Devices
What is the contraindication for getting an arterial line?
A positive Allen's test
What two rhythms do you cardiovert for?
unstable SVT and afib RVR
What disease is characterized by fluid in the pleural space and pleuritic chest pain? How do you treat it?
Pulmonary effusion. Treat with thoracentesis and chest tube
Medicine given during codes when patient is in asystole or PEA
epinephrine
How do you confirm an intubation?
X-ray, auscultate, look for even chest rise
As an RN what is your responsibility during insertion of a swan ganz catheter?
Monitor VS, make sure it is sterile, watch for PVCs and v tach
The patient is being tested for PVD, what test is being used on them? And what is a normal value for them to get on the test?
They may have an ultrasound or Ankle brachial index. The normal value for ankle brachial index is 1
What is the virchow's triad for pulmonary embolism?
Venous stasis, vessel wall injury, hypercoaguable
Uses for Digoxin and the normal levels.
SVT and heart failure
0.6-1.2
A high pressure alarm goes off on the ventilator, what will you check for and how will you fix each cause?
If patient is biting tube or breathing over vent (sedate), coughing/gagging/mucus plug (suction), tube in right main stem or pneumothorax (xray)
Your patient has been given an internal pacemaker for bradycardia. The pacemaker senses the atria and ventricles, but only paces the atria, the mode is trigger. What is the acronym for the pacemaker?
ADT
Chamber paced, chamber sensed, mode of pacing
Your patient is 1 day post op prosthetic valve surgery, what cardiac infection will you keep your eye out for? What are the common signs and symptoms?
What do you do when a patients chest tube comes out of the chest and when it dislodges from the container?
When it comes out of the chest you cover the opening with a sterile gauze and tape on three sides of gauze. When it comes out of container you put the tube in sterile water
When do you use Adenosine, atropine, and amiodarone?
Adenosine: unstable SVT
Atropine: Unstable bradycardia
Amiodarone: Afib RVR
The low peak pressure alarm goes off on the ventilator, what are possible causes and how will you treat them?
ETT cuff deflating/air escaping from chest tube (call RT and Dr), disconnection (reconnect), tidal volume set too low (increase tidal volume)
The patient has a central venous pressure of 14. What side of the heart is the device measuring and what does the pressure indicate?
Measures the fluid balance on the right side of the heart. 14 is greater than 0-8, so the patient is hypervolemic or has right sided heart failure
Assess that the compression device is properly applied, that the insertion site is not bleeding, hematoma, thrombus, poor perfusion. Educate patient to not bend at site (if femoral must be laying with HOB 15-30 degrees), keep clean, and no exertion
What are signs and symptoms of ARF?
PaO2 <50 or PaCO2>50 and pH<7.35. High HR and RR, restless, confusion, papilledema, asterixis
Two meds that lower BP, decrease cardiac contractility, and slow conduction
Cardizem and verapamil
VAP Bundle
elevate HOB, oral care q4h with CHG q12h, DVT and PUD prophylaxis, sedation vacation
What is an ICD used for and what do patients need to avoid when they have one?
ICD continuously monitors rhythm and shocks for vfib and vtach. The patient must wear a medical alert bracelet. They can not go though an MRI. They can not be near items with magnetic forces- phone in shirt pocket, airport scanners, car engines, large speakers
Name the different symptoms between left and right sided heart failure. What medicines can be used to treat it?
Left: Poor perfusion to peripheral, pulmonary edema, pink frothy sputum, crackles, SOB, LV hypertrophy
Right: high BP, JVD, peripheral edema, increased weight
Meds: inotropes, diuretics, digoxin, ACEs and ARBs, Beta blockers
Treatment for ARDS
Mechanical ventilation with PEEP, maintain fluids, supplemental nutrition, diuretics, antibiotics, steroids
Medicine used to treat pulmonary hypertension and what special considerations go with it
Epoprostenol. Must be given through a central line 24/7, can not stop infusion, flush line, or draw labs from it
When a patient is eligible for weaning
Alert, able to follow commands, strong cough, good tidal volume, minimal secretions, stable on minimal vent settings