CARDIAC ELECTRICAL
what does p wave represent
atrial depolarization, systole. pushing blood into the ventricles.
portal htn puts pt at risk for what?
Variceal bleeding can get ugly fast, pt can hemorrhage.
Ascites—remember peristaltic wave
rising portal pressure obstructs venous outflow in portal system..
what med to reduce esophageal variecies bleeding??
VASOCONSTRICTORS: Vasopressin and somatostatin-octreotide reduce portal pressure AND bleeding.
*airway and o2, large bore iV access for mass transfusion, endoscopic control.
**blakemore/sengstaken tube, balloon tamponade of the esophagus and gastric fundus
basal cell carcinoma
purpose of hospice?
comfort, treat symptoms, not cure. <6months. think quality of life.
when to defibrilate? what rhythm
vfib or pulseless vtach
dont shock asystole, theres nothing to shock.
shock @200j, if no change, 300j, then if needed 360j. CPR in between shocks.
what medication to give for hepatic encephalopathy?
lactulose, rifaximin. makes pt stool to BRING DOWN AMMONIA LEVELS.
Hepatic encephalopathy puts pt in a coma-like state.
acute vs. chronic pancreatitis?
acute- fever, sudden severe pain, reversible, ecchymosis
chronic- recurrent pain. pts are very thin, permanent damage. steatorhhea, foul smelling. may have no bowel sounds
*shock, aki, multi organ dysfunction syndrome
-bed rest
ABCDE in melanoma assesment?
Assymetry
Border
Color
Diameter >6mm
Evolution
stages of death and grief
denial, anger, bargaining, depression, acceptance
grief- normal, anticipatory, complicated,
emegency meds for
bradycardia, svt, vtach, vfib
brady- 0.5mg atropine max 3mg
svt- rapid iv push of adenosine 6mg, expect transient asystole then return to nl rhythm :)
vtach- amiodarone, epi, lidocaine, perhaps
vfib- immediate defib and CPR. amiodarone, epi, find the cause.
Jaundice and clay-colored stool indicate what complication?
blocked bile duct
Stones block up the common bile duct, block bile drainage, which then causes cholestasis and jaundice.
risk factors for cirrhosis
alcohol, hepatitis, fatty liver disease.
Put the liquor down, lol, practice hand hygiene, safe needle use, and follow a low-sodium and low-fat diet.
chemo side effects
surgery side effects
n/v, alopecia, bone marrow suppression, fatigue
infection, bleeding, pain, altered body image
body changes at end of life
cheyne stokes breathing, mottling, decreased UOP, weakness, decereased LOC
what is icd and why is it used?
implantable cardiac defibrilator
Continuous monitoring of heart, delivers shock if VF/VT occurs. acts as a pacemaker if brady occurs.
treatments for ascities
-LOW SODIUM DIET
-paracentesis
-diuretics- SPIRONOLACTONE favored over lasix with these pts.
-iv albumin, pulls fluid from the peritoneum, expands intravascular volume
monitor daily weights, abdo girth, I+O, electrolytes and respiratory status.
s/s of hepatic encephalopathy
confusion, asteixis (flapping hands) decrease in lOC
safety measures for radiation
limit exposure, private room, shielding, restrict visitors—especially children, pregnant women
(immunocompromised)
compare pallative vs hospice
pallative- any stage of disease process, alongside medical treatment.
hospice- end stage, no curative treatment
Cardioversion vs. defibrillation: what is the nurse's role in both?
cardioversion- synchronized shock for tachyarrythmias with QRS to get pt back into a safe rhythm. (DONT SHOCK DURING T WAVE!) ensure synch mode. 100j
defibrilation- unsynchronized shock for pulseless rhythms, call code, all clear, continue CPR, 2 min recheck. 200-300j
how will a pt appear with decerased liver function
jaunciced. ascities. weight loss? clay stools. dark urine. spider angiomas.
low albumin. all vitamins low.
what is the sphincter of oddi and why is it important?
Controls bile/pancreatic flow; spasm or obstruction here causes biliary pain and contributes to obstructive jaundice.
*story of the morphine thought to worsen pain ?
what are risk factors of cancer
smoking, drinking, hepatitis, obesity, abesestos.genetic hx, sunlight, bacteria, viruses
list goes on
physician-assisted suicide
is not legal in all states. nurse needs to honor the autonomy and dignity of pt.
self-administered lethal medication.