Shocking
Clinical manifestations of hypovolemic shock
Increased HR - Decreased SBP - Dry mucosa - Decreased urine output - Cyanotic skin - Decreased peripheral perfusion
Tx: stop loss; fluid resuscitation; blood if hemorrhagic; keep warm; monitor urine out
Parts of a Primary Survey
Airway & Alertness, Breathing, Circulation, Disability, Exposure, Disability, Exposure & Environmental Control, Full Vitals & Family, and Get (LMNOP - Labs, Monitor, Naso/Orogastric, Oxygen (capnography), & Pain)
Parts of Cushing's Triad
Hypertension with widening pulse pressure, bradycardia, and irregular breathing (Cheyne-Stokes)
Administration of PPIs, fluids, and blood products for patients with
Gastrointestinal bleeding
RN responsibilities for hemodynamic monitoring
Education, equipment setup, monitor tracings/data, safe practice of equipment, and observe the patient for complications.
Wheezing, hives, itching, tachycardia, hypotension, light-headedness, swelling of lips, tongue, or throat
What are the symptoms of anaphylactic shock?
TX: Epinephrine, O2, H1 blocker, H2 blocker, fluids
Sweating, nausea, weakness, pallor, tachycardia, confusion, dilated pupils, extreme thirst, elevated temperature, tachypnea, vasodilation, and cerebral edema
Signs and symptoms of heat-related emergencies.
Heat cramps, Heat exhaustion, Heat stroke
Autonomic dysreflexia
Restoration of fluids and insulin, acid-base and electrolyte monitoring are a focus for the RN caring for these types of patients
Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar state (HHS)
Slow, continuous therapy ideal for unstable, critically ill patients, providing gentle fluid and solute removal
What is CRRT (continuous renal replacement therapy)
Hemodialysis is faster and used for stable patients, but can cause rapid fluid shifts and hemodynamic instability.
Common cause of Cardiogenic shock
Myocardial Infarction / Arrhythmias, Myocarditis / Endocarditis, Cardiomyopathy, Mechanical Problem (septal rupture/valve disease)
Tx: Inotropes/vasopressors, monitor hemodynamic numbers, avoid fluid overload.
This patient can wait up to 2 hours to receive treatment in a mass casualty incident
Urgent or Yellow tag
Possible causes for a seizure?
Fatigue, confusion, abdominal distension, clotting issues, jaundice, pruritis, petechiea.
What are signs/symptoms of liver cirrhosis?
Tx: check ammonia & other liver markers, help symptoms (diuretics, lactulose), paracentesis, transplant
Raccoon eyes, battle's signs, clear drainage from ears or nose, pupillary changes, decrease in motor or sensory function
What are the signs of a basilar or skull fracture?
Tx: stabilize neck, ABC, neuro checks, infection control, monitor ICP, safety precautions
bradyarrhythmia, poikilothermia, hypotension, warm, dry, flushed skin, and priapism
What are signs/symptoms seen in neurogenic shock?
Tx: fix cause, vasopressors, monitor HR, temp, and avoid fluid overload.
Therapeutic measures for Cerebrovascular accidents
Thrombolytic (ischemic less than 4 hours), endovascular (embolectomy), and surgical management (hemorrhagic)
Seizure considerations for RN
Airway, protect from injury, recovery position, document type and length, precautions, medications, and patient education
Severe hyperthermia, severe hypertension, vomiting, abdominal pain, tachycardia, chest pain, dyspnea, delirium, and heart palpitations
Acute thyrotoxicosis or Thyroid Storm
TX:
hypotension, renal artery stenosis, nephrotoxic medications, BPH, and ureterolithiasis
What are possible causes of AKI?
Complications of septic shock
ARDS - AKI - DIC - MODS - Myocardial dysfunction
TX: IV fluids, ABX, Vasopressors, Mechanical Ventilation, or surgical interventions (source control)
RN considerations for frosbite
Avoid massaging the injured area, remove jewelry and clothing, warm water soaks, cover blisters with a sterile dressing, and treat pain.
Nursing Interventions for ICP
Monitor v/s, bed 30-45 degree, neutral positions, avoid stimulations, I&O, and medication management
Intact GI tract, liquid administration, 30 ml water flush
What is Enteral Nutrition?
NG, PEG tubes, monitor pt tolerance, elevate HOB, site care, q24h tubing change, reconstitute formula correctly.
Hyperkalemia reduction methods
IV Ca gluconate, IV Regular insulin, IV glucose, Sodium bicarbonate, Sodium polystyrene, dialysis