Flo Night
You walk in a room and someone is having a seizure. What do you do?
Protect pt from injury
Do not put anything in their mouth
Turn on side
Remove objects from bed that may hurt pt
Loosen restrictive clothing
Record the time
Oral suction → try not to let them close their mouth on it
DO NOT RESTRAIN
** after seizure, take v/s, keep lying on side, allow pt to rest, neurologic checks; document date, time and duration
Explain the rule of 15
Consume 15 g of SIMPLE carbs
Recheck in 15 minutes, if still low repeat
Recheck again in 15 minutes
When it hits over 70, recheck in an hour and give a complex carb to keep them up
What are our 'rescue' or reliever medications (short acting meds) for an exacerbation of asthma and what are our side effects?
albuterol, levalbuterol
tachycardia, nervousness, anxiety, hypokalemia, tremors
What are signs and symptoms of fluid volume deficit (hypovolemia)? What assessments should we be doing?
Weight loss, decreased BP & urine output, tachycardia, cool clammy skin
DAILY WEIGHTS; I&O; Vitals; Administration of oral fluids; Skin turgor, mucosa, mental status
DO NOT WALK BAREFOOT OUTSIDE
Shoes that fit right → shoes that don’t cause ulcers, which don’t heal well
Should probably go to a podiatrist
Check feet daily
Changes shoes a couple times a day
You have a patient who has hyperkalemia. What all would you do with this patient?
EKG monitoring
Sodium polystyrene Sulfonate (aka Kayexalate) --> Removes potassium through stool and is drank through a straw
Diuretics → non potassium sparing ; We want to use furosemide NOT spironolactone
Emergent care
IV calcium gluconate → SHEILD FOR THE HEART
IV regular insulin and dextrose → move potassium from outside the cell back into the cell where it belongs
What is our main medication for hypothyroidism?
levothyroxine; take 30 minutes before breakfast
What is the golden standard for treatment of Parkinson's (what drug) and what do you instruct?
levadopa/carbidopa;Increases dopamine in the body
Only usually works for 1-2 years
Helps slow the progression of the disease
DOES NOT CURE!
What are clinical manifestations of COPD
Weight loss; “Barrel chest”; Fatigue; Clubbing of nails; Crackles in lungs; Tripod positioning
Three 'cardinal' signs -->
Chronic cough, sputum production, dyspnea
You have a pt with hypercalcemia; what do you do at this time?
AT RISK FOR RESPIRATORY DEPRESSION
NS administration → rehydrating the pt
IF HYDRATION IS NOT AN ISSUE → Loop diuretic administration
Calcitonin administration
Helps bring down calcium level
What is COPD patients drive to breathe?
PEOPLE WITH COPD HAVE THE DRIVE TO BREATH FROM LOW OXYGEN; A NORMAL PERSON HAS THE DRIVE TO BREATH FROM HIGH CO2
Remember, if we give them too much oxygen their drive to breathe goes away
What do you do for someone in status epilepticus?
IV lorazepam or diazepam
If the seizure is >5 minutes, or if they have repeated seizures for >30 minutes
What is our home teaching for COPD?
All patients will be on oxygen to keep stats 88-92%
Rest at least 30 minutes before eating
Prepare foods in advanced before eating
Eat 4-6 small meals a day
High protein, high calorie
Modify ALDs to conserve energy
STOP SMOKING
Get your vaccinations (especially pneumonia and flu)
Plan sexual activity when breathing is best
Decongestants or nasal steroids to help with sleep
Pursed lip breathing → helps blow off CO2
Give sumatriptin
What do we do in a thyroid storm?
Hypothermia blankets
Ice packs
Oxygen
IV fluids
PTU/methimazole
Iodine
propranolol
What are some priority problems for Parkinson's?
Impaired Physical Mobility; aspiration risk; malnutrition risk; fall risk; impaired communication
What is our order for glucose glucose administration when it comes to hypoglycemia?
ORAL FIRST, if they’re unconscious do D50 IV, and then if they do not have IV access do an glucagon IM
What are our side effects of opioids? What type of pain do we use them for?
Constipation, sedation, respiratory depression, hypotension; moderate to severe pain
Tell me what you know about ACE inhibitors; what medication do we switch do if they cannot tolerate these?
End in -pril
Blocks the RAAS system
Decreases BP
Side effects → think ‘ACE’
Angioedema (swelling of tongue), Cough, hypErkalemia
Switch to ARBs (-artans) if they cannot tolerate
What is the green, yellow, and red range for asthma and what do they mean?
Green zone
- 80-100% of the personal best and must remain on medications
Yellow zone
- 50-80% of personal best
- Caution; something is triggering this person's asthma
Red zone
- <50% of personal best
- Serious problem; must contact health care provider
What is this?
ABG values:
pH: 7.30
PaCO₂: 50 mmHg
HCO₃⁻: 24 mEq/L
Respiratory acidosis
pH 7.30 → low → acidosis
PaCO₂ 50 mmHg → high → points to respiratory cause
HCO₃⁻ 24 mEq/L → normal
What is hypertensive emergency?
Patient has evidence of target organ damage; BP >180/120
What are our s/s of left sided HF?
SOB, cough, decreased O2 sats, crackles in lungs, pallor, dizziness, tachycardia
What are our priorities for hypermagnesemia?
AIRWAY → need to assess LOC & DTRs
ESPECIALLY IF THEY ARE IN A COMA
Loop diuretics, NaCl, LR
** also will be on calcium gluconate
Ensure patent airway
First we need to do do fluid resuscitation → severely dehydrated --> PRIORITY
Start regular insulin drip
When they hit around 250 blood glucose, we will add D5 to prevent hypokalemia