INTRACEREBRAL HEMORRHAGE Change of Shift (1901-0730) Report Mr. O's level of consciousness remains impaired with a Glasgow Coma Scale score of 4. No verbal response. It does not open eyes. Pupils were unequal and sluggishly responsive to light. No spontaneous movement Decerebrate rigidity of extremities to painful stimuli on the right side. Unresponsive on the left side. Change of Shift (1901-0730) Report Shallow respiratory effort. No cough or gag reflex. Clear oral secretions suctioned as needed to keep the airway clear. On 2 liters of oxygen by nasal cannula with Spo2 94%. Peripheral IV of D5NS with KCL at 100 ml/hr., site without redness or edema. NPO. Family at the bedside. Family requests palliative care only. 0700 vital signs: T 101F, BP 160/86, P 88, R 22, SpO2 94%. Acetaminophen suppository was given for elevated temperature. 0731-1115 Report ---Physical assessment unchanged. 2 liters flow oxygen by nasal cannula continues. SpO2 decreased to 88% at 1100. The temperature remains elevated at 101.2 F. The last dose of Acetaminophen received at 0700. Palliative care continues. Family at the bedside. Urine output decreased with only 200 ml voided since 0700. Peripheral IV of D5NS with KCL infusing at 100 ml/hr., the site without redness or edema. 1116-1500 Report --Neurological assessment with altered findings at 1130. Left pupil fixed and dilated. Blood pressure increased and SpO2 remains decreased at 88%. Oxygen administration increased at 1115 to 4 liters flow by nasal cannula without improvement in oxygen saturation. Increasingly labored respiratory effort. Positive Babinski reflex. No urine output since 1000. Palliative care continues. Family at the bedside. Treatment Emergency treatment of intracerebral hemorrhage focuses on controlling the bleeding and reducing the pressure in your brain caused by the excess fluid. Surgery Clipping Coiling AVM surgery Stereotactic radiosurgery

Mr. O was transferred to the ICU Sunday night while arrangements could be made for hospice care in a skilled nursing facility. Mr. O received Nitroprusside 50mg in 250mLD5W to titrate systolic<140>110, Mannitol25%solution to decrease intracranial pressure, Famotidine 20mg, IV to prevent stress ulcers, and IV therapy of D5 NS with 20mEqKCl at100mL per hour. on Monday morning, Mr. O's blood pressure stabilized as a systolic BP of 140-150. The Nitroprusside and Mannitol were discontinued. He was transferred to skilled nursing for hospice care. Allergies: None is known to food or medication. Past medical history: Hypertension for the past10years which has been controlled by medication (Amlodipine/Benazepril2.5/10mg every morning) until the past year when he began experiencing a high degree of stress over his company failing. Hyperlipidemia for the past 5years controlled by medication (Atorvastatin 20mg at bedtime).

Question 13. How was the mannitol administered to Mr. O? A. Intravenously, through a filter B. Intramuscularly, deep in a large muscle C. Subcutaneously, with care taken to rotate sites D. Route depended on the severity of the patient's condition

Question 14. After mixing the IV nitroprusside drip, the nurse should do which of the following? A. Place the IV bag in an opaque wrapper. B. Let the solution sit for 10 minutes before administration. C. Give the medication immediately. D. Allow the solution to turn slightly blue before administration.

Question 15. The order reads "Nitroprusside sodium 50 mg in 250 cc D5W to titrate systolic B/P <140 >110." How many mcg per milliliter of nitroprusside are contained in a 250-cc solution? A. 0.2 mcg B. 2 mcg C. 20 mcg D. 200 mcg

Question 16. The order reads "Famotidine 20 mg IVPB q12h." The nurse decides to add the solution to the primary IV of 1000 cc of D5NS with 20 mEq KCl set at 100 cc/hr. Which of the following is a true statement concerning the nurse's actions? A. This is a bad decision; IV famotidine is incompatible with KCl. B. This is a good decision; this will deliver a steady dose of famotidine over a 12-hour period. C. This is a bad decision; famotidine should be delivered rapid IV push for best effect D This is a good decision; this will eliminate an unnecessary IV line.

Please l will appreciate if one of Expert will help me to ans these questions.