Perfusion
What are 3 lethal rhythms?
A. Names
B. Treatments
VT; amiodarone or lidocaine, cardiovert vs defibrillation
V-fib; defibrillation and anti-arrythmias
asystole: CPR and epi
What are things you can monitor during the sepsis period?
Temperature
Blood pressure (MAP)
mental status
Cultures
changes in wound/ skin/ swelling/ redness/ edema
Use of fluids (Intake and output)
Use of vasopressors
changes in CVP
Your patient presents with pancreatitis, rigid abdomen, hx alcohol use, steatorrhea, on pancreatic enzymes. Which assessment findings are concerning? Why?
rigid abdomen - if distended also could be peritonitis/pseudocysts
hx alcohol use = major risk factor
steatorrhea + enzymes= not working
Your patient is ordered 2 units of PRBCs for transfusion. Between the 1st and 2nd infusion, your patient complains of pain and itching. What do you do?
Stop the transfusion & call the MD
BP: 135/78 ICP: 20
Calculate CPP Is this normal?
MAP= (1/3 systolic BP) + (2/3 diastolic BP)
MAP= 45 + 52 + 97
MAP-ICP = CPP
97-20 = 77
50-100 is normal
With Congenital heart disease; ASD/ VSD, what are some s/s associated with this?
Fluid volume overload
shunting of the blood
murmur
elevated cvp
elevated pulmonary pressures
SOB
decreased stamina / unable to feed
meeting milestones
infections risks and clots.
What is DIC? in sepsis
How do you treat it?
Clotting and bleeding, decreasing clotting factors leading to MSOF
Anti-coagulation- heparin
fluids
Antibiotics
oxygen
Blood products
Name 3 expected findings/complications from cirrhosis
bleeding, ammonia elevation, ascites, dyspnea (Fluid), jaundice, distended abdomen (peritonitis), problems with detox, portal hypertension (varices, hemorrhoids, renal issues, encephalopathy)
Name 3 things we need to teach someone newly diagnosed with iron deficiency anemia
dietary changes (protein, green veggies)
Iron supplements/compliance
s/s of worsening anemia
Patient's VS & GCS at 0800: GCS 12 & HR 110, BP 118/78, RR 16 regular
Patient's VS & GCS at 0900: GCS 7 & HR 55, BP 107/50, RR 11 irregular
What is this patient exhibiting? What intervention for the GCS?
Cushing's triad & Intubate!
With a patient in hypovolemic shock, what are some treatments and why?
IVF: replace volume
vasopressors: support bp and map and perfusion
VS/ a-line/ cvp; monitor the patient's fluid status and resolution of the IVF treatment
consider blood products if bleeding
underlying cause correction
A. What are different modes of ventilation for respiratory distress?
When and why do we use them?
B. Considerations when on a ventilator.
A. bipap/ cpap mask
oxygen
ventilator: AC, SIMV, CPAP
B. Airway security, VAP bundle, HOB up, sedation, anxiety assessment, and ventilator setting toleration.
Name the medical emergency associated with:
Hyperthyroidism
Hypothyroidism
hyper: thyroid storm - how to treat? prevention?
hypo: myxedema coma - how to treat? prevention?
Name 3 teaching points for someone who has just undergone abdominal/colorectal surgery for colon cancer?
any dietary changes (fluids 3L),
When they can eat (Always assess)
S/s of infection
pouches/ostomy care
A child had his first seizure - It resolved by itself. What teaching would be provided for the child/parents/school?
prevention - triggers, med compliance, sports, family/classmate support, basic interventions/emergency plan, dietary changes (maybe), emergency medications, psychological support
Cardiogenic shock; what are some treatments?
Dobutamine/ dopamine
nitroglycerine
watch IVF
weights/ I/O's
MAP management MAP and BP
ARDS patient priorities
Oxygenation/Airway
Prevention of infection
Supportive care
Ventilator support/ weaning/ tracheostomy
A patient with an ischemic stroke develops right-sided flaccidity.
A. Causes?
B. Care priorities
A. Clotting abnormalities, anti-coagulation sub-therapeutic, and Atrial fibrillation
B. Neurological assessment frequently, possible TPA or anti-coagulation, maintain independence, PT/OT/ speech when stable. Airway protection, nutrition, and mobility
Your patient has just been diagnosed with cancer. Name 2 lifespan considerations/teaching points for each age group. Child? Adolescent? Adult? Older adult?
Child - check understanding, education of guardians, simple terminology, development of organs/hormones
Adolescent - body image, understanding, psychosocial, alterations to daily routine, med compliance, appliance care
Adult - health literacy, professional alterations, med compliance, appointments, appliance care, psychosocial support, neutropenic precautions
older adult - sensitivity to drugs, effects of aging vs. malignancy, allowing time to answer, psychosocial support, neutropenic precautions
What are you going to do for self-care before the final exam on Monday?
Yes! We're so proud of you all!