Improving outcomes with therapeutic hypothermia

doi: 10.1097/01.NURSE.0000425950.21341.54
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INSTRUCTIONS Improving outcomes with therapeutic hypothermia


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Improving outcomes with therapeutic hypothermia

GENERAL PURPOSE: To provide nurses with information about management of patients undergoing therapeutic hypothermia. LEARNING OBJECTIVES: After reading the preceding article and taking this test, you should be able to: 1. Describe the physiology related to therapeutic hypothermia. 2. Identify indications for therapeutic hypothermia. 3. Discuss patient management issues related to therapeutic hypothermia.

1. Which temperature is within the target range for therapeutic hypothermia?

a. 90° F

b. 94° F

c. 30° C

d. 35° C

2. Which statement about therapeutic hypothermia is accurate?

a. It decreases metabolism by 1% for every 1° C drop in body temperature.

b. It protects long-term brain function.

c. It's used in patients who regain consciousness after ROSC.

d. It's most appropriate for hemodynamically unstable patients.

3. Which parameter would generally make a patient a candidate for therapeutic hypothermia?

a. age 15

b. BP 78/60

c. pulseless for less than 60 minutes

d. Glasgow Coma Scale of 10

4. Excluded from therapeutic hypothermia would be the patient who

a. was pulseless for 45 minutes.

b. is mechanically ventilated.

c. arrives at the hospital 4 hours post cardiac arrest.

d. is pregnant.

5. Noninvasive cooling methods

a. include closed-loop systems.

b. require less nursing care than invasive methods.

c. are extremely effective in reducing body temperature.

d. don't require temperature monitoring.

6. What percentage of the body should be covered with gel pads for cooling?

a. 40%

b. 50%

c. 60%

d. 80%

7. One disadvantage of gel pads is that they

a. frequently leak.

b. are expensive to use.

c. require manual temperature adjustments.

d. frequently cause skin breakdown.

8. The cold water immersion system described

a. is used for all cooling phases.

b. cools target organs as effectively as invasive methods.

c. keeps patients cool for 48 hours.

d. is portable.

9. Advantages of the cold water immersion suit include

a. rare overcooling.

b. ease of maintaining target temperature.

c. cooling in less than 1 hour.

d. defibrillation safety.

10. Invasive cooling methods

a. rapidly induce hypothermia.

b. use moderately cold solutions to prevent shivering.

c. use D5W I.V. infusions.

d. are preferred in patients with renal failure.

11. Baseline data to collect before induction include

a. erythrocyte sedimentation rate.

b. Western blot.

c. type and crossmatch.

d. serum amylase.

12. Recommendations for patient management during therapeutic hypothermia include all of the following except

a. an oro- or nasogastric tube.

b. two CVADs.

c. electroencephalographic monitoring.

d. I.V. sedation and analgesia.

13. After ROSC, target temperature should be achieved within no more than

a. 1 hour.

b. 2 hours.

c. 3 hours.

d. 4 hours.

14. What's the ideal heart rate for patients undergoing therapeutic hypothermia?

a. 40 to 45 bpm

b. 50 to 60 bpm

c. 65 to 75 bpm

d. 80 to 85 bpm

15. To avoid dysrhythmias, body temperature should be no less than

a. 82° F.

b. 84° F.

c. 86° F.

d. 88° F.

16. To combat shivering, warm compresses should be placed on the patient's

a. face.

b. axilla

c. chest.

d. groin.

17. Hypothermia is most likely to cause

a. hyperphosphatemia.

b. hyperkalemia.

c. hypermagnesemia.

d. hyperglycemia.

18. Which statement about rewarming is accurate?

a. It's usually started 48 hours after induction.

b. It should be done over 2 to 4 hours.

c. It can cause hypotension.

d. It usually includes a potassium infusion.

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