N486 Final Review Student PDF

Final Review NUR 486 AAA AAA AAA Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring CO CI SV SVR PVR SvO2/ScvO2 Hemodynamic Monitoring Cerebral Perfusion Pr...

Final Review NUR 486 AAA AAA AAA Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring Hemodynamic Monitoring CO CI SV SVR PVR SvO2/ScvO2 Hemodynamic Monitoring Cerebral Perfusion Pressure CPP=pressure needed to ensure blood flow to brain CPP=MAP-ICP ICP Cerebral Vasospasm Brain Death Oculocehpalic Oculovestibular Apnea test Ischemic stroke vs Hemorrhagic stroke Traumatic Brain Injury Ventilator PEEP: positive end-expiratory pressure ACV: assist-control ventilation SIMV: synchronized intermittent mandatory ventilation PS: pressure support PC: pressure control CPAP: continuous positive airway pressure PC-IRV PC CMV / ACV SIMV-PS SIMV CPAP Greatest control Least control NIPPV Intubation Drugs Common Sedation agents Benzodiazepines: Ativan (lorazepam), Versed (midazolam) Antidote flumazenil (Romazicon) Propofol (Diprivan) Dose related effects Doses of 5-50 mcg/kg/min produce state of deep sedation Common NMB agents Zemuron (rocuronium) Norcuron (vecuronium) Tracrium (atracurium) Pavulon (pancuronim) Succinylcholine ABGs Ph –7.34- 7.45 PaCO2—35—45 HCO3– 22—26 ABGs Respiratory Opposite Metabolic Equal Respiratory Decrease Increase Normal Acidosis Respiratory Increase Decrease Normal Alkalosis Metabolic Decrease Normal Decrease Acidosis Metabolic Increase Normal Increase Alkalosis ABGS: acute respiratory acidosis Ph 7.35- 7.45 PaCO2–35- 45 HCO3- 22-26 no change or up to compensate ABGS Metabolic acidosis Ph 7.35-7.45 PaCO 2 -35-45 HCO3- 22-26 (loosing bicarb/ alk ) ABG: acute respiratory alkalosis Ph 7.35- 7.45 PaCo3- 35 -45 HCO3- 22-26 ABG: acute metabolic alkalosis Ph 7.35- 7.45 PaCo2- 35-45 or low in compensation HCO3- 22-26 End Stage COPD Esophageal Varices  Enlarged swollen veins 2nd to portal HTN  Fragile tissue bleeds easily  Massive hemorrhage is life- threatening Acute Pancreatitis Cirrhosis Hepatic Encephalopathy Terminal complication of liver disease Associated with rising ammonia levels – (Normal 15-45 mcg N/dL ) Liver unable to convert ammonia to urea Results in cerebral edema HHS vs. DKA Hyperthyroidism Retroperitoneal aortic rupture If intra-abdominal hemorrhage is suspected focused abdominal sonography for trauma (FAST) to determine the presence of blood in the peritoneal space (hemoperitoneum) Medical Emergencies** Suctioning Every 2-4 hrs and PRN unless contraindicated Pre-oxygenate Don’t exceed 10 sec Monitor O2 sats and EKG for dysrhythmias NO NORMAL SALINE in ETT! Elevated Potassium Tx Treatment CBIGKD (see big kid) Calcium gluconate Bicarb Insulin Glucose Kayexalate (exchanges sodium or K+) dialysis Chronic & Acute Renal Failure MI Unique to each individual patient Ranging from no symptoms to sudden cardiac arrest Chest pain radiating to neck, jaw, shoulder, back, or left arm, tightness May be epigastric (indigestion) May deny pain but describe vague feeling of discomfort May include shortness of breath, cold sweat, weakness, paresthesias of arm, nausea and vomiting DELAY HISTORY TAKING IF IN PAIN MI Aspirin 81-325 mg chewable or swallowed Nitrates SL, IV, topical Morphine Sulfate IV, 2-8mg diluted in NS Antidysrythmics Beta-adrenergic Blockers Propranolol (Inderal), Metoprolol ( Lopressor), Atenolol (Tenormin) Calcium Channel Blockers Nifedipine (Procardia) MI MI MI Lead Changes Coronary Artery Area of Heart Involved Affected II, III, aVF RCA Inferior I, aVL, V5V6 Left Circumflex Lateral V2-V4 LAD Anterior I, aVL, V1-V6 Left Main coronary Anterior Lateral Artery V1-V2 LAD Septal Reciprocal: V1-V2 Left Circumflex or Posterior RCA Stable vs. Unstable Angina Electrolytes IABP Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Name the rhythm Cardiac Cycle Pneumothorax Pneumothorax – Simple: chest tube – Open: cover wound, then chest tube – Tension: needle decompression, then chest tube Femur Fracture Femur fracture blood loss estimated blood loss in the study group averaged 1,276 mL Compartment syndrome Rhabdomyolysis ↑ lactic acid leading to metabolic acidosis ↑ myoglobins leading to renal failure Decreased blood flow to kidneys Crystallization of myoglobin in renal tubules Toxic effect of myoglobin on renal tubules ↑ K+ Can be from prolonged immobility compromised circulation secondary to pressures Autonomic Dysreflexia Spinal Cord Injury Critical that initial care & management be initiated ASAP to limit further destruction Spinal Shock Neurogenic Shock Trauma ABCDEFG Alertness and airway with cervical spine stabilization and/or immobilization Breathing Circulation Disability Exposure and environmental control Facilitate adjuncts and family Get resuscitation adjuncts Bites Poisoning Drowning Burns Airway Fluid Resuscitation Parkland Baxter Formula 4ml LR per kg of body weight per % of total body surface area burned = total fluid requirements for first 24 hour after burn ½ of total in 1st 8hr ¼ of total in 2nd 8 hr ¼ of total in 3rd 8 hr Drug therapy VTE Nutrition