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Nitroprusside purpose - ✔✔decreases preload and afterload by vasodilation (mainly afterload) Dobutamine mechanism of action - ✔✔contractility Dopamine at a low-end dose "renal dose" - ✔✔0.5-4mcg/kg/min increases renal and mesentric perfusion Dopamine at a mid-range dose - ✔✔ 4 - 10mcg/kg/min increases contractility and heart rate Dopamine at a high-range dose - ✔✔greater than 10mcg/kg/min vasoconstriction and increases BP Dopamine and Levophed infiltration - ✔✔leads to tissue necrosis Dopamine antidote - ✔✔regitine (phentolamine) TpA monitor for - ✔✔bleeding-hemorrhagic CVA diltiazem (cardizem) works by? - ✔✔(calcium channel blocker) slows ventricular rate by slowing conduction through the SA and AV node Diltazem (cardizem) biggest effect on which hemodynamic - ✔✔hypotension diltazem is used for patients with - ✔✔a-fib or a-flutter
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amiodarone (Cordarone) is a - ✔✔antiarrythmic prolongs the cardiac duration You MUST use a when using amiodarone infusion - ✔✔0.22 micron filter Watch out for in patients on a amiodarone infusion - ✔✔hypotension, prolongation of QT interval and bradycardia amiodarone is used for patients with - ✔✔a-fib, a-flutter and VT how much amiodarone is given to a stable VT with a pulse and a unstable pulseless VT/VF? - ✔✔150mg over 10min for VT with pulse 300mg push; repeat x1 at 150mg Epinephrine has what effect on the body? - ✔✔increases HR, BP, and contractility what is the first line drug for pulseless arrest? - ✔✔Epinephrine What rhythms are considered fatal? - ✔✔V-fib, Vtach (pulseless), and asystole Epinephrine is also given for? - ✔✔anaphylaxis and as a vasopressor for hypotension Heparin is used for? Antidote is? - ✔✔anticoagulant Protamine Sulfate What is the osmotic diuretic of choice to decrease intracranial pressure? - ✔✔mannitol
Digoxin increases contractility by - ✔✔slowing the heart rate which decreases conduction through the AV node What should be monitored in patients taking Digoxin? - ✔✔hypotension, bradycardia, and symptoms of toxicity Signs/Symptoms of Digoxin toxicity - ✔✔nausea, yellow vision/halo, paroxysmal atrial tachycardia (PAT with block). True/Flase: Digoxin WILL NOT cause rapid AV conduction or hypertension - ✔✔True what medication is a antiarrhythmic that suppresses automaticity and depolarization? - ✔✔lidocaine Lidocaine is used to treat? - ✔✔ventricular dysrhythmias lidocaine toxicity sign - ✔✔mental confusion/change in LOC Monitor serum levels with - ✔✔Lidocaine DO NOT give medications to patients with suppressed respirations - ✔✔Narcotics (morphine, dilaudid) What changes on a EKG would you expect to see on a patient with a acute MI? - ✔✔ST elevation normal QRS: Prolonged QRS indicates: - ✔✔<0.12 seconds is normal QRS prolonged QRS indicates intraventricular conduction defect, typically a bundle branch block
Distinguishing V-fib - ✔✔fibrillatory waves with no recognizable pattern Defib the Vfib Distinguishing V-Tach - ✔✔atrial rhythm and rate cannot be identified "Tombstones" First degree block interpretation - ✔✔looks like sinus rhythm but the PR is longer than normal. there will be 1 p for every qrs, but the PR interval will be greater than 0.20 sec Type 1 second degree block interpretation - ✔✔"Wenckebach" "Longer, Longer... drop" prolonged PR intervals and the missing QRS Type 2 second degree block interpretation - ✔✔PR interval is constant...QRS is missing "2 small p waves right after each other" give atropine, dopamine, or epi to increase HR is symptomatic bradycardic Third degree AV block interpretation - ✔✔a strip of p-waves laid independently over a strip of QRS complexes. Note that the p wave doesn't conduct the QRS complex that follows it. A-flutter interpretation - ✔✔abnormal p-waves that produce a saw-tooth appearance Failure to Capture interpreation - ✔✔spike without a complex Failure to Pace interpretation - ✔✔no pacemaker activity or spike at the set rate on an ECG. usually caused by battery or circuit failure, cracked or broken pacing leads, loose connections, oversensing, or the pacing output is too low--->can lead to asystole Failure to Sense - ✔✔undersensing: giving help when not needed; spikes occur on the ECG where they shouldnt
When defibrillating VT/VF use joules for biphasic defibrillator or joules for monophasic. - ✔✔ 200 360 Normal PR interval is - ✔✔0.12-0.20 seconds Patient presents with anginal pectoris. what is initial management? - ✔✔allow rest, amdinister oxygen, nitroglycerin, etc. Causes of elevated cardiac enzymes - ✔✔MI, pericarditis, closed chest trauma, cardiac surgery Goal of treatment for cardiogenic shock (any shock) - ✔✔increase the patient's cardiac output A patient exhibits depression after their recent MI, you should - ✔✔encourage the patient to verbalize their concerns and allow interaction with family How does a cardiac tamponade occur - ✔✔blood or fluid accumulates in the pericardial space what does a cardiac tamponade do to the heart - ✔✔prevents the heart to pump effectively (impaired ventricular filling and contraction) S/S of cardiac tamponade - ✔✔pulsus paradoxus, decreased BP, JVD, tachycardia, mufled heart sounds PAP values - ✔✔Systolic: 15 - 25 Diastolic: 8- 18 PAOP (wedge) - ✔✔ 6 - 12 PA Catheter waveforms - ✔✔
PAOP (wedge) reflects pressures in the - ✔✔left ventricle An elevated PAOP may indicate - ✔✔left ventricular failure If you notice a continual PAOP wave form is present you should - ✔✔ensure the balloon is deflated, reposition the patient and try have the patient cough You should not do what to PA catheter if a continual wedge pressure is present - ✔✔Flush the line What reading reflects the right atrium - ✔✔CVP An elevated CVP may indicate - ✔✔fluid overload, right ventricular failure, pulmonary HTN, cardiac tamponade Eventually sided heart failure will lead to an elevated. - ✔✔right sided HF will eventually lead to increased CVP decreased CVP can be from - ✔✔hypovolemia True/False Medication can be administered through an a-line - ✔✔False: no medications are to be given via a-line Arterial line waveform:
- Overdampened
- Underdampened - ✔✔-dicrotic notch on the downslope
- overdampened: air bubbles, blood clots, kinked tubing, loose connections
- underdampened:excessive tubing length or too many stopcocks
Your patient with an ETT is making audible sounds (or can be a trach without a passy-mauir valve) it is most likely related to.... - ✔✔the cuff is deflated which allows air to pass through the vocal cords In a patient with any kind of chest trauma ALWAYS assess for symptoms of - ✔✔pneumothorax impaired gas exchange, SOB S/s of tension pneumothorax - ✔✔deviated trachea, acute respiratory distress trauma patients are at risk for developing embolisms, especially those with long bone fractures. - ✔✔fat S/s of fat embolus - ✔✔may develop after surgery SOB, tachycardia, petechiae over upper body Your patient has diminished breath sounds and you notice limited movement of their chest. This can indicate possible atelectasis due to - ✔✔hypoventilation ABG Interpretation - ✔✔pH: 7.35-7. PaCO2: 35- 45 HCO3: 22 - 26 (ROME) What antibiotics are given to TB patients - ✔✔INH, Rifampin, Rocephin What antibiotics should be renal-dosed - ✔✔Vancomycin, gentamycin, and tobramycin Before suctioning a patient be sure the vacuum pressure is set to - ✔✔ 120 PPE for suctioning with a open sterile system - ✔✔mask, eye protection, gloves
Most important intervention for a patient with cervical spinal cord injury is to - ✔✔immobilize the head and neck You have just received an patient with a high level SCI what are you concerned with and why - ✔✔respirations high level spinal cord injuries could lead to paralysis/dysfunction of the respiratory muscles and cause respiratory arrest What is an early sign of increased ICP - ✔✔change in LOC treatment for increased ICP - ✔✔keep HOB 30, keep patient calm/quiet, avoid suctioning, avoid hip flexion, medications to decrease What medications may help decrease ICP - ✔✔mannitol and hypertonic saline List interventions made the RN during the acute phase of a stroke - ✔✔-minimize stimulation, provide quiet enviornment
- control secretions
- prevent injuries
- monitor for seizures
- close assessment of neurologic Is a positive babinski normal in adults? - ✔✔positive babinski is a dorsiflexion (upward) of toes. it is abnormal in patients >1 yr it indicates lesion of corticospinal tract What is the most important part of a neuro assessment - ✔✔LOC is a common complication of any kind of neurologic surgery. - ✔✔Diabetes Insipidus
Lab values for BUN and Creatinine K+ - ✔✔BUN 10- 20 Creatinine < K+ 3.5-4. Renal failure diet consist of - ✔✔low protein, low K+, low Na+, and a volume restriction Your patient has a NG tube you should keep the HOB - ✔✔>/30 degress to prevent aspiration EKG changes in hyperkalemia would present as - ✔✔tall peaked t-waves, wide QRS Urine specific gravity is - ✔✔1.003-1. How do you check placement of NG tube - ✔✔auscultation/ph fluid but first CXR Coffee ground material in NG tube may indicate blood. you should do what with this drainage - ✔✔have it tested for blood low intermittent suction is used for: - ✔✔preventing aspirations, reducing abdominal distention, to facilitate drainage with absent bowel sounds or decreased motility True/False you should use low intermittent suction to control bleeding - ✔✔False it can make it worse in active GI bleed Cold gastric lavage- you would use - ✔✔isotonic fluid (NS) not distilled water
What is the earliest detection of gastric bleeding in patients with gastric tubes? - ✔✔check the gastric contents for microscopic blood Explain advanced directives:
- living will
- Healthcare power of attorney - ✔✔living will indicates what care/procedures the patient would choose if unable to make decisions healthcare POA appoints a person to make decisions regarding care blood transfusion reactions
- symptoms
- treatment - ✔✔increased temperature, low back pain, chills if you suspect reaction STOP the transfusion a burn patient's most important treatment is during the first ___ hrs with - ✔✔ 24 hrs with fluid resuscitation infection control intervention for a healthcare worker *most important - ✔✔hand hygeine with obese patients it is important to remember the safety of the and pt - ✔✔nurse and patient when rewarming a hypothermic patient you would do this to prevent and - ✔✔slowly to prevent vasodilation and hypotention Total patient care involves - ✔✔spiritual and emotional needs as well as physical NEVER tell a patient - ✔✔everything will be alright
