Cardiac
Definition of Defibrillation
The process of delivering a controlled electrical shock to terminate a lethal arrythmia.
Name the 3 chambers in a chest tube.
1. Drainage Chamber
2. Water Seal Chamber
3. Suction Control Chamber
First line intervention for septic shock
Fluid resuscitation with normal saline
30ml/kg immediately
Guide for primary survey in prioritizing care.
ABCDE
(Airway, Breathing, Circulation, Disability, Exposure)
Priorities for managing clients with seizure disorders.
Seizure pads as a precaution
Suction set up at the bedside
IV access
Most common cause of upper gastrointestinal bleeding
Peptic ulcer
What is the pathophysiology of Diabetic Ketoacidosis?
Profound deficiency in insulin --> body breaks down fats for energy --> accumulation of ketones in blood --> acidotic state
Unstable Bradyarrhythmias (ex: 3rd degree heart block)
Indications for chest tube.
Priorities of care for all shock states
Oxygenation and ventilation
Adequate tissue and organ perfusion
Fluid resuscitation for a 75 kg client with third degree burns over 40% if the body
Parkland formula
4ml Lactated Ringers x % TBSA x kg
1/2 over 8 hrs
1/2 over 16 hours
Early sign of increased intracranial pressure
Altered level of consciousness
Restlessness
Medications common in the management of hepatic encephalopathy secondary to cirrhosis
Lactulose (Cephulac)
Rifaximin (Xifaxan)
Neomycin
What is the pathophysiology of Hyperosmolar Hyperglycemic Syndrome (HHS)?
The body can produce insulin, however amount is insufficient. Buildup of glucose in blood leads to osmotic diuresis --> fluid loss --> profound dehydration and hyperglycemia
Indications for Synchronized Cardioversion
Unstable Tachyarrythmias
What diagnostic would the nurse expect to find in the orders for a patient with a chest tube?
Chest x-ray is the gold standard.
Pharmacological management of cardiogenic shock
Dobutamine (positive inotrope)
Nitroglycerin (afterload reducer)
Furosemide (preload reducer)
Signs of compartment syndrome
Severe pain
Paresthesia
Pallor
Pulselessness (r/t vascular compromise)
Paralysis
Signs of autonomic dysreflexia
Hypertension
Bradycardia
Sweating above the level of injury
Pounding headache
Priorities of care in managing a client with ruptured esophageal varices
Maintenance of airway
Assessment of blood loss (vital signs)
Replace fluid loss (IVF, PRBCs)
Collaborative management of DKA & HHS
Establish IV access with fluid resuscitation with sodium chloride (0.9% or 0.45%)
Continuous regular insulin drip
Add 5% or 10% dextrose (blood glucose ~250mg/dL)
Pulseless shockable rhythms
Pulseless V-tach and V-Fib
What is the role of the water seal chamber in a chest tube system?
It acts as a one-way valve. The water allows air to escape the system but not to reenter; maintaining a negative pressure.
Maintain at 2 cm of H20
Signs of shock
Restlessness, confusion Decreased urine output
Cool and clammy skin Weak peripheral pulses
Hypotension Sluggish capillary refill
ESI level for patient who presents to ED with suicidal ideations
2
First tier treatment for managing increased intracranial pressure.
Osmotic diuretic (Mannitol)
External ventricular drain (EVD)
Brief period of permissive hyperventilation
Dietary considerations for end-stage liver disease
High protein
High calories
High fat
Low Sodium
What electrolyte imbalance should the RN monitor for a patient who is on a regular insulin drip?
Hypokalemia
Interventions for Supraventricular Tachycardia (SVT)
Vagal
Adenosine (6mg, followed by 12 mg)
Synchronized Cardioversion
What should the nurse do if there is continuous bubbling in the water seal chamber?
Assess for possible air leaks, retape all tubing connections, and notify the healthcare provider. Continuous bubbling may indicate an air leak
Etiology of obstructive shock
Superior vena cava syndrome / compression
Cardiac tamponade
Abdominal compartment syndrome
Tension pneumothorax
Pulmonary embolism
Focus of care for heatstroke
Provide 100% oxygen
Administer fluids
Cool, wet sheets / ice packs
Priorities of care for clients with spinal cord injuries
ABC, ABC, ABC
Spinal precautions
Corticosteroids
Monitor for complications
Pharmacological agents for managing clients with risk for (or actual) gastrointestinal bleeding.
Antacids
Reducing gastric acid secretion
Mucosal barrier enhancer
Why is glucose gradually reduced in DKA and HHS?
To mitigate the risk for cerebral edema secondary to rapid fluid shifts.