Cardiac
NSTEMI VS STEMI Dx and Tx
STEMI = ST elevation
NSTEMI = ST depression
Thrombolytic therapy (Fibrinolytic) for STEMI w/o, give w/in 30 minutes of ED arrival
Shockable vs non shockable rhythms
V-Fib or pulseless v tach is SHOCKABLE
Non shockable would be PEA and asystole
Phases of shock
Compensatory = body's natural way of trying to maintain homeostasis thru neural, chemical, and hormonal ways (Activating the SNS and RAAS)
Progressive = when compensatory mechs fail, pt is now moved to ICU, third spacing occurs into the interstitial spaces, changes in mental status also happen
Refractory = Lactic acid accumulation contributes to increased capillary permeability and dilation, Multisystem organ failure starts to occur due to hypoxemia and hypotension/poor perfusion
Cirrhosis s/s and patho
Patho: caused by chronic liver disease such as an HCV infections and alcohol induced liver disease
Scar tissue forms over time in the livers attempts to heal itself
s/s
Early = fatigue, weight change, vomiting, abd pain
Late = yellow skin, pruritus, ascites, edema, confusion
Cholecystitis (Inflammation of the Gallbladder)
s/s
usually caused by gallstones
s/s = steady pain and sometimes spasms if the stone is lodged, tachycardia, diaphoresis, and prostration, residual RUQ tenderness
Nitro education
HA is an expected SE, teach how to take a sublingual tablet
Do not take more than 3 tablets within 15 minutes
Cardioversion vs Defib
Cardiovert: pt is awake and hemodynamically stable, pt is sedated with IV agents
If pt becomes pulseless, turn the synchronizer switch off
De fib = pt is unconscious or intubated
Spetic shock management
FLUIDS, end when vitals are returned to normal
- Fluid response with passive leg raise or fluid challenge
Obtain cultures before antibiotics, monitor temp and BG
Drugs = Vasopressors (Norepi), Anticoags, antibiotics
Cirrhosis complications
Portal hypertension (Venous pressure in the portal circulation, splenomegaly, large collateral veins, ect)
Esophageal varices = Fragile large veins at the lower end of esophagus, these tend to bleed easy so look for hematemesis or melena
- Bleeding from these is a medical emergency
ERCP (Endoscopic retrograde cholangiopancreatography)
Allows for visualization of the biliary system, dilation, and placement of the stents and sphincterotomy
Bile taken from these is sent for cultures
Meds: Calcium channel blockers and beta blockers
CCB: Vasodilation, decreased contractility, coronary vasodilation, decreased HR
- used if BB's are contraindicated, closely monitor digoxin levels as these can increase them
BB's: Decrease contractility, HR, BP, SVR, and reduces
Hypo and hyperkalemia T wave presentation
Hypo = shallow t wave
Hyper = Peaked t wave
DIC process
Massive thromboplastin secretion
coagulation goes into overdrive
clotting happens in microvessels (Excessive)
Clots (Fibrin breaks down before healing) losing prothrombin and fibrinogen (clotting factors)
D dimer (Breakdown protein) and increase of the breakdown products of fibrin FDPs
Drug therapy for Cirrhosis and EV
Lactulose and propranolol are used to tx portal HTN and EV
- For portal HTN = ABCs, TWO large bore IVs, bleeding precautions, fluids
Octreotide and vasopressin help with bleeding varices
Diet for cholecystitis attacks
low in saturated fats, and high fiber and calcium
Avoid rapid weight loss bc that could lead to gallstone formation
A fib s/s, who is at risk, management
At risk: underlying HD (CAD, Valvular HD, HTN HD)
Management: Anticoags, cardioversion, and last is ablation
s/s: Fast, fluttering HB, chest pain, dizziness, SOB
Hypovolemic shock clinical s/s
Tachycardia, decreased CO/SVR/BP/Preload
Decreased cerebral perfusion, Anxiety, decreased urine OP, Tachypnea leading to respiratory alkalosis
Hepatitis types
Food / water born = A, E
Blood = B,C
Nursing observations before and after paracentesis
Pre op = Void or insert an indwelling, Baseline vitals and labs (CBC, electrolytes, coags), sedation if ordered, weigh pt, obtain abd girth and palpate abd
post op = compare baseline vitals, labs, and abd assessments, note any signs of hypovolemia, give fluid if ordered, reweigh the pt and record intake and output
Pancreatitis pain
Abdominal pain, LUQ but also mid epigastric pain, has a sudden onset and described as severe
They will be in positions involving flexion of the spine
SVT Strip and Adenosine
Adenosine = short half life, will flatline for 10 seconds but no more
rhythm = 151-220 BPM, this rate prolonged will cause decreased CO bc of decreased stroke volume
Septic shock at risk pts
More immunocompromised pts are at risk, pt on neutropenic precautions, chronic diseases, malnourished and debilitated
Jaundice types and patho
Hemolytic = Breakdown of RBCs (Blood transfusion reaction
Hepatocellular = Livers altered ability to take up bilirubin from blood, conjugate or excrete it
Obstructive jaundice = Impeded outflow of bile through liver and duct system
- dark orange brown urine and clay colored stools
Hepatic encephalopathy asterixis
Flapping tremors, the pt is unable to hold arms out straight with out involuntarily flapping them.