Renal and GI
What electrolytes tend to be elevated in a pt with CKD?
Which a diet for a pt with stage 4 ESRD be more or less restrictive than a pt with stage 5 ESRD?
Phos and K
stage 4 is less restrictive
1. has upper airway obstruction
2. intubated for greater than 14 days
3. cannot maintain their airway for long term
What are lethal non-shockable rhythms? What are your first interventions?
PEA and asystole
IV push Epi and CPR
the loss of function of the autonomic nervous system
Neurogenic shock
Name 4 possible causes of cardiogenic shock
acute MI, tamponade, arrhythmias, valve damage, cardiomyopathies, tension pneumothorax, hypoglycemia, hypocalcemia, acidosis, severe hypoxemia
What medications must be held prior to a patient reieving IHD?
any BP meds (lisinopril), or any cardiac meds, abx
What is an RSI and what do we need for the procedure?
Rapid sequence intubation - emergency procedure to secure an airway within a patient
• Emergency equipment - ZOLL, Suction, Ambu Bag, Ventilator, MedicationsCo2 Detector, Stethoscope, Restraints
Sedation or paralytic first?
This is an electrical impulse that shock the pt’s intrinsic electrical activity on the R wave
When would we utilize this technology?
electro cardioversion
Use for a-fib (w/RVR) or SVT when after therapies options are tried and not effective
What is Cushing's triad? When would you see this?
Decrease in RR, Increase in systolic BP and decrease in HR.
Seen as late sign in TBI
Name the f/e changes that occur during the emergent or resus phase for a burn patient
hyperkalemia, hyponatremia, metabolic acidosis, hemoconcentration
generalized edema, reduced UO
How would care for a small bowel obstruction compare to care for a large bowel obstruction?
Upper - NG decompression
Lower - Create a colostomy
What are some diagnostics that we can perform for ARF? name as many as you can
ABGs, CXR, sputum culture, CT, V/Q scan, angiography, ECG, Echo, Thoracentesis
- remember that ARF is a very generalized/umbrella term for any type of disease process that will cause respiratory failure - Dx can vary greatly
A patient has just undergone PCI and needs education. Name 4 things that need to be taught post-op?
Avoid heavy lifting (more than 10 lbs.)
avoid heavy pushing or pulling or strenuous activity
4-6 hr bed rest post-op (fem site)
increase PO fluids to clear contrast
Infection prevention - hand hygiene, no cream or lotion, loose clothing, no bath or pool/lake for 1 week
Racoon Eyes and Battle Sign
Basilar Skull Fracture
This disease Process is indicative by platelet levels dropping by 50%
Heparin induced thrombocytopenia
What is hepatic encephalopathy?
what lab is important to watch (hint: will be elevated)? What med must we give to bring that lab down?
build up of ammonia secondary to liver failure or cirrhosis. Will give lactulose to these pts (ammonia will be deposited within BM).
Name reasons for high pressure alarms and how would troubleshoot them
biting - assist in stopping it
coughing/secretions - O2 boost
mucus plug - call healthcare team, will need suction
tube in R bronchus - Xray and call provider
Vent desynchrony - more sedation or SBT
pneumothorax - will need chest tube - call provider
Name all sternal precautions and when they would be needed
Cannot push or pull, keep arms at sides and not above head, use leg strength when standing up (not arms)
needed for Open heart CABG (what is needed at bedside post-op?) or AVR
A pt presents with GBS what are important questions that the RN should ask regarding cause.
The MD orders methylprednisolone for this pt. Is this an order the RN should question?
Ask about any recent viral infections - most likely the reason for GBS.
Always watch breathing for these pts - remember they will have ascending or descending edema.
Yes! Question this order bc corticosteroids will delay recovery for GBS pt.
Which stage is sepsis is characterized by lactate >2, mottled skin, abrupt change in MS and capillary refill >3 sec
Severe Sepsis
A patient has a upper GI bleed from esophageal varices bursting. What are the healthcare teams initial interventions?
What are you to never do for a pt with esophageal varices?
1. intubate - secure airway
2. maintain adaquate perfusion - blood products, crystalloids, volume expanders
3. administer med - replace lytes, vasopressin etc.
4. stop the bleed - Blakemore insertion
Never insert NG or OG tube in these pts!!
Describe the patho of ARDS and the common S/S that you will see with these pts
S/S: rapid onset of dyspnea, hypoxemia, adventitious lung sounds
- be sure to prone these pts to decrease WOB and increase ventilation
Assessment - (L) lung crackles in lungs, dyspnea, pink tinged sputum, weak pulses, cool and pale
(R) - increased BP, JVD, Enlarged liver, weight gain, extra heart sounds
Labs - increased BNP, decreased EF
A pt with Myasthenia Gravis has recieved an overdose of their anticholinesterase medication. What kind of crisis does the RN anticipate? What are expected findings for this crisis?
Cholinergic crisis
Brady, pinpoint pupils, sudden severe muscle weakness, warm and flushed
32 y/o (weighing 73kg) patient comes to ED with severe burns on anterior chest, front of left arm, circumferential left leg and front of right leg. use rule of 9s and parkland formula to determine the rate of LR given in the first 8 hrs
(answer is in ml/hr, round to nearest whole number).
903 ml/hr.