Chapter 11, 22, and Resp Failure

Medication

100

What is atropine and the dosage to administer?

Atropine is a medication that belongs to a class of drugs known as anticholinergics. It is primarily used to treat various medical conditions, and its effects are mainly related to blocking the actions of the neurotransmitter acetylcholine in the body. 

Atropine can have several effects on the body, including increasing heart rate, dilating the pupils, reducing salivary and respiratory secretions, and relaxing smooth muscles in the gastrointestinal and urinary tracts.

The dosage of atropine can vary depending on the specific condition being treated, the patient's age, weight, and individual response to the medication. 

Here are some general guidelines for atropine dosages in common medical scenarios:

1. Bradycardia (slow heart rate): In adults, the initial recommended dose for atropine to treat bradycardia is typically 0.5 to 1.0 mg intravenously, and it can be repeated every 3-5 minutes as needed. Pediatric dosages will be much lower and are determined based on the child's weight.

200

What is the general action, classification, side effects of:

procainamide

Procainamide is a medication primarily used for the treatment of certain heart rhythm disorders, particularly ventricular arrhythmias and atrial fibrillation or flutter. Here is some general information about procainamide:

General Action:

• Procainamide is classified as an antiarrhythmic drug, and its primary action is to stabilize abnormal heart rhythms by affecting the electrical properties of cardiac cells. It works by blocking sodium channels in the heart muscle cells, which helps to slow down the conduction of electrical signals in the heart.

Classification:

• Procainamide belongs to the Class Ia antiarrhythmic drugs, which are categorized based on their effects on cardiac sodium channels and action potential duration. Class Ia drugs, like procainamide, are used to treat various types of arrhythmias by decreasing the excitability and conductivity of cardiac tissues.

Side Effects: Procainamide can have various side effects, and individuals taking this medication should be closely monitored by a healthcare provider. Common side effects may include:

• Nausea and vomiting
• Headache
• Dizziness
• Fatigue
• Low blood pressure
• Skin rashes
• Changes in blood cell counts
• Fever
• Joint pain
• Gastrointestinal disturbances

Serious side effects are less common but can be more severe. These may include:

• Blood disorders (e.g., agranulocytosis, which is a severe decrease in white blood cell count)
• Heart rhythm disturbances (proarrhythmia)
• Systemic lupus erythematosus (an autoimmune disease)
• Liver toxicity

300

What is the general action, classification, side effects of: 

Verapamil

Verapamil is a medication that belongs to a class of drugs known as calcium channel blockers. It is primarily used to treat various cardiovascular conditions, including hypertension (high blood pressure), angina (chest pain), and certain types of arrhythmias (irregular heart rhythms). Here is some general information about verapamil:

1. General Action: Verapamil works by blocking calcium channels in the cells of the heart and blood vessels. This action reduces the influx of calcium into these cells, leading to several effects:

   • It relaxes and dilates blood vessels, which helps lower blood pressure and increase blood flow to the heart muscle, reducing the workload of the heart.
   • It can slow down the heart rate and decrease the force of contractions, making it useful for managing certain types of irregular heart rhythms.
   • Verapamil can also reduce the frequency and severity of angina attacks by improving blood flow to the heart.

2. Classification: Verapamil is classified as a calcium channel blocker, specifically a non-dihydropyridine calcium channel blocker.

3. Side Effects: Verapamil, like all medications, can have side effects. The severity and occurrence of these side effects can vary from person to person. Some common side effects of verapamil include:

   • Constipation
   • Dizziness
   • Headache
   • Low blood pressure
   • Swelling of the ankles, feet, or legs (peripheral edema)
   • Nausea
   • Fatigue
   • Flushing
   • Bradycardia (slow heart rate)
   • Heart rhythm disturbances (in rare cases)

4. Serious side effects are rare but can include severe low blood pressure, heart block, and other cardiovascular issues. It's essential to take verapamil as prescribed by a healthcare professional and to report any unusual or severe side effects promptly.

400

What is the epinephrine dosage/route given for anaphylactic reactions

epi anaphylaxis 1:1000        1mg/ml IM

epi cardiac       1;10,000      0.1 mg/ml 0.1m/ml  IV

500

What is the general action, classification, side effects of:

Amiodarone

Amiodarone is a medication commonly used to treat certain types of irregular heart rhythms, particularly ventricular arrhythmias and atrial fibrillation. Here's some general information about amiodarone:

1. Action:

   • Amiodarone is classified as an antiarrhythmic drug, which means it helps regulate heart rhythm by affecting the electrical signals in the heart.
   • It primarily works by blocking sodium, potassium, and calcium channels in cardiac cells, which helps stabilize the electrical activity of the heart.

2. Classification:

   • Amiodarone is classified as a class III antiarrhythmic medication according to the Vaughan Williams classification system, which categorizes antiarrhythmic drugs based on their electrophysiological effects on the heart.

3. Common Uses:

   • Treatment of ventricular arrhythmias: Amiodarone is often used to manage life-threatening ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation.
   • Atrial fibrillation and atrial flutter: It is also prescribed for certain atrial arrhythmias, like atrial fibrillation and atrial flutter, particularly when other treatments have failed.

4. Side Effects:

   • Amiodarone can have numerous side effects, some of which can be serious. Common side effects may include:
     • Nausea
     • Vomiting
     • Fatigue
     • Dizziness
     • Skin discoloration (bluish-gray color)
     • Visual disturbances (halos or difficulty adjusting to darkness)
     • Tremors
     • Thyroid problems, including hypothyroidism or hyperthyroidism
     • Liver function abnormalities
   • Serious side effects that may occur but are less common include pulmonary toxicity (which can be life-threatening), cardiac effects, and nerve problems.
   • It's essential to monitor patients closely while on amiodarone and be aware of these potential side effects.

Amiodarone is a potent antiarrhythmic medication that can be highly effective in managing certain heart rhythm disorders. However, its use should be carefully monitored by healthcare professionals due to the risk of significant side effects. It is typically reserved for cases where other antiarrhythmic treatments have proven ineffective or when the benefits outweigh the potential risks. Patients taking amiodarone should have regular follow-up appointments to assess their response to the medication and monitor for any side effects.

Cardiac

100

What change in status should the nurse  monitor to detect a decrease in cardiac output after dysrhythmic event?

1. Hypotension: A sudden drop in blood pressure can indicate reduced cardiac output. The nurse should monitor the patient's blood pressure regularly and be alert to any significant decreases.

2. Tachycardia: While a rapid heart rate can sometimes compensate for a decrease in cardiac output, persistent high heart rates may indicate an inability to meet the body's demands. It can be a sign of decreased cardiac output.

3. Weak or thready pulses: If the nurse detects weak, thready, or irregular peripheral pulses (e.g., radial or pedal pulses), it may indicate decreased cardiac output. Comparing pulses on both sides of the body can help identify discrepancies.

4. Cyanosis: A bluish discoloration of the skin, particularly in the lips, nail beds, or extremities, may signal inadequate oxygen delivery, which can be related to decreased cardiac output.

5. Altered mental status: Decreased cardiac output can result in reduced oxygen supply to the brain. Patients may become confused, agitated, or lethargic. Any sudden change in mental status should be closely monitored.

6. Decreased urine output: A decrease in urine output may indicate reduced renal perfusion due to decreased cardiac output. Monitoring the patient's urinary output can provide valuable information.

7. Shortness of breath: Dyspnea or increased work of breathing may occur if cardiac output decreases, leading to inadequate oxygen delivery to the body's tissues.

8. Crackles in the lungs: Fluid accumulation in the lungs can result from congestive heart failure, reducing cardiac output. Auscultating the lungs for crackles or wheezing can help identify this issue.

9. Decreased capillary refill time: Prolonged capillary refill time may be indicative of poor perfusion and decreased cardiac output. It can be assessed by pressing a fingertip on the patient's nailbed and measuring the time it takes for the color to return.

200

What are the nutritional needs for patient in shock? 

Rationale: Nutritional support is an important aspect of care for clients in shock. Clients in shock may require 3,000 calories daily. This caloric need is directly related to the release of catecholamines and the resulting increase in metabolic rate and caloric requirements. Albumin is not primarily metabolized as an energy source. The special nutritional needs of shock are not related to increased parasympathetic activity, but are instead related to increased sympathetic activity. GI function does not increase during shock.

300

What is the action and nursing interventions for dopamine in shock?

Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on the dosage. When vasoactive medications are given, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated), not “routinely.” Vasoactive medications should be given through a central, not peripheral, venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. High doses can cause vasoconstriction, which increases afterload and thus increases cardiac workload. Because this effect is undesirable in clients with cardiogenic shock, dopamine doses must be carefully titrated.

400

What assessment findings would you expect to find in the progression of sepsis

Rationale: As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the client begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (e.g., acute kidney injury, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Adventitious lung sounds occur throughout the lung fields, not just in the upper fields of the lungs.

500

What is the general action, classification, side effects of: digitalis

Digitalis refers to a group of medications derived from the foxglove plant (Digitalis purpurea) that have been used in medicine for centuries. The most common digitalis medication is digoxin. Here's some information on the general action, classification, and potential side effects of digitalis, particularly digoxin:

1. General Action:

   • Digitalis, such as digoxin, is primarily used to treat certain heart conditions, especially congestive heart failure and arrhythmias like atrial fibrillation.
   • It works by increasing the force and efficiency of the heart's contractions, which can help the heart pump blood more effectively.
   • Digitalis can also slow down the heart rate, making it useful for certain arrhythmias.

2. Classification:

   • Digitalis medications are classified as cardiac glycosides, which are natural compounds derived from plants like foxglove.
   • Digoxin is a specific cardiac glycoside used in clinical practice.

3. Side Effects:

   • Common side effects of digoxin may include nausea, vomiting, loss of appetite, and headache.
   • More serious side effects can occur if the medication is not used correctly or if there is an overdose, including:
     • Arrhythmias: Digoxin can potentially cause or exacerbate certain arrhythmias, so careful dosing and monitoring are essential.
     • Visual disturbances: Some people may experience visual disturbances such as seeing halos or colored lights.
     • Gastrointestinal disturbances: This can include stomach pain or diarrhea.
     • Central nervous system effects: These may include confusion or changes in mood.
     • Cardiac toxicity: In rare cases, digoxin toxicity can lead to life-threatening arrhythmias, especially if the dose is too high.

Shock

100

What is hypovolemic shock/nursing care?

Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.

Nursing Care

Restore and redistribute intravascular volume with fluid, blood replacement

Treat underlying cause

Vasoactive medications

CAUSES:Most common type of shock

External fluid losses

Trauma

Surgery

Diarrhea

Internal fluid losses

Occurs with15% to 30% reduction in intravascular volume

Hemorrhage

Burns

Focus on prevention

Ongoing monitoring of those at risk for hypovolemia

Safe administration of fluids and medications

Supplemental oxygen

Comfort measures

CLINICAL MANIFESTATION OF HYPOVOLEMIC SHOCK 

•Decreased blood volume

•Decreased cardiac output

•Decreased tissue perfusion

200

What is neurogenic shock/nursing care ? 

Neurogenic shock can be caused by spinal cord injury. The client will present with a low blood pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased parasympathetic stimulation

•Can be caused by spinal cord injury, spinal anesthesia or nervous system damage 

Clinical Manifestations

Hypotension

Bradycardia

Syncope, fainting

Dry, warm skin

MANAGEMENT MEDICAL/NURSING

•Goal is to restore sympathetic tone through stabilizing spinal injury

•Treat underlying cause

•Prevent through proper patient position and immobilization if an injury

•Support cardiovascular and neurologic function

300

What is shock? 

Shock is a life-threatening condition with a variety of underlying causes. Shock is unpredictable and rapidly changing so the nurse must understand the underlying mechanisms of shock. The nurse must also be able to recognize the subtle as well as more obvious signs and then provide rapid assessment and response to provide the client with the best chance for recovery. Coping skills are important, but not the ultimate priority. Keeping the health care provider updated with the most accurate information is important, but the nurse is in the best position to provide rapid assessment and response, which gives the client the best chance for survival. Monitoring for significant changes is critical, and evaluating client outcomes is always a part of the nursing process, but the subtle signs and symptoms of shock are as important as the more obvious signs, such as blood pressure and skin temperature. Assessment must lead to diagnosis and interventions.

Medical and Nursing Management 

•Treat underlying cause

•Fluid replacement

•Supplementation oxygen, decrease patient anxiety

•Maintain BP and tissue perfusion

•Frequent assessment (subtle changes)

•LOC, I&O, respiratory and heart rate, BP (MAP of 65 mm Hg or less, narrowing or decreased pulse pressure)

•Promote safety (advanced directives)

400

What is Cardiogenic shock? Nursing interventions?

Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues

•Occurs when the heart’s ability to contract and pump blood is impaired leading to inadequate supply of oxygen to the heart and tissues.

•Coronary or noncoronary causes

Clinical Manifestation

•Angina

•Arrhythmias

•Fatigue

•Feelings of doom

•ECG changes

•Increased cardiac enzyme levels and cardiac biomarkers

 may occur following an MI when a large area of the myocardium becomes ischemic, necrotic, and hypokinetic. It also can occur as a result of end-stage heart failure, cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias 

500

What is the difference between septic shock and multiple organ dysfunction syndromes (MODS)?

Sepsis is a systemic inflammatory response syndrome (SIRS) caused by either infectious or non-infectious factors. It can easily develop into septic shock and multiple organ dysfunction syndromes (MODS) if not treated in a timely manner, and its fatality rate can be as high as 28–56% 

Septic Shock: Sepsis-induced hypotension despite fluid resuscitation PLUS hypoperfusion abnormalities. Multiple Organ Dysfunction Syndrome (MODS): Presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention 

Symptoms

• An altered mental state;
• A decrease in renal perfusion (decrease in urine output);
• Respiratory deterioration;
• A decrease in cardiac function;
• Deranged metabolic status;
• A compromised fluid balance;
• Pale, clammy, peripherally cool skin and faint pedal pulses;

AT RISK for MODS

Older age, obesity, diabetes, malnutrition, hypertension and other chronic diseases have a higher risk of developing MODS than others

Nursing Interventions

100

What are the complications of a pacer maker placement?

1. Infection: Infection at the surgical site can occur, leading to redness, swelling, warmth, and pain at the implantation site. Systemic infections can also develop, which may require antibiotics or, in severe cases, removal of the pacemaker.

2. Bleeding or hematoma: Bleeding at the surgical site can result in a collection of blood called a hematoma. While small hematomas may resolve on their own, larger ones may require drainage or surgical intervention.

3. Pneumothorax: During pacemaker placement, there is a risk of accidentally puncturing the lung, leading to a pneumothorax (collapsed lung). This may require chest tube placement to reinflate the lung.

4. Lead-related complications: The leads (thin wires) that connect the pacemaker to the heart can cause various issues, including dislodgement, fracture, or insulation damage. Lead problems may lead to inappropriate pacing or the need for lead revision or replacement.

5. Pericardial effusion: A buildup of fluid around the heart (pericardial effusion) can occur, potentially leading to cardiac tamponade, a life-threatening condition. This requires immediate medical attention and drainage of the accumulated fluid.

6. Thrombosis and embolism: Blood clots can form on the pacemaker leads or in the heart chambers, increasing the risk of embolism, which can lead to strokes or other organ damage.

7. Allergic reactions: Some patients may experience allergic reactions to the materials used in the pacemaker or leads, although this is relatively rare.

8. Nerve or blood vessel injury: During the procedure, there is a small risk of injuring nearby nerves or blood vessels, which may cause pain or other complications.

9. Device malfunction: Although rare, pacemaker malfunction can occur, leading to improper pacing or device failure. Regular follow-up with a healthcare provider is essential to monitor the device's function.

10. Psychological and emotional impact: Some patients may experience anxiety, depression, or other emotional effects related to the procedure and having a device implanted.

200

What are the nursing interventions for a patient in ventricular tachycardia (VT) , ventricular fibrillation  (VF) becomes unconsciousness and no pulse?  

Any type of VT or VF in a client who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice.

300

What are s/sx of digoxin toxicity

What nursing intervention  is given for digoxin toxicity?

Digoxin is a medication commonly used to treat heart conditions such as congestive heart failure and atrial fibrillation. However, it has a narrow therapeutic window, which means that the difference between a therapeutic dose and a toxic dose can be small. Digoxin toxicity can be serious and may lead to a range of signs and symptoms. Common signs and symptoms of digoxin toxicity include:

1. Nausea and vomiting: Gastrointestinal symptoms like nausea and vomiting are common early signs of digoxin toxicity.

2. Anorexia (loss of appetite): Patients may experience a decreased appetite.

3. Visual disturbances: These may include blurred vision, yellow or green halos around objects, or other vision problems.

4. Confusion or mental disturbances: Patients may become disoriented, experience delirium, or have changes in mental status.

5. Fatigue and weakness: Generalized weakness and fatigue can occur.

6. Bradycardia: Digoxin toxicity can lead to abnormally slow heart rates (bradycardia), which can be life-threatening.

7. Arrhythmias: Abnormal heart rhythms, such as atrial or ventricular tachycardia, may occur.

8. Gastrointestinal symptoms: Diarrhea can be a symptom of digoxin toxicity.

9. Hypokalemia: Low potassium levels can be associated with digoxin toxicity.

What nursing intervention  is given for digoxin toxicity?

• Discontinuing digoxin: The first step in managing digoxin toxicity is to stop or reduce the use of digoxin, under the guidance of a healthcare professional.

• Digibind is a brand name for a medication called Digoxin-specific antibody or Digoxin-specific Fab fragments. It is used as an antidote for the treatment of poisoning or overdose with the drug digoxin, which is a medication commonly used to treat certain heart conditions, such as congestive heart failure and atrial fibrillation.

400

What is this rhythm demonstrating? 

Anterior MI Pattern – (Tombstoning) 

 

500

What are the assessment findings of a dysrhythmic event resulting in decreased cardiac output? 

hypotension

decreased urine output 

tachycardia compensate for decreased cardiac output

weak thready pulse

altered mental status

shortness of breath, crackles 

decreased capillary refill time