NUR 486 Final Review Notes PDF

12/3/24 1 Final Review NUR 486 2 AAA 3 AAA 4 AAA 5 Hemodynamic Monitoring 6 Hemodynamic Monitoring 7 Hemodynamic Monitoring 8 Hemodynamic Monitoring 9 Hemodynamic Monitoring 10 Hemodynamic Monitoring 11 Hemodynamic Monitoring CO CI SV...

12/3/24 1 Final Review NUR 486 2 AAA 3 AAA 4 AAA 5 Hemodynamic Monitoring 6 Hemodynamic Monitoring 7 Hemodynamic Monitoring 8 Hemodynamic Monitoring 9 Hemodynamic Monitoring 10 Hemodynamic Monitoring 11 Hemodynamic Monitoring CO CI SV SVR PVR SvO2/ScvO2 12 Hemodynamic Monitoring 13 Cerebral Perfusion Pressure CPP=pressure needed to ensure blood flow to brain CPP=MAP-ICP 14 ICP 15 Cerebral Vasospasm 16 Brain Death Oculocehpalic 17 1 18 14 15 16 Brain Death Oculocehpalic Oculovestibular Apnea test 17 Ischemic stroke vs Hemorrhagic stroke 18 Traumatic Brain Injury 19 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 Greatest control Least control 20 NIPPV 21 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)  Common NMB agents Zemuron (rocuronium) Norcuron (vecuronium) Tracrium (atracurium) Pavulon (pancuronim) Succinylcholine 22 ABGs Ph –7.34- 7.45 PaCO2—35—45 HCO3– 22—26 23 ABGs Respiratory Opposite Metabolic Equal Respiratory Decrease Increase Normal Acidosis Respiratory Increase Decrease Normal Alkalosis Metabolic Decrease Normal Decrease Acidosis 24  Metabolic Increase Normal Increase Alkalosis 24 ABGS: acute respiratory acidosis Ph 7.35- 7.45 PaCO2–35- 45 HCO3- 22-26 no change or up to compensate 25 ABGS Metabolic acidosis Ph 7.35-7.45 PaCO 2 -35-45 HCO3- 22-26 (loosing bicarb/ alk ) 26 ABG: acute respiratory alkalosis Ph 7.35- 7.45 PaCo3- 35 -45 HCO3- 22-26 27 ABG: acute metabolic alkalosis Ph 7.35- 7.45 PaCo2- 35-45 or low in compensation 28 29 27 PaCo2- 35-45 or low in compensation HCO3- 22-26 28 End Stage COPD 29 Esophageal Varices 30 Acute Pancreatitis 31 Cirrhosis 32 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 33 HHS vs. DKA 34 Hyperthyroidism 35 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** 36 Suctioning Every 2-4 hrs and PRN unless contraindicated Pre-oxygenate Don’t exceed 10 sec 37 36 Don’t exceed 10 sec Monitor O2 sats and EKG for dysrhythmias NO NORMAL SALINE in ETT! 37 Elevated Potassium Tx Treatment CBIGKD (see big kid) Calcium gluconate Bicarb Insulin Glucose Kayexalate (exchanges sodium or K+) dialysis 38 Chronic & Acute Renal Failure 39 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 40  40 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) 41 MI 42 MI 43 MI 44 45 Stable vs. Unstable Angina 46 Electrolytes 47 IABP 48 Name the rhythm 49 Name the rhythm 50 Name the rhythm 51 Name the rhythm 52 Name the rhythm 53 54 55 56 57 49 50 51 52 Name the rhythm 53 Name the rhythm 54 Name the rhythm 55 Name the rhythm 56 Name the rhythm 57 Name the rhythm 58 Name the rhythm 59 Name the rhythm 60 Name the rhythm 61 Name the rhythm 62 Name the rhythm 63 Name the rhythm 64 Name the rhythm 65 Name the rhythm 66 Name the rhythm 67 Cardiac Cycle 68 Pneumothorax Pneumothorax –Simple: chest tube –Open: cover wound, then chest tube –Tension: needle decompression, then chest tube 69 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 69 ↑ 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 70 Autonomic Dysreflexia 71 Spinal Cord Injury Critical that initial care & management be initiated ASAP to limit further destruction Spinal Shock Neurogenic Shock 72 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 73 74 75 76  73 Bites 74 Poisoning 75 Drowning 76 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