Pica Final Review PDF

[Ventilators:] PEEP= positive end expiratory pressure. If you increase the PEEP on a patient's ventilator expect a decreased cardiac output. [Intubated patient]: if doing a "weaning trial" and patient becomes tachypnic, tachycardia, and dropping O2 sats, call provider and discontinue weaning trial!...

[Ventilators:] PEEP= positive end expiratory pressure. If you increase the PEEP on a patient's ventilator expect a decreased cardiac output. [Intubated patient]: if doing a "weaning trial" and patient becomes tachypnic, tachycardia, and dropping O2 sats, call provider and discontinue weaning trial! [ARDS:] A secondary condition; usually from some sort of sepsis, shock, or infection, but can even just be from a COPD exacerbation. The patient is usually intubated, sedated and paralyzed. If sedated and paralyzed, RN must do certain cares: reposition, eye drops, maybe close the patient's eyes for them, suctioning, oral care. Proning the patient helps them breathe sometimes. Sedatives= propofol and versed. Paralytics= vecuronium and succinylcholine. If the patient is only sedated and not paralyzed, you'll do "spontaneous awakening trials" where you cut their sedative dose in half (or completely withdraw it) and see how well they are tolerating it. Basically, first pt has to be taken off paralytics, then sedatives, then taken off ventilator; speed of this all depends on how serious the pt's condition is. A patient in ARDS will be in respiratory acidosis with hypoxia, they'll be hypercapnic with high CO2 and low PaO2. [AKI/CKD]: With AKI, the patient will have low protein, with CKD protein will probably be normal. Peritoneal dialysis helps bring protein back into the vascular space. A more stable patient would receive hemodialysis and a hemodynamically unstable patient would receive CRRT. For hemodialysis, you FEEL the thrill and LISTEN to the bruit to assess. People with CKD generally have low Ca and high phosphorus, so they take a calcium supplement that corrects both issues (increases calcium and thus decreases phosphate). Increased BUN leads to uremia (mental status change), need dialysis! Another sign of needing dialysis is electrolyte imbalances, specifically high K and phosphorus. [Cardiac:] CVP has more to do with R side of heart. Essentially, the patient either will need diuretics for high CVP or fluid for low CVP. For PAWP it's more about the left side of the heart. The PAWP will either be high or low, and that tells you about afterload and how well the left side of the heart is doing. For example, a patient has elevated PAWP and decreased cardiac index; they need diuretics and a positive inotrope! (Positive inotrope helps the heart beat harder and diuretics help with that overload of way too much preload). Preload, afterload, and contractility determine the stroke volume of the heart. [Telemetry:] Be able to identify atrial fibrillation and know the treatment (control rate and rhythm and give anticoagulants). Know the difference between defibrillation and cardioversion (cardioversion is synchronized). For sinus bradycardia only treat if symptomatic and you give atropine. For sinus tachycardia, treat the underlying cause (ex: fever, pain). For PSVT, vagal maneuver, if that doesn't work adenosine. Low potassium often causes PVCs. [TPN/ Nutrition:] Albumin is a great indicator for how well the patient is doing nutritionally and wound healing. For TPN, 2 RNs must check the bag first (is it clear?), must go through filtered tubing, BG must be checked every 6 hours, given through a central line. [Pancreatitis]: Hurts!! Give pain meds. Feed into jejunum (J tube) to bypass the stomach and not activate the pancreatic enzymes. Give lots of fluids. [Sepsis]: Know the 1-hour bundle. Essentially, take a lactate level and a blood culture. Give 30 mL/kg of fluids and start on broad spectrum antibiotics. If BP does not increase with fluid resuscitation, give vasopressors. Eventually when blood culture comes back, you'll give a more specific antibiotic. [Math:] Heparin dosage, continuous drip dosage, CPP, parkland, and MAP. [Epidural Hematoma:] Unique because there's the injury with the initial decrease or loss of consciousness. Then the patient feels better, then they have a big decline! Basically just don't take feeling better as being cured. [Stroke:] Assessed with NIHSS. When pt gets to ED, first do neuro assessment, then CT scan to determine what kind of stroke and go from there (Surgery versus TNK).