AACN CCRN-Adult Dumps Questions Answers

Epidural hematoma

An epidural hematoma is a collection of blood that forms between the skull and the dura mater, the outermost layer of the meninges that cover the brain. The most common cause of an epidural hematoma is a head injury that fractures the temporal bone and tears the middle meningeal artery, which runs along the inner surface of the skull. Arterial bleeding is under high pressure and can rapidly expand the hematoma, compressing the brain and causing neurological deterioration. A typical symptom of an epidural hematoma is a brief loss of consciousness followed by a lucid interval and then a rapid decline in consciousness and brain function. This condition requires urgent surgical evacuation of the hematoma to prevent brain damage or death12. Venous bleeding, clot formation, and intracranial aneurysm are not the main factors associated with the deterioration of the patient’s condition in this case.

In a patient with head trauma, the primary pathophysiology underlying acute respiratory failure often involves hypercapnia due to decreased minute ventilation. Head trauma can impair the central nervous system's ability to regulate breathing, leading to inadequate ventilation and a build-up of carbon dioxide (CO2) in the blood. Other factors like shifting of the oxyhemoglobin dissociation curve, increased intrapulmonary shunt, and dehydration due to diabetes insipidus may be present but are not the primary causes. References: CCRN Exam Handbook, AACN, page 25, section on Respiratory.

The nurse’s most appropriate action is to review recent published research about bedrest protocols, as this would provide the nurse with the most current and reliable evidence to guide clinical practice and improve patient outcomes. Bedrest protocols after cardiac catheterization may vary depending on the type of access site, the use of closure devices, the patient’s risk factors, and the clinician’s preference. However, there is a growing body of research that supports early ambulation and shorter bedrest duration to reduce the risk of complications, such as bleeding, hematoma, back pain, and venous thromboembolism, and to enhance patient comfort and satisfaction123. Asking about obtaining an independent evaluation of unit outcomes, conducting an informal chart review and outcome evaluation of patients treated with different bedrest protocols, or asking the nursing supervisor to request standardized physician orders for patients who have undergone catheterization are not the most appropriate actions, as they may not reflect the best available evidence, may be biased or incomplete, or may not address the patient’s concern.

References:

• 1: Bedrest After Cardiac Catheterization: A Systematic Review and Meta-analysis4, p. 1-2.
• 2: Early Ambulation After Cardiac Catheterization: A Literature Review, p. 1-2.
• 3: Bed Rest After Cardiac Catheterization: A Review of the Evidence, p. 1-2.