
Renal disease → Dialysis
Liver failure → Supportive management
Lymphatic blockage → Manual lymphatic drainage

🔹 8. Nursing Management:

Assess site, type, and extent of edema
Measure limb circumference
Monitor vital signs, especially respiratory in pulmonary edema
Position patient to promote venous return
Educate patient about salt and fluid intake
Provide skin care to prevent breakdown

🔹 9. Complications:

Skin breakdown & infection
Impaired mobility
Respiratory distress (in pulmonary edema)
Neurological damage (in cerebral edema)

🔹 10. Golden One-Liners:

“Pitting edema is a hallmark of fluid retention.”
“Anasarca is the most severe form of generalized edema.”
“Pulmonary edema is a medical emergency.”
“Edema results from imbalance in Starling forces.”
“Hypoalbuminemia leads to decreased oncotic pressure → edema.”

🔹 11. MCQs for Practice:

Q1. Which of the following is a common cause of generalized edema?
A. Fracture
B. Appendicitis
C. Nephrotic Syndrome
D. Gastritis
Answer: C. Nephrotic Syndrome
Rationale: Nephrotic syndrome causes loss of protein in urine, lowering oncotic pressure and leading to generalized edema.

Q2. What is the hallmark of pitting edema?
A. Shiny skin
B. Fever
C. Depression remaining after pressure
D. Bleeding
Answer: C. Depression remaining after pressure
Rationale: In pitting edema, pressing the swollen area leaves an indentation.

Q3. Pulmonary edema is most commonly associated with:
A. Liver failure
B. Kidney stones
C. Left-sided heart failure
D. Asthma
Answer: C. Left-sided heart failure
Rationale: Backflow of blood into the lungs from left-sided heart failure causes pulmonary congestion and edema.

Q4. Which medication is used to treat fluid retention in edema?
A. Paracetamol
B. Furosemide
C. Amoxicillin
D. Insulin
Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic used to remove excess fluid in edema.

Q5. Which protein is mainly responsible for maintaining plasma oncotic pressure?
A. Hemoglobin
B. Albumin
C. Fibrinogen
D. Globulin
Answer: B. Albumin
Rationale: Albumin holds water in the blood vessels and prevents it from leaking into tissues.

📘 Topic: Acid-Base Imbalance

🔹 1. Definition:

Acid-base imbalance is a condition in which the pH of the blood deviates from the normal range due to an excess or deficit of acids or bases in the body.

✅ Normal blood pH: 7.35 – 7.45

pH < 7.35 = Acidosis
pH > 7.45 = Alkalosis

🔹 2. Normal ABG Values (Arterial Blood Gas):

Parameter	Normal Value
pH	7.35 – 7.45
PaCO₂	35 – 45 mmHg
HCO₃⁻	22 – 26 mEq/L
PaO₂	80 – 100 mmHg
SaO₂	> 95%

🔹 3. Types of Acid-Base Imbalances:

🟩 A. Respiratory Acidosis

Cause: Hypoventilation → CO₂ retention
Examples: COPD, asthma, respiratory depression
ABG: ↓ pH, ↑ PaCO₂
Compensation: Kidneys retain HCO₃⁻

🟨 B. Respiratory Alkalosis

Cause: Hyperventilation → CO₂ loss
Examples: Anxiety, fever, pain
ABG: ↑ pH, ↓ PaCO₂
Compensation: Kidneys excrete HCO₃⁻

🟥 C. Metabolic Acidosis

Cause: ↑ acid production or ↓ HCO₃⁻
Examples: Diabetic ketoacidosis, diarrhea, renal failure
ABG: ↓ pH, ↓ HCO₃⁻
Compensation: Lungs blow off CO₂ (↑ RR)

🟦 D. Metabolic Alkalosis

Cause: Excess HCO₃⁻ or acid loss
Examples: Vomiting, NG suction, diuretics
ABG: ↑ pH, ↑ HCO₃⁻
Compensation: Hypoventilation (↑ PaCO₂)

🔹 4. Mnemonic for Identification – ROME:

Type	Relationship
Respiratory	Opposite: pH ↓, PaCO₂ ↑ (or pH ↑, PaCO₂ ↓)
Metabolic	Equal: pH ↓, HCO₃⁻ ↓ (or pH ↑, HCO₃⁻ ↑)

🔹 5. Signs & Symptoms:

Imbalance	Signs & Symptoms
Respiratory Acidosis	Confusion, drowsiness, hypoventilation
Respiratory Alkalosis	Dizziness, tingling, hyperventilation
Metabolic Acidosis	Kussmaul breathing, confusion, fatigue
Metabolic Alkalosis	Muscle cramps, vomiting, slow breathing

🔹 6. Causes Summary:

Type	Common Causes
Respiratory Acidosis	COPD, sedative overdose
Respiratory Alkalosis	Anxiety, high altitude
Metabolic Acidosis	DKA, renal failure, diarrhea
Metabolic Alkalosis	Vomiting, NG suction, antacid abuse

🔹 7. Diagnostic Evaluation:

ABG (Arterial Blood Gas) analysis
Electrolyte levels (K⁺, Na⁺, Cl⁻)
Renal function tests
Blood glucose & ketones (for DKA)

🔹 8. Management:

Imbalance	Management
Respiratory Acidosis	Improve ventilation, bronchodilators, oxygen
Respiratory Alkalosis	Rebreathing into paper bag, treat anxiety
Metabolic Acidosis	IV bicarbonate, treat cause (e.g., insulin for DKA)
Metabolic Alkalosis	IV fluids, electrolyte correction (esp. K⁺, Cl⁻)

🔹 9. Nursing Responsibilities:

Monitor ABG and vitals regularly
Administer oxygen or medications as prescribed
Monitor fluid and electrolyte balance
Educate patient on breathing techniques or medication compliance
Notify physician for any worsening condition

🔹 10. Golden One-Liners:

“ROME helps interpret ABG: Respiratory Opposite, Metabolic Equal.”
“Kussmaul breathing is seen in metabolic acidosis.”
“Anxiety is a common cause of respiratory alkalosis.”
“Vomiting is a classical cause of metabolic alkalosis.”
“COPD leads to chronic respiratory acidosis.”

🔹 11. MCQs for Practice:

Q1. Which of the following is a cause of respiratory acidosis?
A. Hyperventilation
B. Anxiety
C. COPD
D. Vomiting
Answer: C. COPD
Rationale: COPD causes hypoventilation and CO₂ retention → respiratory acidosis.

Q2. Kussmaul respiration is seen in:
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Answer: C. Metabolic acidosis
Rationale: Kussmaul breathing is deep, rapid breathing seen in DKA and metabolic acidosis.

Q3. What would ABG likely show in prolonged vomiting?
A. ↓ pH, ↓ HCO₃⁻
B. ↑ pH, ↑ HCO₃⁻
C. ↑ pH, ↓ PaCO₂
D. ↓ pH, ↑ PaCO₂
Answer: B. ↑ pH, ↑ HCO₃⁻
Rationale: Vomiting leads to acid loss → metabolic alkalosis.

Q4. The first line of compensation for metabolic acidosis is:
A. Kidneys excrete acid
B. Lungs increase ventilation
C. Liver increases metabolism
D. Pancreas secretes bicarbonate
Answer: B. Lungs increase ventilation
Rationale: The body compensates by hyperventilating to blow off CO₂.

Q5. Which value indicates alkalosis in ABG?
A. pH 7.20
B. pH 7.32
C. pH 7.40
D. pH 7.48
Answer: D. pH 7.48
Rationale: Normal pH is 7.35–7.45. A value > 7.45 indicates alkalosis.

📘 Topic: Electrolyte Imbalance

🔹 1. Definition:

Electrolyte imbalance refers to an abnormal level of electrolytes in the body, which disrupts nerve, muscle, and organ function.

✅ Electrolytes are charged ions in the body fluids that regulate hydration, nerve impulses, muscle function, and acid-base balance.

🔹 2. Major Electrolytes and Normal Values:

Electrolyte	Normal Value
Sodium (Na⁺)	135 – 145 mEq/L
Potassium (K⁺)	3.5 – 5.0 mEq/L
Calcium (Ca²⁺)	8.5 – 10.5 mg/dL
Magnesium (Mg²⁺)	1.5 – 2.5 mEq/L
Chloride (Cl⁻)	96 – 106 mEq/L
Phosphate (PO₄³⁻)	2.5 – 4.5 mg/dL

🔹 3. Types and Clinical Features:

🟩 A. Sodium Imbalance

✅ 1. Hyponatremia (Na⁺ < 135 mEq/L)

Causes: Vomiting, diarrhea, diuretics, SIADH
Symptoms: Confusion, headache, seizures, muscle cramps

✅ 2. Hypernatremia (Na⁺ > 145 mEq/L)

Causes: Dehydration, diabetes insipidus
Symptoms: Thirst, dry mucosa, restlessness, seizures

🟨 B. Potassium Imbalance

✅ 1. Hypokalemia (K⁺ < 3.5 mEq/L)

Causes: Diuretics, vomiting, diarrhea
Symptoms: Muscle weakness, cramps, arrhythmias, ileus

✅ 2. Hyperkalemia (K⁺ > 5.0 mEq/L)

Causes: Renal failure, K⁺-sparing diuretics, acidosis
Symptoms: Muscle twitching, bradycardia, cardiac arrest

🟥 C. Calcium Imbalance

✅ 1. Hypocalcemia (Ca²⁺ < 8.5 mg/dL)

Causes: Hypoparathyroidism, vitamin D deficiency
Symptoms: Tetany, Chvostek’s sign, Trousseau’s sign, seizures

✅ 2. Hypercalcemia (Ca²⁺ > 10.5 mg/dL)

Causes: Hyperparathyroidism, bone cancer
Symptoms: Constipation, polyuria, lethargy, kidney stones

🟦 D. Magnesium Imbalance

✅ 1. Hypomagnesemia (Mg²⁺ < 1.5 mEq/L)

Causes: Alcoholism, GI losses
Symptoms: Tremors, tetany, seizures, dysrhythmias

✅ 2. Hypermagnesemia (Mg²⁺ > 2.5 mEq/L)

Causes: Renal failure, excessive Mg²⁺ intake (e.g., antacids)
Symptoms: Hypotension, bradycardia, respiratory depression

🔹 4. Diagnostic Evaluation:

Serum electrolyte levels (Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl⁻, PO₄³⁻)
ECG (for K⁺, Ca²⁺ disturbances)
Urine electrolyte levels
Renal function tests

🔹 5. Management Overview:

Imbalance	Management Strategy
Hyponatremia	Fluid restriction, IV NS, hypertonic saline (severe)
Hypernatremia	Oral/IV fluids, treat underlying cause
Hypokalemia	Oral/IV potassium replacement, monitor ECG
Hyperkalemia	Calcium gluconate, insulin + glucose, dialysis
Hypocalcemia	Calcium gluconate IV, vitamin D supplementation
Hypercalcemia	IV fluids, loop diuretics, bisphosphonates
Hypomagnesemia	Magnesium sulfate IV
Hypermagnesemia	IV calcium gluconate, dialysis if severe

🔹 6. Nursing Responsibilities:

Monitor electrolyte values and ECG
Administer prescribed electrolytes carefully
Observe for muscle weakness or twitching
Maintain intake-output chart
Provide education on dietary sources
Prevent complications (e.g., seizures, arrhythmias)

🔹 7. Golden One-Liners:

“Chvostek’s and Trousseau’s signs are indicators of hypocalcemia.”
“Peaked T-waves on ECG suggest hyperkalemia.”
“Loop diuretics may cause hypokalemia and hypocalcemia.”
“Renal failure is a common cause of hyperkalemia and hypermagnesemia.”
“Calcium gluconate is an antidote for hyperkalemia and hypermagnesemia toxicity.”

🔹 8. MCQs for Practice:

Q1. Which of the following is a sign of hypocalcemia?
A. Edema
B. Chvostek’s sign
C. Polyuria
D. Bradycardia
Answer: B. Chvostek’s sign
Rationale: Facial muscle twitching when the cheek is tapped is seen in hypocalcemia.

Q2. Which electrolyte imbalance is most dangerous for the heart?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C. Hyperkalemia
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias.

Q3. Trousseau’s sign is elicited by:
A. Pressing on tibia
B. Inflating BP cuff above systolic for 3 mins
C. Cold water exposure
D. Deep tendon reflex
Answer: B. Inflating BP cuff above systolic for 3 mins
Rationale: Carpal spasm seen is diagnostic of hypocalcemia.

Q4. Magnesium is primarily regulated by:
A. Liver
B. Adrenal gland
C. Kidneys
D. Lungs
Answer: C. Kidneys
Rationale: Kidneys excrete excess magnesium; renal failure causes retention.

Q5. Which food is rich in potassium?
A. Cheese
B. Banana
C. Egg
D. Rice
Answer: B. Banana
Rationale: Bananas are a good source of potassium, beneficial in hypokalemia.

📘 Topic: Hemorrhage

🔹 1. Definition:

Hemorrhage is the escape or loss of blood from the blood vessels (arteries, veins, or capillaries), either internally or externally, due to injury or rupture.

✅ “Hemorrhage is defined as excessive or uncontrolled bleeding from a blood vessel.”

🔹 2. Types of Hemorrhage:

🟩 A. According to Source:

Arterial Hemorrhage:
– Bright red, spurting blood (due to high pressure)
– Most dangerous
Venous Hemorrhage:
– Dark red, steady flow
Capillary Hemorrhage:
– Oozing, slow blood loss from small vessels

🟨 B. According to Site:

External Hemorrhage – Visible from body surface (wound, cut)
Internal Hemorrhage – Bleeding inside the body (e.g., abdomen, brain)
Postoperative Hemorrhage – After surgery (primary, reactionary, secondary)

🟥 C. According to Time:

Primary – At the time of injury or surgery
Reactionary – Within 24 hours (usually due to slipped ligature)
Secondary – After 24 hours (e.g., infection or ulceration)

🔹 3. Causes of Hemorrhage:

Trauma (accident, surgery, weapon injury)
Bleeding disorders (e.g., hemophilia, DIC)
Ruptured aneurysms
Peptic ulcers
Ectopic pregnancy rupture
Cancer or erosion of blood vessels
Anticoagulant overdose

🔹 4. Clinical Manifestations:

Visible bleeding (external)
Cold, clammy skin
Pallor and cyanosis
Tachycardia
Hypotension
Restlessness, anxiety
Decreased urine output
Shock (if severe)

🔹 5. Stages of Hemorrhage (by % of Blood Loss):

Class	Blood Loss	Symptoms
I	< 15%	Mild ↑ HR, normal BP
II	15–30%	↑ HR, ↓ pulse pressure
III	30–40%	Hypotension, confusion
IV	> 40%	Life-threatening shock

🔹 6. Diagnostic Evaluation:

Visual inspection (for external bleeding)
Hemoglobin & Hematocrit levels
Coagulation profile (PT, INR, APTT)
Blood grouping and crossmatch
Imaging: Ultrasound, CT scan (internal bleeding)
Endoscopy (GI bleeding)

🔹 7. Management of Hemorrhage:

🔸 A. Immediate First Aid:

Apply direct pressure over bleeding site
Elevate the limb (if applicable)
Pressure bandage
Tourniquet (as last resort, for arterial bleed)

🔸 B. Medical Management:

IV fluids (NS or RL) for volume replacement
Oxygen therapy
Blood transfusion (PRBCs, FFP, platelets)
Hemostatic agents (e.g., tranexamic acid)
Correct coagulation defects

🔸 C. Surgical Management:

Ligation of bleeding vessel
Electrocauterization
Repair of ruptured organ or vessel
Packing or drain placement

🔹 8. Nursing Responsibilities:

Monitor vital signs closely
Measure and record blood loss
Administer IV fluids and blood products
Maintain patient in supine position with legs elevated
Monitor urine output (kidney perfusion)
Prepare for surgery if required
Educate patient and relatives
Ensure calm environment to reduce anxiety

🔹 9. Complications of Hemorrhage:

Shock
Organ failure (esp. kidney, brain, heart)
Hypoxia
Death (if unmanaged)

🔹 10. Golden One-Liners:

“Arterial bleeding is bright red and spurting – needs immediate control.”
“Hypovolemic shock is the most serious complication of hemorrhage.”
“Direct pressure is the most effective method to control external bleeding.”
“Postoperative hemorrhage can be primary, reactionary, or secondary.”
“Massive blood loss >40% requires urgent blood transfusion and surgery.”

🔹 11. MCQs for Practice:

Q1. What is the most common early sign of hemorrhage?
A. Cyanosis
B. Bradycardia
C. Tachycardia
D. Hypothermia
Answer: C. Tachycardia
Rationale: Heart rate increases as a compensatory mechanism for blood loss.

Q2. Which type of hemorrhage is most dangerous?
A. Capillary
B. Venous
C. Arterial
D. Internal
Answer: C. Arterial
Rationale: Arterial hemorrhage is rapid and under high pressure, leading to quick blood loss.

Q3. A patient is bleeding profusely from the thigh. What is the first aid?
A. Give antibiotics
B. Apply ice
C. Apply direct pressure
D. Administer fluids
Answer: C. Apply direct pressure
Rationale: The priority in hemorrhage is to control bleeding, and direct pressure is most effective.

Q4. Which of the following is NOT a cause of internal hemorrhage?
A. Liver rupture
B. Peptic ulcer
C. Bladder infection
D. Ruptured ectopic pregnancy
Answer: C. Bladder infection
Rationale: Bladder infections typically do not cause significant internal bleeding.

Q5. Chvostek’s and Trousseau’s signs are associated with:
A. Hemorrhage
B. Electrolyte imbalance
C. Hypertension
D. Dehydration
Answer: B. Electrolyte imbalance
Rationale: These signs are related to hypocalcemia, not hemorrhage.

📘 Topic: Prioritization of Care

🔹 1. Definition:

Prioritization of care is the systematic decision-making process used by nurses to determine the urgency and importance of patient care tasks in order to address the most critical needs first.

✅ It involves assessing, planning, and executing care based on what will protect life, prevent deterioration, and promote recovery.

🔹 2. Purpose of Prioritization:

Ensure patient safety and survival
Deliver efficient and timely care
Use limited time and resources wisely
Prevent clinical deterioration
Enhance nursing judgment and critical thinking

🔹 3. Key Guidelines for Prioritization:

🟩 A. Maslow’s Hierarchy of Needs:

Nurses prioritize based on basic human needs:

Physiological needs (ABC – Airway, Breathing, Circulation)
Safety and Security
Love and Belonging
Esteem
Self-actualization

✅ Always address life-threatening physiological needs first.

🟨 B. ABC Framework:

Used in emergencies or critical care:

A – Airway: Open airway = Priority
B – Breathing: Oxygenation, respiratory rate
C – Circulation: Pulse, BP, bleeding, perfusion

✅ If airway is blocked, it is always the highest priority.

🟥 C. Nursing Process (ADPIE):

Use it to logically sequence care:

A – Assessment
D – Diagnosis
P – Planning
I – Implementation
E – Evaluation

✅ Assessment is always the first step unless there is a critical emergency.

🟦 D. Stable vs. Unstable Clients:

Prioritize unstable over stable clients.
Clients with new-onset symptoms or post-operative complications come before those with chronic or expected symptoms.

🔹 4. Examples of High-Priority Conditions:

Condition	Priority
Airway obstruction	High
Severe bleeding	High
Chest pain / suspected MI	High
Anaphylaxis	High
Confusion / altered LOC	Medium
Dressing change for stable wound	Low
Education / discharge teaching	Low

🔹 5. Delegation Considerations:

Prioritize tasks that must be done by the RN
Delegate stable, routine tasks to LPN or nursing assistant
Do not delegate assessment, teaching, or unstable client care

🔹 6. Common Errors in Prioritization:

Focusing on tasks, not outcomes
Ignoring signs of deterioration
Treating stable patients before unstable ones
Failure to reassess patient status

🔹 7. Nursing Responsibilities in Prioritization:

Perform initial and ongoing assessments
Identify urgent needs
Evaluate outcomes and reprioritize if needed
Use clinical judgment and protocols
Communicate with the healthcare team

🔹 8. Golden One-Liners:

“Airway is always first. If it’s blocked, nothing else matters.”
“Unstable clients take priority over stable clients.”
“Maslow’s Hierarchy guides care from survival to self-actualization.”
“Assessment comes before implementation unless life-threatening.”

🔹 9. MCQs for Practice:

Q1. A nurse enters a room and finds a client unconscious and not breathing. What is the first priority?
A. Start IV line
B. Call the family
C. Assess airway
D. Administer oxygen
Answer: C. Assess airway
Rationale: Airway must be evaluated and cleared before other actions.

Q2. According to Maslow’s hierarchy, which of the following needs is highest in priority?
A. Self-esteem
B. Love and belonging
C. Airway and breathing
D. Spiritual beliefs
Answer: C. Airway and breathing
Rationale: Physiological needs come before psychological needs.

Q3. Which client should the nurse assess first?
A. A client with a mild headache
B. A client with 2+ pitting edema
C. A client post-op day 2 reporting shortness of breath
D. A client asking about discharge medications
Answer: C. A client post-op day 2 reporting shortness of breath
Rationale: New-onset respiratory symptoms after surgery can indicate serious complications.

Q4. A nurse is caring for multiple patients. Which task can be delegated to a nursing assistant?
A. Administer IV antibiotics
B. Assess pain levels
C. Measure oral temperature
D. Teach insulin injection
Answer: C. Measure oral temperature
Rationale: Vital signs can be delegated to trained nursing assistants.

Q5. What is the first step in the nursing process when prioritizing care?
A. Planning
B. Diagnosis
C. Assessment
D. Implementation
Answer: C. Assessment
Rationale: Assessment is always the first step in clinical decision-making.

📘 Topic: Triage

🔹 1. Definition:

Triage is the process of sorting and prioritizing patients based on the severity of their condition and the urgency of treatment required.

✅ “Triage aims to provide the greatest good for the greatest number of people.”

🔹 2. Purpose of Triage:

Ensure quick and effective care for the most critical patients
Prevent death and deterioration of serious cases
Allocate limited resources wisely during mass casualty or emergency
Improve overall patient outcomes

🔹 3. Types of Triage:

🟩 A. Emergency Department (ED) Triage

Used in hospitals for routine patient sorting

Mild vs. moderate vs. critical

🟨 B. Disaster or Mass Casualty Triage

Used in battlefield, accidents, natural disasters

Focus is on saving maximum lives

🔹 4. Triage Categories (4-Tier Color Code System):

Color	Category	Meaning	Examples
🔴 Red	Immediate	Life-threatening, needs urgent care	Severe bleeding, airway obstruction
🟡 Yellow	Delayed	Serious but not immediately life-threatening	Fractures, burns without airway issues
🟢 Green	Minor	Walking wounded, can wait	Minor cuts, abrasions, sprains
⚫ Black	Expectant/Deceased	No chance of survival or already dead	Massive head injury, cardiac arrest (unresponsive)

✅ Mnemonic: “RPM – Respirations, Perfusion, Mental status” is used for disaster triage decision-making.

🔹 5. START Triage System (Simple Triage and Rapid Treatment):

Used in disaster scenarios to assess:

R – Respirations
P – Perfusion (capillary refill)
M – Mental Status

Based on these 3 parameters, patients are categorized as Red, Yellow, Green, or Black.

🔹 6. Principles of Triage:

Treat most urgent cases first
Do not necessarily treat first-come, first-served
Re-triage if patient’s condition changes
Quick evaluation (usually within 60 seconds per person)

🔹 7. Who Performs Triage?

Trained nurses (often senior/emergency nurses)
EMTs, Paramedics, Physicians (in disaster or battlefield)

🔹 8. Common Triage Tools:

START system
ESI (Emergency Severity Index)
CTAS (Canadian Triage and Acuity Scale)
SATS (South African Triage Scale)

🔹 9. Nurse’s Role in Triage:

Rapid assessment and categorization
Maintain clear communication with team
Document triage level and symptoms
Provide basic interventions (e.g., oxygen, IV line)
Reassess and reprioritize if status changes
Offer psychological support during crisis

🔹 10. Golden One-Liners:

“Triage means to sort.”
“The Red category receives immediate life-saving treatment.”
“START is used for mass casualty triage.”
“In triage, priority is based on clinical urgency, not arrival time.”
“Green-tagged patients are the ‘walking wounded.’”

🔹 11. MCQs for Practice:

Q1. What does the red tag in triage indicate?
A. Minor injuries
B. Dead
C. Immediate care needed
D. Delayed treatment
Answer: C. Immediate care needed
Rationale: Red-tagged patients have life-threatening conditions requiring urgent attention.

Q2. In triage, which patient should be seen first?
A. Patient with a fractured leg
B. Patient walking with minor cuts
C. Patient with no pulse and fixed pupils
D. Patient with severe respiratory distress
Answer: D. Patient with severe respiratory distress
Rationale: Airway/breathing compromise takes top priority in triage.

Q3. Which of the following triage systems is used in disaster situations?
A. Glasgow Coma Scale
B. START
C. APGAR
D. Braden Scale
Answer: B. START
Rationale: START (Simple Triage and Rapid Treatment) is specifically for mass casualty incidents.

Q4. What is the role of a nurse in triage?
A. Do only paperwork
B. Perform surgeries
C. Categorize and prioritize patients
D. Clean wounds only
Answer: C. Categorize and prioritize patients
Rationale: Nurses assess and classify patients based on urgency of care needed.

Q5. What does the black tag mean in triage?
A. Minor condition
B. Reassess every 10 minutes
C. Expectant or dead
D. Needs CPR
Answer: C. Expectant or dead
Rationale: Black-tagged individuals are those unlikely to survive despite treatment or already deceased.

📘 Topic: Ventilator

🔹 1. Definition:

A ventilator is a mechanical device that supports or replaces spontaneous breathing by moving air in and out of the lungs.

✅ “A ventilator is used to deliver oxygen and remove carbon dioxide in patients who are unable to breathe adequately on their own.”

🔹 2. Types of Ventilators:

🟩 A. Invasive Ventilation:

Delivered via endotracheal tube or tracheostomy
Used in ICU, surgeries, respiratory failure

🟨 B. Non-Invasive Ventilation (NIV):

Delivered via face mask or nasal mask
Examples: CPAP (Continuous Positive Airway Pressure), BiPAP (Bilevel Positive Airway Pressure)

🔹 3. Indications for Mechanical Ventilation:

Respiratory failure (e.g., ARDS, COPD)
Post-surgical respiratory support
Severe trauma or head injury
Drug overdose causing respiratory depression
Coma or unconsciousness
Neuromuscular disorders (e.g., Guillain-Barré, myasthenia gravis)
COVID-19 pneumonia with hypoxia

🔹 4. Basic Ventilator Settings:

Setting	Description
FiO₂	Fraction of inspired oxygen (21–100%)
RR	Respiratory Rate (e.g., 12–20 breaths/min)
TV (Tidal Volume)	Volume of air delivered per breath
PEEP	Positive End Expiratory Pressure
Mode	How breaths are delivered (e.g., AC, SIMV)

🔹 5. Modes of Ventilation:

Mode	Description
AC (Assist Control)	Full support; ventilator delivers preset breaths
SIMV	Allows spontaneous breathing between supported breaths
CPAP	Used in non-invasive ventilation, provides constant pressure
BiPAP	Provides two pressure levels – inspiratory and expiratory

🔹 6. Nursing Responsibilities:

Ensure airway patency (check ET tube/tracheostomy)
Monitor vital signs, ABG, SpO₂
Check ventilator settings and alarms regularly
Suction airway as needed (with sterile technique)
Prevent ventilator-associated pneumonia (VAP):
- Elevate head of bed to 30–45°
- Oral care every 2–4 hrs
- Hand hygiene
Monitor for complications: barotrauma, infection, hypotension
Provide psychological support to patient/family
Coordinate for weaning from ventilator when stable

🔹 7. Complications of Mechanical Ventilation:

Ventilator-Associated Pneumonia (VAP)
Barotrauma (due to high pressure)
Volutrauma (due to excessive volume)
Oxygen toxicity (high FiO₂ for long duration)
Hypotension (due to decreased venous return)
Tracheal injury (from prolonged intubation)
Delirium or psychological effects

🔹 8. Weaning from Ventilator:

Weaning is the gradual withdrawal from ventilator support:

Criteria:
- Stable vital signs
- Adequate oxygenation (SpO₂ > 90% on FiO₂ ≤ 40%)
- Good cough/gag reflex
- Minimal secretions
- Alert and cooperative

✅ Spontaneous Breathing Trial (SBT) is often used for weaning assessment.

🔹 9. Golden One-Liners:

“Ventilator supports gas exchange when the lungs cannot.”
“PEEP prevents alveolar collapse and improves oxygenation.”
“VAP is the most common complication of mechanical ventilation.”
“High FiO₂ > 60% for > 24 hours may cause oxygen toxicity.”
“AC mode provides full ventilatory support, SIMV allows partial breathing.”

🔹 10. MCQs for Practice:

Q1. What is the full form of PEEP in ventilator settings?
A. Pulmonary Expansion Enhancement Pressure
B. Positive End Expiratory Pressure
C. Pulmonary End Expiration Point
D. Pressure Equalization in Expiration Phase
Answer: B. Positive End Expiratory Pressure
Rationale: PEEP maintains positive pressure at the end of expiration to keep alveoli open.

Q2. Which ventilator mode allows the patient to breathe spontaneously between supported breaths?
A. AC
B. CPAP
C. SIMV
D. BiPAP
Answer: C. SIMV
Rationale: SIMV allows both machine and patient-initiated breaths.

Q3. One of the most common complications of mechanical ventilation is:
A. Myocardial infarction
B. Ventilator-Associated Pneumonia
C. Stroke
D. Deep vein thrombosis
Answer: B. Ventilator-Associated Pneumonia
Rationale: VAP is a frequent and serious infection caused by prolonged mechanical ventilation.

Q4. Which of the following helps reduce the risk of VAP?
A. Feeding through a nasogastric tube
B. Keeping the patient flat
C. Frequent oral care
D. Using humidified oxygen
Answer: C. Frequent oral care
Rationale: Regular oral care with antiseptic reduces oral colonization and risk of pneumonia.

Q5. Which parameter is most commonly monitored in patients on ventilator?
A. Blood urea
B. Urine pH
C. ABG (Arterial Blood Gas)
D. ESR
Answer: C. ABG (Arterial Blood Gas)
Rationale: ABG gives direct information about oxygenation, ventilation, and acid-base status.

📘 Topic: Defibrillator

🔹 1. Definition:

A defibrillator is a medical device that delivers a controlled electrical shock to the heart to restore a normal heart rhythm during life-threatening arrhythmias like ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).

✅ “Defibrillation is the process of stopping fibrillation of the heart by delivering electric shock to allow normal rhythm to resume.”

🔹 2. Purpose of Defibrillation:

Terminate abnormal heart rhythms (like VF or pulseless VT)
Restore organized electrical activity of the heart
Improve survival in sudden cardiac arrest (SCA)

🔹 3. Types of Defibrillators:

Type	Description
Manual Defibrillator	Used by trained professionals; allows control of energy, timing, and rhythm
Automated External Defibrillator (AED)	Used by laypersons or basic responders; fully automatic
Semi-Automatic Defibrillator	Analyzes rhythm and prompts operator to deliver shock
Implantable Cardioverter Defibrillator (ICD)	Surgically implanted in high-risk patients
Wearable Defibrillator	External vest-like device for high-risk individuals

🔹 4. Indications for Use:

Ventricular Fibrillation (VF)
Pulseless Ventricular Tachycardia (VT)
Sudden cardiac arrest (SCA)
Cardioversion (in elective cases like atrial fibrillation with pulse)

❗ Not used in asystole or pulseless electrical activity (PEA) — these are non-shockable rhythms.

🔹 5. Contraindications:

Asystole (flat line on ECG)
PEA (organized ECG without pulse)
Conscious, stable patient without arrhythmia

🔹 6. Steps of Defibrillation (Basic Process):

Confirm cardiac arrest (unresponsive, no pulse)
Call for help / activate code blue
Start CPR immediately
Turn on defibrillator / AED
Attach pads to chest (right upper chest & left side)
Analyze rhythm – if shockable (VF/VT):
- Ensure no one is touching patient
- Deliver shock
- Resume CPR for 2 minutes
Reassess rhythm and pulse
Repeat as necessary

🔹 7. Safety Measures During Use:

Clear area before shock (“All clear!”)
Avoid water or metal contact
Use conductive gel or adhesive pads
Monitor ECG and vitals continuously
Do not touch the patient during shock delivery
Ensure correct pad placement

🔹 8. Nursing Responsibilities:

Know how to operate defibrillator
Maintain defibrillator in working condition (battery, pads, alarms)
Attach electrodes properly and monitor ECG
Document time of shock and patient’s response
Assist during CPR and post-resuscitation care
Educate staff/patients on AED usage if applicable

🔹 9. Golden One-Liners:

“Defibrillation is the only effective treatment for VF and pulseless VT.”
“AED is designed for use by the public in sudden cardiac arrest.”
“Asystole and PEA are non-shockable rhythms.”
“Early defibrillation within 3–5 minutes improves survival rates up to 70%.”
“Implantable defibrillators continuously monitor and treat dangerous rhythms.”

🔹 10. MCQs for Practice:

Q1. What is the primary purpose of a defibrillator?
A. To pace the heart
B. To decrease heart rate
C. To restart normal heart rhythm in cardiac arrest
D. To measure blood pressure
Answer: C. To restart normal heart rhythm in cardiac arrest
Rationale: A defibrillator delivers a shock to depolarize the heart and allow normal rhythm to resume.

Q2. In which of the following conditions is defibrillation NOT indicated?
A. Ventricular fibrillation
B. Pulseless VT
C. Asystole
D. Sudden cardiac arrest due to VF
Answer: C. Asystole
Rationale: Asystole is a flat-line rhythm and is non-shockable.

Q3. Which device can be used by a layperson in a public place during cardiac arrest?
A. Manual defibrillator
B. Implantable defibrillator
C. Pacemaker
D. Automated External Defibrillator (AED)
Answer: D. Automated External Defibrillator (AED)
Rationale: AEDs are designed for use by non-medical persons during emergencies.

Q4. Before delivering a shock with a defibrillator, the nurse should:
A. Administer oxygen
B. Inject adrenaline
C. Confirm no one is touching the patient
D. Start IV fluids
Answer: C. Confirm no one is touching the patient
Rationale: To avoid accidental shock to others and ensure effective delivery.

Q5. Where are defibrillator pads placed on the body?
A. Both on the abdomen
B. One on chest, one on back
C. Right upper chest and left lower chest
D. Both on the neck
Answer: C. Right upper chest and left lower chest
Rationale: Proper pad placement ensures current passes through the heart

📘 Topic: Stages of Death and Dying (Kübler-Ross Model)

🔹 1. Definition:

The Stages of Death and Dying refer to the emotional responses experienced by individuals when they are facing terminal illness or loss, as proposed by psychiatrist Elisabeth Kübler-Ross in 1969.

✅ It describes 5 universal stages of grief and emotional adjustment in response to dying or loss.

🔹 2. Purpose of the Model:

Helps patients cope with terminal illness
Assists nurses and families in providing emotional support
Guides palliative care and end-of-life nursing

🔹 3. 5 Stages of Death and Dying (Kübler-Ross Model):

🟥 1. Denial – “This can’t be happening.”

The individual refuses to accept the reality of the situation.
A protective mechanism to cushion the initial shock.
Example: “I feel fine. The tests must be wrong.”

✅ Nursing Role:

Provide information calmly and honestly
Do not argue; allow time to adjust

🟨 2. Anger – “Why me?”

Realization of the truth leads to frustration and anger.
May be directed at healthcare staff, family, God, or self.
Example: “It’s not fair! How could this happen to me?”

✅ Nursing Role:

Remain calm, nonjudgmental
Acknowledge the patient’s feelings

🟩 3. Bargaining – “I’ll do anything to live longer.”

Attempts to negotiate or make deals to avoid the inevitable.
Often directed to a higher power or fate.
Example: “If I live longer, I’ll give up smoking.”

✅ Nursing Role:

Listen empathetically
Offer spiritual support or refer to chaplain

🟦 4. Depression – “What’s the point?”

Deep sadness as the reality of death sets in.
May include withdrawal, crying, or despair.
Example: “I don’t want to see anyone. I’m already gone.”

✅ Nursing Role:

Provide emotional support
Allow expression of sorrow
Encourage involvement of family/counseling

⬛ 5. Acceptance – “I’m ready.”

Comes with emotional peace and readiness for death.
The patient may want to say goodbye or finalize affairs.
Example: “I’ve lived my life. Now I’m at peace.”

✅ Nursing Role:

Support patient’s decisions
Maintain comfort and dignity
Promote family presence and palliative care

🔹 4. Key Points to Remember:

Not all patients experience all 5 stages
Stages may occur in different orders, may repeat, or overlap
There is no fixed timeline
Children and adults may express these stages differently
Nurses should tailor care to individual needs and cultural beliefs

🔹 5. Applications in Nursing:

Palliative care
Hospice nursing
Oncology and terminal illness care
Post-death grief counseling
Patient and family education
Communication and empathy skills

🔹 6. Golden One-Liners:

“Kübler-Ross described 5 emotional stages of dying: DABDA.”
“Grief is a process, not a one-time event.”
“Supportive communication is key at every stage of dying.”
“Patients may fluctuate between stages; it’s a non-linear journey.”

🔹 7. MCQs for Practice:

Q1. Who proposed the 5 stages of grief?
A. Florence Nightingale
B. Sigmund Freud
C. Elisabeth Kübler-Ross
D. Abraham Maslow
Answer: C. Elisabeth Kübler-Ross
Rationale: She developed the model in her book “On Death and Dying.”

Q2. What is the first stage of the Kübler-Ross model?
A. Acceptance
B. Bargaining
C. Denial
D. Anger
Answer: C. Denial
Rationale: Denial is the initial response to protect the person from the shock.

Q3. In which stage does the person try to make deals to delay death?
A. Denial
B. Bargaining
C. Depression
D. Acceptance
Answer: B. Bargaining
Rationale: This stage involves making promises to change in exchange for more time.

Q4. The stage in which the person feels hopeless and withdrawn is:
A. Acceptance
B. Depression
C. Anger
D. Denial
Answer: B. Depression
Rationale: Depression stage is marked by deep sadness and withdrawal.

Q5. What is the final stage in the 5-stage grief model?
A. Depression
B. Acceptance
C. Denial
D. Anger
Answer: B. Acceptance
Rationale: Acceptance is the final stage where the person comes to terms with reality.

Published May 28, 2025By mynursingapp

Categorized as MSN-PHC-SYNP, Uncategorised