surprise
Name the 2 categories of fluids (& list them) needed to tx hypovolemic shock and lab needed.
crystalloids/ isotonic--> LR, NS, D5W
colloids--> blood, albumin
H&H
What is an early sign of hypovolemic shock?
cool, clammy skin
You observe Vtach on the monitor, what do you do?
tx?
check patient was pulse
pulse- fluids, amiodarone
pulseless- defib, CPR
What is the difference between pacemaker and ICD?
pacemaker- sends electrical impulses, increases HR
ICD- paces and defibs 2 lethal rhythms (vtach no pulse, vfib)
Name 3 medications that can be given to treat cardiogenic shock and what they do to the body?
dobutamine, nitroglycerin, dopamine--> causes vasodilation
What should you monitor for when blood or fluids are being administered?
blood reaction, 1st 15 minutes- 24hrs, flash pulmonary edema (SS- crackles, SOB, hemoptysis), cardiac tamponade, temperature changes, vitals often, tissue perfusion to tip of their toes, good assessment, I+O's (AKI), phlebitis, infiltration
What labs should we get for cardiogenic shock?
CBC, BNP, INR, aPTT, PTT,
What is the HR for sinus tachycardia? How is it treated?
>100-<150 BPM
fluids, treat underlying cause
Name 4 problems that can occur with a pacemaker
failure to capture- electrical signal does not cause cardiac response
failure to pace- no spikes or pacing
failure to sense/ undersensing- pacemaker don't sense electrical activity, heart rhythm causes too many or not enough pacing
oversensing-detects electrical signals it shouldn't
what does atropine treat?
bradycardia
List the treatments/ management for cardiogenic shock
fluctuation in temperature
What rhythms can be cardioverted?
What rhythms can be defibrillated?
cardiovert- Afib, Aflutter, SVT, Vtach
defib- vfib, pulseless vtach
Pacemaker failure to capture, what should be done?
When would a patient get epinephrine?
anaphylactic shock, during a code
In DIC, what's a sign of neurological compromise/ problem?
widely fluctuating BP
When a pt. is getting a cardiac cath. when should be done pre-op and post-op?
pre-op: labs (coags), 5 P's, NPO, patent IV, written consent
post-op: vitals, 5 P's, bleeding, pressure dressing, check insertion site
Pt has SVT, what is the treatment?
adenosine, cardioversion
what heart rhythm may need a pacemaker?
symptomatic afib, 2nd degree- Mobitz II, 3rd degree
How often can epinephrine be administered during code?
every 3-5 minutes
What are the normal ranges for the following labs: Plts, PT, aPTT, INR, K+, Troponin?
PLTS- 150,000-450,000
PT 10-13 sec
aPTT 25-25 sec
INR <2 sec
K+ 3.5-5.3
troponin < .04
urinary output, LOC, oxygenation
ST elevation in 2 leads
MONA, cath lab
What do monitor after pacemaker implantation?
site for bleeding/ hematoma, infection, malfunction (tele)
beta & Ca+ blockers