Podcast
Questions and Answers
What is the first step in managing a patient with suspected stroke?
What is the first step in managing a patient with suspected stroke?
Which medication is commonly used to treat symptomatic sinus bradycardia?
Which medication is commonly used to treat symptomatic sinus bradycardia?
What is a critical step in the administration of Total Parenteral Nutrition (TPN)? SATA
What is a critical step in the administration of Total Parenteral Nutrition (TPN)? SATA
In the case of atrial fibrillation, which treatment is primarily focused on achieving rate and rhythm control?
In the case of atrial fibrillation, which treatment is primarily focused on achieving rate and rhythm control?
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What is one of the key initial actions in managing sepsis according to the 1-hour bundle?
What is one of the key initial actions in managing sepsis according to the 1-hour bundle?
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What effect does increasing PEEP on a ventilator have on cardiac output?
What effect does increasing PEEP on a ventilator have on cardiac output?
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During a weaning trial, which of the following signs indicates that the trial should be discontinued?
During a weaning trial, which of the following signs indicates that the trial should be discontinued?
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When a patient is in ARDS and not paralyzed, which of the following interventions is appropriate?
When a patient is in ARDS and not paralyzed, which of the following interventions is appropriate?
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In patients with chronic kidney disease (CKD), what is a common condition regarding calcium and phosphorus levels?
In patients with chronic kidney disease (CKD), what is a common condition regarding calcium and phosphorus levels?
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What signs indicate a patient needs dialysis based on laboratory results?
What signs indicate a patient needs dialysis based on laboratory results?
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How should a patient with elevated PAWP and decreased cardiac index be managed?
How should a patient with elevated PAWP and decreased cardiac index be managed?
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What does a high central venous pressure (CVP) indicate about a patient?
What does a high central venous pressure (CVP) indicate about a patient?
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What is the first step in weaning a patient off a ventilator who has been paralyzed?
What is the first step in weaning a patient off a ventilator who has been paralyzed?
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Study Notes
Ventilators
- Increasing positive end-expiratory pressure (PEEP) on a ventilator decreases cardiac output.
- If a patient on a ventilator becomes tachypneic, tachycardic, and has dropping oxygen saturation during a weaning trial, discontinue the trial.
ARDS (Acute Respiratory Distress Syndrome)
- ARDS is a secondary condition, often caused by sepsis, shock, or infection (or even COPD exacerbation).
- Patients are typically intubated, sedated, and paralyzed.
- Nurses must reposition, administer eye drops, suction, and provide oral care.
- Prone positioning can sometimes improve breathing.
- Sedatives (e.g., propofol, versed) and paralytics (e.g., vecuronium, succinylcholine) are used.
- Spontaneous awakening trials may be used where sedation is reduced, then discontinued.
- Patients usually show respiratory acidosis and hypoxia (low oxygen, high carbon dioxide).
AKI/CKD (Acute Kidney Injury/Chronic Kidney Disease)
- AKI patients have low protein; CKD patients often have normal protein levels.
- Peritoneal dialysis can help increase protein in the vascular space.
- Hemodialysis or continuous renal replacement therapy (CRRT) may be used for unstable patients.
- Hemodialysis patients require assessing the thrill and bruit.
- CKD patients may have low calcium and high phosphorus, needing a calcium supplement to correct imbalances.
- Uremia (due to increased BUN) may require dialysis.
- Electrolyte imbalances (especially high potassium and phosphorus) are a sign of needing dialysis.
Cardiac
- Central venous pressure (CVP) reflects right heart function; high CVP may need diuretics, low may require fluids.
- Pulmonary artery wedge pressure (PAWP) reflects left heart function; high PAWP may indicate afterload issues and needing diuretics or positive inotropes, low may indicate fluid issues.
- Preload, afterload, and contractility determine stroke volume.
Telemetry
- Recognizing atrial fibrillation and managing it with rate and rhythm control, along with anticoagulants, is important.
- Differentiate between defibrillation and cardioversion (for symptomatic sinus bradycardia use atropine).
- Sinus tachycardia treatment depends on the underlying cause (e.g., fever, pain).
- For PSVT, try vagal maneuvers; if unsuccessful, adenosine can be used.
- Low potassium is often linked to PVCs.
Nutrition (TPN)
- Albumin levels indicate nutritional status and wound healing.
- TPN requires double-checking by two nurses and uses filtered tubing.
- Blood glucose (BG) should be checked every 6 hours.
- TPN is administered through a central line.
Pancreatitis
- Pain management is crucial.
- Feeding through a jejunostomy tube (J-tube) bypasses the stomach to prevent pancreatitis activation by enzymes.
- Fluid administration is essential.
Sepsis
- The one-hour bundle includes lactate level and blood culture, along with 30 mL/kg fluids and broad-spectrum antibiotics.
- Continuous fluid resuscitation is required if blood pressure does not rise.
Epidural Hematoma
- Unique symptom profile; initial loss/decrease of consciousness, followed by a period of feeling better, rapidly followed by a worsened decline.
Stroke
- NIHSS (National Institutes of Health Stroke Scale) assessment is initial.
- CT scan is performed to determine stroke type and initiate appropriate treatment (surgery option vs. TNK).
Math
- Formulas and calculations related to heparin drip dosage, CPP (Cerebral Perfusion Pressure), Parkland formula, and MAP (Mean Arterial Pressure) are relevant.
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Description
Test your knowledge on ventilators, ARDS, and kidney disorders like AKI and CKD. This quiz covers important concepts, management strategies, and key interventions crucial for patient care in critical situations.
