A
This is the primary medication class utilized in alcohol withdrawal treatment.
Benzodiazepines
This major risk persists even when a-fib is rate‑controlled.
Thromboembolism / stroke
“Worst headache of life,” vomiting, and rapid neurologic decline indicate this stroke type.
Hemorrhagic stroke
These drugs can be used to help relieve dyspnea and promote comfort in end-of-life care.
Morphine, oxygen
Asking the psychotic patient to describe the voices they are hearing helps assess this safety concern.
Potential for command hallucinations - which may be telling patient to hurt themselves or others
Describe the difference between primary and secondary brain injury.
Primary brain injury occurs at the time of impact and includes contusions, hemorrhage, and diffuse axonal injury. Secondary brain injury develops in the hours and days following the initial trauma and is caused
by factors such as hypoxia, hypotension, cerebral edema, and increased intracranial pressure (ICP).
This is the priority intervention in treatment of HHS.
IV fluids
This is a rare and life-threatening reaction that may occur with use of antipsychotic medications.
Neuroleptic Malignant Syndrome
Primary symptoms: Fever, muscle rigidity, altered LOC, autonomic instability
A nurse is providing education on daily weights to a HF patient. A gain of how many pounds in 24 hours should be reported?
>1 kg (2-3 lbs)
This structure regulates respiratory and cardiovascular functions and can become compromised during herniation.
Brainstem
In stable patients with AFib w/RVR, what is the FIRST goal: rate control or rhythm conversion?
Rate Control - First-Line in Stable AF w/RVR
Rhythm Control (If Indicated or Hemodynamically Unstable)
List 3 early signs of increased ICP.
Headache, restlessness, anxiety, subtle
changes in level of consciousness, slowed
cognition
Define the Monro-Kelly Doctrine
Principle that says due to limited space for expansion within the skull, an increase in any one of the cranial contents—brain tissue, blood, or cerebrospinal fluid (CSF)—causes a change in the volume of the others
List two non-pharmacological interventions that help to avoid IICP.
HOB 30-45, keep head + neck neutral alignment, avoid hip flexion, minimize stimulation (reduce light, noise, unnecessary interventions), schedule care in a way to allow rest periods, avoid coughing/straining, maintain euvolemia, maintain adequate oxygenation + ventilation, maintain temperature control
Sudden unilateral sharp chest pain the worsens with breathing or coughing and unilateral decreased breath sounds suggest this diagnosis.
Pneumothorax
Describe 3 differences between DKA and HHS.
DKA: typically DM1, BG >/= 250, positive for ketones, metabolic acidosis, elevated anion gap, acetone breath + kussmaul breathing
HHS: typically DM2, more gradual onset than DKA, BG >600, elevated serum osmolality, no/minimal ketones, no acidosis, AMS + sig. dehydration
Define Cushing's triad.
Late sign of increased ICP - hypertension, bradycardia, irregular respirations
These three aspects make up the "triad of death" in trauma patients.
Hypothermia + Acidosis + Coagulopathy
Other than blood glucose, this should be evaluated before starting an insulin drip.
Potassium!
If K⁺ <3.3 → hold insulin and replace K⁺
If K⁺ ≥3.3 → start insulin
List two potential complications that may occur as a result of hypercalcemia.
Cardiac dysrhythmias, severe dehydration, AKI, kidney stones, neuro decline + coma, bone fractures
These are the four types of shock.
Distributive (Septic, anaphylactic, neurogenic)
Hypovolemic
Cardiogenic
Obstructive
This type of ventilatory support helps keep the alveoli open (resulting in improved arterial oxygenation) and is a key part of ARDS treatment.
Positive End-Expiratory Pressure - "PEEP"
This is why it is important not to lower glucose levels too fast during treatment with IV insulin.
Lowering glucose too fast can drop serum osmolality → water shifts into brain cells → cerebral edema / increased ICP (especially in kids).
This is why electrolyte monitoring is important in burn patients.
Electrolytes shift dramatically due to fluid losses, tissue destruction, and resuscitation:
• Potassium
o ↑ Hyperkalemia early from cell lysis
o ↓ Hypokalemia later due to fluid resuscitation and diuresis
• Sodium
o Dilutional hyponatremia from fluid shifts
o Loss through burn exudate
• Calcium/Magnesium
o Low Mg and Ca common due to protein loss and transfusions
There are six priority actions included in the sepsis bundle - what are they?
Draw cultures, administer broad-spectrum antibiotics within 1 hour, fluid resuscitation, measure lactate, measure urine output, oxygen to maintain adequate perfusion