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Questions and Answers

What are the stages of shock?

Compensatory, Progressive, Irreversible

What are the clinical findings of compensated shock?

Normal BP, Increased HR, JVD, confused, agitated, cold, clammy, respiratory alkalosis

What are the clinical findings of progressive shock?

SBP < 90, MAP < 65, rapid shallow breathing, UO/Anuric, cold, lethargic, possible coma, dysrhythmias, acidosis

What are the clinical findings of irreversible shock?

<p>Severe hypotension, erratic HR, asystole, anuric, jaundice, necrosis, coma, mechanical ventilation, acidosis</p> Signup and view all the answers

Write out the Parkland Formula.

<p>2 mL x patient weight in kg x TBSA%<br /> 4 mL for electrical burns</p> Signup and view all the answers

What are the goals/priorities of care in the emergent phase of burns?

<p>Initiate wound care</p> Signup and view all the answers

What are the different types of shock, excluding septic shock?

<p>Hypovolemic, Cardiogenic, Distributive (Circulatory), Obstructive (Mechanical)</p> Signup and view all the answers

What are some signs and symptoms of hypovolemic shock?

<p>Pallor/Cool/Clammy Skin</p> Signup and view all the answers

What are some signs and symptoms of cardiogenic shock?

<p>Hypotension</p> Signup and view all the answers

What are some signs and symptoms of distributive shock?

<p>Systemic vasodilation</p> Signup and view all the answers

What are the early signs and symptoms of increased ICP?

<p>Headache</p> Signup and view all the answers

What are the nursing interventions for a patient with increased ICP?

<p>Padded side rails</p> Signup and view all the answers

What are some treatment options for a patient with increased ICP?

<p>Ventriculostomy</p> Signup and view all the answers

What are some signs and symptoms of an aneurysm?

<p>Asymptomatic until rupture or dissection</p> Signup and view all the answers

What are the nursing interventions for a patient with an aneurysm?

<p>Calm environment</p> Signup and view all the answers

What are some treatment options for a patient with an aneurysm?

<p>Statins</p> Signup and view all the answers

What are the components of Beck's Triad?

<p>JVD</p> Signup and view all the answers

What is the treatment for cardiac tamponade?

<p>Pericardiocentesis</p> Signup and view all the answers

What are some signs and symptoms of tension pneumothorax?

<p>Decreased breath sounds</p> Signup and view all the answers

What are the nursing interventions for a patient with tension pneumothorax?

<p>Advanced airway/vent</p> Signup and view all the answers

What is the treatment for tension pneumothorax?

<p>Chest tube insertion and needle decompression</p> Signup and view all the answers

What does 'A' stand for in ABCDE?

<p>Airway</p> Signup and view all the answers

What are the signs and symptoms of acute respiratory distress syndrome (ARDS)?

<p>Tachypnea</p> Signup and view all the answers

What are the nursing interventions for a patient with ARDS?

<p>Medications</p> Signup and view all the answers

What are some treatment options for a patient with ARDS?

<p>Prone positioning early</p> Signup and view all the answers

What are some complications of a flail chest?

<p>Barotrauma</p> Signup and view all the answers

What are the signs and symptoms of a flail chest?

<p>Paradoxical chest wall movement</p> Signup and view all the answers

What are the nursing interventions for a patient with a flail chest?

<p>Assess ventilation-perfusion mismatch</p> Signup and view all the answers

What are some treatment options for a patient with a flail chest?

<p>Spinal nerve block</p> Signup and view all the answers

What are the signs and symptoms of a hemothorax?

<p>Respiratory acidosis</p> Signup and view all the answers

What are the nursing interventions for a patient with a hemothorax?

<p>Assess respiratory status</p> Signup and view all the answers

What are some treatment options for a patient with a hemothorax?

<p>Chest tube insertion</p> Signup and view all the answers

What are the two main types of angina?

<p>Stable angina</p> Signup and view all the answers

Describe stable angina.

<p>Occurs with activity, predictable, resolved with rest/medications. Usually due to a fixed plaque.</p> Signup and view all the answers

Describe Prinzmetal's angina.

<p>A variation of unstable angina, it occurs at night or in the early morning and is related to coronary artery spasm.</p> Signup and view all the answers

What are the indications for placement of a chest tube?

<p>Pneumothorax</p> Signup and view all the answers

What are some normal findings with a chest tube?

<p>Tidaling</p> Signup and view all the answers

What are some nursing care considerations for a patient with a chest tube?

<p>Pulmonary toileting</p> Signup and view all the answers

What are the normal parameters for a central venous pressure (CVP)?

<p>2-6 mmHg</p> Signup and view all the answers

What does a low CVP indicate?

<p>Hypovolemia or fluid depletion</p> Signup and view all the answers

What are the normal parameters for pulmonary wedge pressure (PWP) or pulmonary artery occlusion pressure (PAOP)?

<p>8-12 mmHg</p> Signup and view all the answers

What does a low PWP/PAOP indicate?

<p>Fluid depletion or hypovolemia</p> Signup and view all the answers

What are the normal parameters for pulmonary artery pressure?

<p>25/10 mmHg</p> Signup and view all the answers

What does a low pulmonary artery pressure indicate?

<p>Hypovolemia or decreased cardiac output</p> Signup and view all the answers

What are the differences between synchronized cardioversion and defibrillation?

<p>Synchronized cardioversion is a controlled delivery of electrical current to the heart at the peak of the R wave, restoring normal heart rhythm. Defibrillation is an uncontrolled delivery of electrical current to the heart at any point in the cardiac cycle, with the aim of terminating ventricular fibrillation or ventricular tachycardia.</p> Signup and view all the answers

What are the rhythms for which synchronized cardioversion is indicated?

<p>Supraventricular tachycardia (SVT)</p> Signup and view all the answers

What are the rhythms for which defibrillation is indicated?

<p>Ventricular tachycardia (VTach) without a pulse</p> Signup and view all the answers

What are some treatments for atrial fibrillation?

<p>Antiarrhythmic medications</p> Signup and view all the answers

What are some treatments for bradycardia?

<p>Transcutaneous pacing</p> Signup and view all the answers

What are some treatments for SVT?

<p>Adenosine</p> Signup and view all the answers

What are some treatment options for ventricular tachycardia?

<p>CPR</p> Signup and view all the answers

What are some treatments for asystole?

<p>Epinephrine and CPR</p> Signup and view all the answers

What are some signs and symptoms of infective endocarditis?

<p>Osler's nodes</p> Signup and view all the answers

What are the nursing interventions for a patient with infective endocarditis?

<p>Antibiotics for a minimum of 4-6 weeks</p> Signup and view all the answers

What are some complications of infective endocarditis?

<p>Embolic events</p> Signup and view all the answers

What are some signs and symptoms of myocarditis?

<p>Fatigue</p> Signup and view all the answers

What is an important instruction to give a patient with myocarditis?

<p>Avoid strenuous activities and return to sports in at least 3-6 months after diagnosis</p> Signup and view all the answers

What are some treatment options for a patient with myocarditis?

<p>Antivirals</p> Signup and view all the answers

What are some nursing interventions for a patient with pericarditis?

<p>Assess heart sounds</p> Signup and view all the answers

What is aortic stenosis?

<p>A narrowed aortic valve opening, causing reduced blood flow from the left ventricle into the aorta. This leads to increased pressure in the left ventricle, which results in hypertrophy and eventually heart failure.</p> Signup and view all the answers

What is mitral valve regurgitation?

<p>The mitral valve leaflets do not close properly, leading to backward flow of blood from the left ventricle into the left atrium during systole. This can lead to left ventricular hypertrophy, left atrial enlargement, pulmonary congestion, and eventually heart failure.</p> Signup and view all the answers

What are the different types of blood transfusion reactions?

<p>Hemolytic reaction</p> Signup and view all the answers

What is the treatment for a hemolytic transfusion reaction?

<p>Stop the transfusion immediately, administer IV fluids, and monitor closely for complications.</p> Signup and view all the answers

What is the treatment for a febrile transfusion reaction?

<p>Antipyretic medication</p> Signup and view all the answers

What is the treatment for an allergic transfusion reaction?

<p>Antihistamines</p> Signup and view all the answers

What is the treatment for a bacterial transfusion reaction?

<p>Blood cultures and antibiotics</p> Signup and view all the answers

What is the treatment for a circulatory overload transfusion reaction?

<p>Diuretics, elevate the head of bed, administer oxygen, and monitor vital signs closely.</p> Signup and view all the answers

What is the indication for cardiac catheterization?

<p>Blockage in the coronary arteries</p> Signup and view all the answers

What are some nursing assessments post-cardiac catheterization?

<p>Provide pillow</p> Signup and view all the answers

What is the indication for a pulmonary artery catheter (PA catheter)?

<p>To measure pressure in the pulmonary arteries, assess left ventricular function, and monitor oxygen saturation (SvO2)</p> Signup and view all the answers

What is the indication for an arterial line?

<p>To continuously monitor blood pressure and obtain arterial blood gas samples</p> Signup and view all the answers

What is the indication for a central line?

<p>To provide access to the central veins, allowing for medication administration, fluid resuscitation, and hemodynamic monitoring</p> Signup and view all the answers

What is the difference between a complete and incomplete spinal cord injury?

<p>A complete spinal cord injury results in total loss of function below the level of injury, while an incomplete spinal cord injury allows for some function below the level of injury.</p> Signup and view all the answers

Study Notes

Acute Myocardial Infarction

  • Symptoms (S/S):

    • Constant, unstable chest pain
    • Diaphoresis
    • Shortness of breath (SOB)
    • Pain radiating to jawline/shoulder
    • Nausea/vomiting (N/V)
    • Syncope (fainting)

  • Nursing Interventions (NI):

    • Vital signs monitoring
    • Continuous ECG monitoring
    • Pain assessment
    • Skin assessment (color, temperature, pulses)
    • Intake and output (I&O)
    • Lab work

  • Treatment (TX):

    • Aspirin
    • Nitroglycerin
    • Morphine
    • Supplemental oxygen (O2)
    • P2Y12 inhibitor (e.g., Plavix)
    • Two intravenous (IV) lines
    • Bed rest

Shock

  • Stages of Shock:
    • Compensatory: Normal blood pressure, increased heart rate, confusion, agitation, cold clammy skin, respiratory alkalosis, Paco2 >20 <35
    • Progressive: Systolic blood pressure (SBP) <90, mean arterial pressure (MAP) <65, rapid shallow breathing, lethargy, possible coma, dysrhythmias, Paco2 >45, acidosis
    • Irreversible: Severe hypotension, erratic heart rate, asystole, anuric, jaundice, necrosis, coma, mechanical ventilation, and acidosis

Burns

  • Parkland Formula:

    • 2 mL x patient weight (kg) x % total body surface area (TBSA) burned
    • 4 mL for electrical burns
    • 50% given over 8 hours, 50% over 16 hours

  • Emergent Phase Priorities:

    • Fluid resuscitation
    • Pain management
    • Prevention of hypothermia
    • Airway management
    • Initiation of wound care
    • Diagnostic testing

Different Types of Shock (excluding septic)

  • Hypovolemic Shock:

    • S/S: Hypotension, tachycardia, thirst, pallor, cool/clammy skin, altered mental status
    • TX: Isotonic solution or blood replacement; treat underlying cause

  • Cardiogenic Shock:

    • S/S: Hypotension, tachycardia, tachypnea, weak pulses, pallor, cool clammy skin, altered mental status, chest pain, dysrhythmias,
    • TX: Oxygen, medications to support the heart, pain management, fluid management

TBI & Increased ICP

  • Symptoms (S/S):

    • Early: Nausea/vomiting (N/V), headache (HA), lethargy, irritability, slow decision making
    • Late: Pupil changes, seizures, coma, bleeding from nose/ears, Battle's sign, halo sign, scalp wounds

  • Nursing Interventions (NI):

    • HOB elevated 30-45 degrees
    • Head in neutral position
    • Limit stimuli
    • Maintain blood pressure
    • Nutritional support
    • Monitor vital signs (vitals)
    • Use padded side rails

  • Treatment (TX):

    • Neuro assessment
    • Suction as needed
    • Hypertonic solution to pull fluid off brain
    • Ventriculostomy
    • Craniectomy
    • Craniotomy

Aneurysms

  • Symptoms (S/S):

    • Atherosclerosis, hypertension (HTN), high cholesterol
    • Asymptomatic until rupture or dissection
    • Rupture: Chest pain
    • Dissection: Flank pain

  • Nursing Interventions (NI):

    • Neuro checks
    • CT scan with contrast
    • Control HTN and atherosclerosis
    • Maintain calm environment

  • Treatment (TX):

    • Stop smoking
    • Surgery
    • Antihypertensives
    • Statins

Cardiac Tamponade

  • Symptoms (S/S):

    • Beck's triad: Hypotension, jugular venous distention (JVD), muffled heart sounds
    • Narrowed pulse pressure

  • Nursing Interventions (NI):

    • Continuous cardiac monitoring
    • Two intravenous (IV) lines

  • Treatment (TX): Pericardiocentesis

Tension Pneumothorax

  • Symptoms (S/S):

    • Chest pain
    • Tracheal deviation to the unaffected side
    • Shortness of breath (SOB)
    • Anxiety
    • Cyanosis
    • Decreased breath sounds on affected side

  • Nursing Interventions (NI):

    • Monitor vital signs (respiration, O2 saturations)
    • Assist respirations/treatment
    • CXR (chest x-ray)
    • Supplemental oxygen (O2)
    • Advanced airway management/ventilation

  • Treatment (TX):

    • Chest tube placement
    • Needle decompression.

Primary Survey (ABCDE)

  • Airway (A):

    • Open airway
    • Patency (obstruction assessment)
    • Jaw thrust, suction if needed

  • Breathing (B):

    • Chest rise and fall
    • Effort required to breathe
    • Assess for deviations or abnormal sounds.
    • Rate / quality. Sounds of breathing.

  • Circulation (C):

    • Palpate pulses
    • Assess skin color, temperature, capillary refill time
    • IV access
    • Control external bleeding

  • Disability (D):

    • Glasgow Coma Scale (GCS) (eyes, verbal, motor)
    • Pupil assessment (PERRLA)

  • Exposure (E):

    • Remove clothing, keep patient warm
    • Identify injuries
    • Maintain Body Temperature

Adult Respiratory Distress Syndrome (ARDS)

  • Symptoms (S/S): Tachypnea, tachycardia, progressive refractory hypoxemia, bilateral pulmonary infiltrates on CXR, worsening PaO2/FiO2 ratio

  • Nursing Interventions (NI):

    • Suction airway
    • Medications (e.g., infection prevention)
    • Prone positioning (where appropriate)
    • UO 0.5mg/kg/hr
    • Continuous monitoring of mechanical ventilation parameters.

  • Treatment (TX):

    • High-flow nasal cannula (NC)
    • Mechanical ventilation
    • High positive end-expiratory pressure (PEEP)
    • Extracorporeal Membrane Oxygenation (ECMO) if necessary
    • Early prone positioning

Flail Chest

  • Symptoms (S/S):

    • Paradoxical chest wall movement
    • Tracheal deviation to affected side

  • Nursing Interventions (NI):

    • Assess respiratory/O2 status
    • Monitor vitals
    • Assess for respiratory depression
    • Assess for V/Q mismatch
    • Manage pain
    • Encourage coughing, deep breathing, and movement.

  • Treatment (TX):

    • Ventilation
    • Pain management
    • Spinal nerve block

Hemothorax

  • Symptoms (S/S):

    • Hypovolemia/shock
    • Respiratory acidosis
    • Absent breath sounds on affected side, hypotension, reduced O2 saturation, reduced blood pressure.

  • Nursing Interventions (NI):

    • Assess breathing status (rate, sounds, O2 saturations)
    • Assess for Shock
    • Obtain chest X-ray(CXR)

  • Treatment (TX):

    • Chest tube insertion
    • Thoracotomy (rare)

Angina

  • Stable Angina:

    • Occurs with activity
    • Predictable
    • Resolves with rest/medications
    • Fixed Plaque

  • Unstable Angina:

    • Occurs with or without activity.
    • Unpredictable
    • Emergency

  • Prinzmetal's Angina:

    • Variation of unstable angina
    • Occurs during the night/early morning (midnight to early AM)
    • Coronary artery spasm

Chest Tubes

  • Indications for Placement:

    • Pneumothorax
    • Hemothorax

  • Normal Findings:

    • Tidaling in the water seal chamber
    • Occasional bubbling in the water seal chamber

  • Abnormal Findings:

    • No tidaling
    • Continuous bubbling
    • Drainage exceeding 500 mL
    • Bright red blood gush
    • Crepitus

Nursing Care Considerations for Hemodynamic Monitoring

  • Normal Parameters:
    • Central Venous Pressure (CVP): 2-6 mm Hg
    • Pulmonary Artery Wedge Pressure (PAWP) / Pulmonary Artery Occlusion Pressure (PAOP): 8-12 mmHg
    • Pulmonary Artery (PA) Pressure: 25/10 mmHg.

Synchronized Cardioversion vs. Defibrillation

  • Cardioversion:

    • Controlled electric shocks delivered at the peak of the R wave during a cardiac cycle
    • Treats specific dysrhythmias (e.g., SVT, atrial fibrillation with a pulse, flutter).

  • Defibrillation:

    • Uncontrolled electric shock delivered at any point during the cardiac cycle
    • Treats life-threatening cardiac rhythms (e.g., ventricular fibrillation, ventricular tachycardia without a pulse)

Dysrhythmias - Treatments

  • Atrial Fibrillation (A-Fib):

    • Antiarrhythmics, cardiac ablation, rate control.

  • Bradycardia:

    • Atropine IV bolus (up to 3mg). Transvenous pacing.

  • Supraventricular Tachycardia (SVT):

    • Adenosine (6-12 mg) IV push. Vagal maneuvers

  • Ventricular Tachycardia (V-Tach) - with a pulse:

    • Cardioversion.

  • Ventricular tachycardia (V-Tach) - without a pulse:

    • Defibrillation.

  • Polymorphic Ventricular Tachycardia (Torsades de Pointes):

    • Magnesium IV.

Infective Endocarditis

  • Symptoms (S/S):

    • Osler nodes
    • Janeway lesions
    • Splinter hemorrhages
    • Fever
    • Fatigue
    • Confusion
    • Murmur

  • Nursing Interventions (NI):

    • Long-term antibiotic therapy (minimum 4-6 weeks)
    • PICC line for long-term antibiotics
    • Oral hygiene
    • Notify healthcare providers of any procedures

Myocarditis

  • Symptoms (S/S):

    • Viral infection-related symptoms
    • Shortness of breath (SOB)
    • Chest pain
    • Myalgia (muscle pain)
    • Fatigue
    • Dysrhythmias
    • Heart failure (HF)
    • Dyspnea
    • Palpitations
    • Syncope

  • Nursing Interventions (NI):

    • Monitor vital signs.
    • Assess for cardiac rhythm disturbances.
    • Assess for heart failure (HF) symptoms.
    • Avoid strenuous activity.
    • No return to sports activities for at least 3-6 months following diagnosis.

Pericarditis

  • Symptoms (S/S):

    • Pleuritic chest pain, relieved by sitting up or leaning forward
    • Friction rubs
    • Abnormal ECG
    • New or worsening pericardial effusion
    • Fever
    • Pain
    • ECG abnormalities

  • Nursing Interventions (NI):

    • Monitor vital signs
    • Administer medications as ordered
    • Elevate head of bed
    • Emotional support
    • Avoid strenuous activities

Heart Valve Disorders - Aortic Stenosis

  • Pathophysiology:
    • Narrowed aortic valve opening reduces blood flow.
    • Ventricular hypertrophy develops (overgrowth).
    • Left Ventricular hypertrophy leads to heart failure (HF)

Blood Transfusion Reactions

  • Hemolytic: low back pain, blood in urine, tight chest, impending doom
  • Febrile: temperature increased by at least 1 degree F
  • Anaphylactic: Hching(hives), urticaria(skin rash), Antihistamine
  • Bacterial: wheezing, dyspnea, send culture

Cardiac Catheterization

  • Indications: Blockages in coronary arteries

  • Post-procedure Nursing Interventions and Assessments:

    • Monitor respiratory status
    • Monitor cardiac rhythm
    • Monitor vital signs (BP, HR, temperature)
    • Monitor surgical site for infection/hematoma
    • Tight blood pressure control
    • Pulmonary hygiene
    • Avoid lifting >10 pounds

Hemodynamics - Devices

  • Pulmonary Artery (PA) Catheter:
    • Measures pressure in pulmonary arteries.
    • Evaluates left ventricle function
    • Measures mixed venous oxygen saturation (SvO2)

Arterial Line

  • Indications: Continuous BP monitoring, ABG/O2
  • Considerations: ARDS

Central Line

  • Indications: Monitoring right heart function (SvO2)
  • Considerations: Medications can be administered through line

Spinal Cord Injury – Complete vs. Incomplete

  • Complete: No motor or sensory function below the level of injury.
  • Incomplete: Some motor or sensory function remains below the level of injury.

Incomplete SCI types and symptoms

  • Central Cord Syndrome: Hyperextension injury, more motor and sensory loss in the upper extremities than the lower extremities.
  • Anterior Cord Syndrome: Compression of the anterior spinal cord, resulting in motor loss, loss of pain and temperature sensation, with preserved proprioception.
  • Posterior Cord Syndrome: Compression of the posterior spinal cord, resulting in loss of proprioception and vibration sense, with preserved pain, and temperature sensation.
  • Brown-Sequard Syndrome: Hemisection of the spinal cord; ipsilateral (same side) motor paralysis and loss of proprioception and vibration; contralateral (opposite side) loss of pain and temperature sensation.

Burn Assessment Methods

  • Rule of Nines: Divides the body into percentages to quickly estimate the total body surface area (TBSA) burned.
  • Rule of Palms: Palm of the patient's hand covers approximately 1% of TBSA
  • Lund-Browder Chart: More precise method for estimating TBSA burned compared to the Rule of Nines. Takes into account the patient's body proportions.

Mass Casualty Incidents (MCI)

  • Triaging Goals: To maximize the overall survival rate by prioritizing the "Greatest Good for the Greatest Number" (e.g. greatest number of lives saved).

START Triage

  • Time Objective: Complete in 60 seconds
  • Components:
    • Respirations (R: 30 seconds)
    • Perfusion (P: 20 seconds)
    • Motor (M: can do )
    • Assess airway, control breathing, apply pressure to bleeding areas, immobilize the injury area.

Disaster Cycle

  • Mitigation: Prevention measures (e.g., disaster preparedness planning )
  • Preparation: Gathering supplies, training.
  • Response: First responders and agencies respond to the incident.
  • Recovery: Restoring function/community to a pre-disaster state.

Burn Types

  • First-degree: Superficial burning of the epidermis only, mild redness, pain, and blanching on touch.
  • Second-degree (superficial): Epidermis and some dermis burned, blisters, pink/red, easily blanches, heals in weeks.
  • Second-degree (deep): All epidermis and dermis are damaged, waxy appearance, cherry-red scarring, slow healing, considerable edema.
  • Third-degree: Severe burn. All layers of skin are destroyed - including underlying tissues, subcutaneous fat, muscle, and bone. Appearance: dry/leather-like, no pain, pale, white, or black color, and no blanching.

Basilar Skull Fractures

  • Symptoms (S/S): Battle's sign, raccoon eyes, halo sign, bleeding from ears, nose

  • Nursing Interventions (NI):

    • No NG tubes
    • Monitor for CSF leak/Increased intracranial pressure (ICP)
    • Neuro checks
    • Monitor vital signs
    • Don't allow blowing nose

  • Treatment (TX): Airway management and head elevation.

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