Medications: The good, the bad and the ugly
Think Fast!
Look, Listen & Feel
Fix Me!
Melting Pot
100
This medication may be given to the patient with the follow hemodynamic pressures: CVP 12, PAWP 17, CI 1.8, B/P 120/82.
What is nitrates (nitroglycerine, sodium nitroprusside)
100
What is your first intervention if a mechanically ventilated patient alarms "high pressure" from the vent?
What is check the tubing (biting), check for kinks, respiratory assessment for presence of secretions. ASSESS
100
This condition is a result of damage to the alveoli, causing impaired gas exchange, alveoli being filled with fluid, and formation of scar tissue.
What is acute respiratory distress syndrome (ARDS)
100
This therapy is indicated for a patient with a pulmonary embolism
What is heparin therapy, possible fibrinolytics, coumadin, lovenox (any of these)
100
A client with a myocardial infarction is developing cardiogenic shock. Because of the risk of myocardial ischemia, what condition should the nurse carefully assess the client for? 1. Bradycardia 2. Ventricular dysrhythmias 3. Rising diastolic pressure 4. Falling CVP
What is 2
200
This medication may be given to help pull fluid into the intravascular space
What is albumin
200
A mechanically ventilated patient becomes hypotensive with decreased cardiac output. What do you believe could be causing this?
What is PEEP (too high of a setting = barotrauma)
200
Deviation of the trachea to the unaffected side indicates the presence of what
What is tension pneumothorax
200
This may be indicated for a patient in cardiogenic shock to help reduce afterload and increase the aortic diastolic pressure.
What is intraaortic balloon pump (IABP)
200
A client is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours post-op, what type of drainage should the nurse expect? 1. Serous 2. Bloody 3. Serosanguinous 4. Bloody, with frequent small clots
What is 2
300
This medication may be utilized in a patient who is hypotensive, despite aggressive fluid resuscitation.
What is norepinephrine, etc.
300
The following ABG results indicate this acid base imbalance: pH 7.25, PaCO2 60, HCO3 12, PaO2 50
What is Partially compensated respiratory acidosis
300
These would indicate a decrease in cardiac output
What is decreased urinary output, changes in LOC, poor peripheral perfusion, etc.
300
This type of ventilation may be indicated for a patient who is able to provide his/her own breaths, but still needs volume and PEEP regulated
What is synchronized intermittent mandatory ventilation (SIMV)
300
When caring for the patient with ARDS, the critical care nurse knows that therapy is appropriate for the patient when which goal is being met? 1. pH is 7.32 2. PaO2 greater than or equal to 60 mm Hg 3. PEEP increased to 20 cm H2 O caused BP to fall to 80/40. 4. No change in PaO2 when patient is turned from supine to prone position
What is 2
400
This medication may be given in a patient with the following hemodynamic pressures: U.OP 20 ml in last 2 hours, CVP 12, PAWP 14
What is furosemide, bumetanide, torsemide, etc. (diuretic)
400
These would be priority concerns with a patient who has just been extubated
What is maintaining airway, respiratory assessment (presence of stridor?), recheck ABG's (later), cardiac assessment, suctioning prior to extubation, etc.
400
In children, hypotension is usually found in this stage of shock.
What is Progressive (late changes w/ children)
400
A "low pressure" alarm sounds on your mechanically ventilated patient. You assess for these problems.
What is disconnection from ventilator, leak in tubing
400
The hemodynamic changes the nurse expects to find after successful initiation of the IABP therapy in a patient with cardiogenic shock include (select all that apply): 1. decreased SV 2. decreased SVR 3. decreased PAWP 4. increased diastolic BP 5. decreased myocardial oxygen consumption
What is 2, 3, 4, 5
500
This may be given to a patient with the following hemodynamic pressures: B/P 60/44, CVP 13, PAWP 17, CO 3.5
What is epinephrine (or similar constrictor)
500
A client who sustained a blunt chest injury suddenly complains of severe chest pain and dyspnea. You anticipate this condition.
What is pneumothorax
500
These are considered normal hemodynamic pressures. Name all.
What is CVP 2-8, PAWP 8-12, PADP 5-15, SVR 800-1200, CO 4-8, CI 2.2-4.0
500
These are some primary concerns in a patient who has an arterial line
What is risk for infection, risk for hemorrhage due to removal, maintaining patency of line, decrease in circulation (assess CMTS in extremity), etc.
500
The most common early clinical manifestations of ARDS that the nurse may observe are 1. dyspnea and tachypnea 2. cyanosis and apprehension 3. hypotension and tachycardia 4. respiratory distress and frothy sputum
What is 1