1. What are the main components of the comprehensive geriatric assessment (CGA) and why is it important for older adults in acute care settings? (10 points) Answer: The CGA is a multidimensional, interdisciplinary, and individualized evaluation of an older adult's medical, functional, cognitive, psychological, and social status. It is important for older adults in acute care settings because it can identify their needs, preferences, strengths, and limitations, as well as guide the development of a holistic and person-centered care plan. The CGA can also help prevent or reduce adverse outcomes such as delirium, functional decline, hospital-acquired infections, falls, pressure ulcers, and readmissions. Rationale: The CGA is a key component of geriatric medicine and nursing practice that aims to optimize the health and well-being of older adults. It is especially relevant for older adults in acute care settings who are at risk of experiencing complex and multifactorial problems that require comprehensive and coordinated care. 2. What are the common causes and clinical manifestations of acute respiratory failure (ARF) in adults? How would you assess and manage a patient with ARF in the acute care setting? (15 points) Answer: The common causes of ARF in adults are divided into two categories: hypoxemic and hypercapnic. Hypoxemic ARF is caused by impaired gas exchange in the lungs, resulting in low arterial oxygen levels. Hypercapnic ARF is caused by inadequate alveolar ventilation, resulting in high arterial carbon dioxide levels. The clinical manifestations of ARF depend on the severity and duration of the condition, but may include dyspnea, tachypnea, cyanosis, confusion, agitation, lethargy, or coma. To assess a patient with ARF in the acute care setting, the nurse should obtain a detailed history, perform a physical examination, monitor vital signs and oxygen saturation, and review laboratory and imaging results. To manage a patient with ARF in the acute care setting, the nurse should provide oxygen therapy, mechanical ventilation, or noninvasive positive pressure ventilation as indicated, administer medications to treat the underlying cause and relieve symptoms, monitor for complications such as pneumothorax or pulmonary edema, and provide supportive care such as hydration, nutrition, and infection control. Rationale: ARF is a life-threatening condition that requires prompt recognition and intervention. The nurse should be familiar with the common causes and clinical manifestations of ARF in adults, as well as the assessment and management strategies to improve the patient's outcome. 3. What are the indications and contraindications for initiating extracorporeal membrane oxygenation (ECMO) in adults with refractory cardiogenic shock or respiratory failure? What are the potential complications and nursing implications of ECMO? (15 points) Answer: ECMO is a form of mechanical circulatory support that provides temporary oxygenation and/or perfusion to patients with severe cardiac or respiratory failure that is unresponsive to conventional therapies. The indications for initiating ECMO in adults are based on the patient's diagnosis, hemodynamic status, organ function, prognosis, and availability of resources. Some examples of indications are cardiogenic shock due to acute myocardial infarction, cardiomyopathy, or cardiac arrest; refractory ventricular arrhythmias; acute respiratory distress syndrome (ARDS); severe pneumonia; or pulmonary embolism. The