AACN Updated CCRN-Adult Exam Questions and Answers by magnus

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.

When seeking to make changes to a documentation screen in the electronic health record (EHR), it is crucial to involve all relevant stakeholders to ensure their buy-in and support. This includes discussing the proposed changes with those who will be directly impacted by it and obtaining their feedback. This collaborative approach can help in identifying potential issues and garnering the necessary support for the proposal, increasing the likelihood of it being accepted by the EHR committee in the future.References: = CCRN Exam Handbook, page 58

Disseminated intravascular coagulation (DIC) is a condition where blood clots form excessively and block blood vessels, leading to organ damage and bleeding. The pathophysiology of DIC involves excess and unregulated thrombin generation, which consumes coagulation factors and platelets, and activates fibrinolysis1. Thus, in severe DIC there is paradoxically simultaneous thrombosis and spontaneous bleeding2. This is due to the depletion of clotting factors, which is a key aspect of the underlying pathophysiology of DIC12.

Subcutaneous emphysema (SE) is a condition where gas or air accumulates in the subcutaneous tissue layer of the skin, causing swelling and a crackling sensation when touched. SE can occur after esophagectomy, a surgical procedure to remove part or all of the esophagus, due to air leakage from the anastomosis site or the lung. SE can also be a sign of a more serious complication, such as anastomotic leakage, mediastinitis, or tracheal injury12. Therefore, the nurse should expect an order for a CT scan, which is a diagnostic imaging test that can detect the source and extent of the air leakage and any associated complications. A CT scan can also guide the appropriate management of SE, which may include conservative measures, such as increasing the suction of the chest tube, or more invasive interventions, such as surgical repair or drainage123. Chest tube insertion, IV antibiotics, and gastric decompression are not likely to be ordered for SE after esophagectomy, as they do not address the underlying cause of the air leakage or the potential complications. Chest tube insertion may be indicated for pneumothorax, but not for SE alone. IV antibiotics may be indicated for infection, but not for SE alone. Gastric decompression may be indicated for gastric distension, but not for SE alone.