ALL Flashcards
Peds Epi Dose
0.01 (1/100th)
Peds Fluid Replacement
20mL/kg over 5-10 minutes
Inferior Leads
II, III, avf
Septal Leads
v1, v2
Anterior Leads
v1-4
Lateral Leads
I, aVL, v5, v6
Muddles: organophosphates, nerve agents (Ex. Sprayed with pesticides)
Sx?
Tx?
Myotonic pupils, myosis, O for the word organic phosphates, and cOnstricted
Urination
Diarrhea, Diaphoresis, Defication
Lacrimation
Valium given for seizures, central nervous system Excitation
Salivation
Don PPE, Dispose of patient clothing
Tx: Atropine, Oxygen, Possible Intubation
Placenta previa versus placental abruption:
How to differentiate = pain
Placenta previa = painless privates
Placental Abruption = Painful Always. Priority Always = Fetus in distress- more emergent (detached not oxygenating).
Measles vs Chicken pox:
Measles: starts on face, all looks same, runs together *koplik spots = classic measles signs
3 C’s: conjunctivitis, cough, coryza (acute inflammation of nasal cavity)
Chicken pox: starts on trunk, various stages, does not run together
Torsion vs Epididymitis: Time of onset
Torsion: Quick onset 4-6 hours. Ischemic testicle d/t rotation and artery flow being cut off.
Epididymitis: Gradual onset over a couple days. Infection of epididymus, may be d/t std
Wide Pulse Pressure , examples?
= usually the result of not enough blood or heart is super hyperdynamic:
Vasodilation
ICP
Sepsis (Cardiac output increased= heart kind of goes into overdrive= we pump more, we pump harder = to try and circulate as much blood as we can = diastolic pressure drops
Aortic regurg (blood backing up into left ventricle, less blood in the vessels = lower diastolic pressure)
Anemia (blood really thin and watery/not thick and full = going to exert less pressure on vessels inside the wall)
Arteriosclerosis (vessels noncompliant, massive swings in systolic pressure)
Hyperthyroid (increased inotropy in heart = heart squeezing harder= systolic pressures will be high, diastolic wont really change because you’re not putting more blood into the system)
Narrow Pulse Pressure, examples?
= heart is not working to generate enough force/pulse, or in the case of bleeding not enough blood in to tank to generate that force. Vasoconstriction. Seen in Early Shock.
Cardiogenic Shock = no squeeze
Bleeding = loss of volume/not enough blood to pump = not enough volume to generate force
Aortic Stenosis = left ventricle trying to pump blood through a very narrow valve = systolic pressure drops cause you’re not generating enough force
Tamponade = if heart being smushed by outside forces = it wont fill very well and definitely wont squeeze well
Stroke Volume influenced by?
contractility, preload, and afterload
Pulse pressure during early shock
narrowed pulse pressure
What happens to pulse pressure with increased ICP?
widening pulse pressure
Three symptoms (Cushings Triad) of increased ICP?
Widening pulse pressure or increased systolic blood pressure
Bradycardia
Irregular breathing pattern
*ICP will BBB
what is preload?
how is preload evaluated?
the stretch = the amount of volume being returned to the heart = volume of blood in ventricles at the end of diastole or end diastolic pressure.
Preload evaluated by = Central venous pressure on right
How do you decrease preload?
diuretics, vasodilators (preload is decreased when hypovolemic)
How do you increase preload?
(meds)
IVF, blood, vasoconstrictors
What is afterload?
the squeeze, the resistance the heart has to pump against (systemic vascular resistance)
example of widened pulse pressure (dx)?
increased ICP
examples of narrowed pulse pressure?
early shock, cardiac tamponade, aortic valve stenosis
4 week old with projectile non-bilious vomiting and persistent hunger?
pyloric stenosis (bilious would be volvulus)
Guillain-Barre Sx?
Tx?
Ascending symmetrical paralysis, numbness, tingling, decreased deep tendon reflexes
Risk of respiratory failure from muscles weakening
Tx: NPO, Swallow Study, pulmonary function tests, IVIG, Plasma Exchange
before inserting foley for trauma patient, assess for?
blood at urinary meatus…may be a sign of pelvic fx, and catheter insertion is contraindicated
Most beneficial action of morphine for pulmonary edema?
Decrease Pre-load…causing vasodilation…reducing pulmonary capillary pressure
Early Signs Increased ICP?
changes in LOC, irritable, restless, lethargic
Late signs increased ICP?
VS changes, Cushings Triad = Bradycardia, Irregular Respirations, & Widening Pulse Pressure
ICP Will BBB
Long leg cast with pain out of proportion to injury, decreased sensation in affected leg, and urinalysis reveals myoglobinemia? (dx)
Compartment Syndrome
Chronic Arterial Insufficiency Sx
Intermittent Claudication
Early complication of MI?
ventricular dysthymias
LEFT sided heart failure sx?
paroxysmal nocturnal dyspnea, pulmonary congestion, pulmonary edema, orthopnea, wet lung sounds/wet cough
*think: fluid/blood backing up into lungs
RIGHT Sided heart failure sx?
dependent edema
JVD
increased central venous pressure
3 year old, acute respiratory distress, sitting forward, drooling, extending neck? (dx)
Epiglotitis (edema of the epiglottis), pt positioning this way for maximum air exchange.
Acute onset
Thumbprint sign on lateral neck XR
3 D’s: Drooling, Dysphasia, Distress
Tx: keep child calm, “if they cry, they die”
When is tranexamic acid administered?
unstable pelvic fracture, blood coming from urinary meatus, hemodynamically unstable
Ocular sx with highest priority?
sudden painless loss of vision in one eye… Indicative of retinal artery occlusion, Risk of permanent vision loss.
Sx of bacterial meningitis?
fever, nuchal rigidity (stiff neck), and altered LOC
also: petechial rash, headache, photophobia
Bacterial = Contagious = Droplet Precautions
Viral = Generally Not Contagious
hyperventilating causes PaCO2 to?
decrease (blowing off too much CO2)
A patient with severe acute pancreatitis develops ascites and diminished breath sounds to right lower lobe… You suspect the patient has developed?
Pleural Effusion… The fluid associated with ascites, moves from the peritoneal space to the pleural space, causing a pleural effusion (70% of pleural effusions occur on the right side). This may lead to ARDS, may need to prep for thoracentesis.
ruptured ovarian cyst symptoms?
Sharp, Constant abdominal pain
Hepatitis A transmission route?
symptom?
Transmitted fecal oral route.
Stools may be clay colored
Others who have been in close contact may need treatment.
eye injury, unable to look up? (dx)
cranial nerve?
blowout fracture… caused by the ocular motor nerve being trapped within the fractured area of the orbit
III Oculomotor cranial nerve:
Eyelid and Eyeball Movement: UPWARD GAZE
Pupil Constriction
Neonate normal VS
HR 120-160 (if less than 100 resp interventions are necessary, less than 60 start compressions)
RR 40-60
infant with sudden onset wheezing, cough, and stridor…Dx? assess for?
foreign body aspiration, assess for unequal breath sounds
Human tetanus immune globulin provides passive immunity for how long?
1 month
snake bite venom, bleeding affects?
May develop decreased platelet count, DIC: activation of the coagulation cascade, abnormal excessive clotting.
Trauma patient complains of shoulder pain…This patient should be examined for?
Visceral injury… injury to the spleen or ruptured diaphragm can manifest with pain to the left shoulder (Kehr’s sign).
Prepare for emergent exploratory laparotomy.
pregnant patient with right upper quadrant pain and low-grade fever? (dx)
Appendicitis… during pregnancy the uterus can displace the appendix causing right UPPER quadrant pain. cholelithiasis would include RUQ pain, but not maybe not fever
left-sided spontaneous pneumothorax sx?
Left sided: Hyperresonance, Diminished or absent breath sounds
High pressure puncture wound tx?
prepare for immediate surgical intervention. Avoid warm saline soaks (May cause increased swelling & ischemia) and direct application of ice (May cause a cold injury)
Lab results with Disseminated Intravascular Coagulation (DIC)?
DIC = Prolonged Bleeding Times (clotting times increased as clotting factors are used up by excessive clotting)
⬆️ PT/PTT, ⬆️ fibrin split products (as fibrin is broken down), ⬆️ Elevated D-Dimer
⬇️ fibrinogen (due to excessive clotting in the Vasculature), ⬇️ Platelets
painless vaginal bleeding sx of?
what is contraindicated?
Placenta Previa (pelvic exam contraindicated)
Tetanus contraindications
acute infection
immunocompromised
corticosteroid use
Open pneumothorax, interventions in order
Apply occlusive dressing to wound
Check for a pulse
Initiate IV of normal saline
Frostbite priority nursing intervention
pain management
Chest pain worsens with inspiration or lying supine, & LESSENS with leaning forward? (dx)
Pericarditis
Hypermagnesia sx?
tx?
normal range?
resp depression
hypoxemia
loss of deep tendon reflexes
Administer: Calcium Gluconate
Normal Magnesium: 1.3-2.1
burn fluid resuscitation formula (rate for the first 8hrs)?
4ml/hr x kg x TBSA% = ______ / 2 = _______ /8
1/2 the total volume given in 1st 8 hours (remaining half over next 16 hours)
Parkland Formula: 4ml/hr
American Burn Association:
2ml/hr = adult (thermal burns)
3ml/hr = peds
4 ml/hr = electrical
LR fluid of choice
Burns: monitor urine output, at least 75-100ml/hr electrical burns
Vital signs with neurogenic shock?
decrease blood pressure and bradycardia
neurogenic shock, such as a spinal cord injury, from a blocked sympathetic nervous system results in maldistribution of blood flow and vasodilation…Which leads to hypotension, and parasympathetic stimulation leads to bradycardia.
heparin antidote?
protamine sulfate
rapid infusion of large amounts of COLD blood can lead to?
hypothermia and increased risk of myocardial dysrhythmias
respiratory distress, tracheal deviation, absent breath sounds on left…dx? tx?
Tension Pneumothorax, treated with needle decompression
skin during early septic shock?
warm and flushed
acute cocaine intoxication symptoms?
Tx?
rising core body temp, tachycardia, HTN, pupils dilated
treatment includes benzos and cooling
Cardiac Tamponade treatment?
Pericardiocentesis: place needle or catheter through chest wall into pericardial space to drain blood/fluid
(or Thoracotomy for Traumatic Cardiac Arrest with Penetrating Cardiac Tamponade)
4 elements negligence that must be proven?
Damages
Duty
Breach of Duty
Proximate Cause
CSF in the ears or nose indicates?
Basilar Skull Fracture
throbbing headache to temporal area, visual disturbances, fatigue, possible fever…dx?
tx?
temporal arteritis = steroids
oculumotor nerve controls?
pupil size
eye ph?
7.0
blunt cardiac injury, first nursing interventions?
monitor cardiac rhythm and administer oxygen
sx hemorrhagic stroke to left cerebral hemisphere?
expressive, receptive, or global aphasia
Clinical signs and symptoms of the patient depend on the size and location of the hemorrhage. Based on how our nervous system is set up an injury to one side of the brain generally affects the opposite side of the body. Left-sided hemorrhagic stroke patients may have aphasia or receptive aphasia if there is damage to language centers of the brain. For almost all right-handers and for about 1/2 of left-handers, damage to the left side of the brain causes aphasia. As a result, individuals who were previously able to communicate through speaking, listening, reading, and writing become more limited in their ability to do so.
pertussis sx
high pitched whoop
paroxysmal bursts of coughing
fever
Highly Contagious Bacterial Infection: Droplet Precautions
Systemic vascular resistance (or afterload pressure) is decreased (low) in which type of shock?
distributive shocks (like neurogenic, septic and anaphylactic) due to vasodilation
Systemic vascular resistance (or afterload pressure) is INCREASED (HIGH) in which types of shock?
Cardiogenic shock, hypovolemic shock, obstructive shock
What type of medication may mask the EARLY signs of HYPOVOLEMIC SHOCK & HYPOGLYCEMIA?
BETA BLOCKERS
What is a hallmark sign of Prinzmetal’s Angina (Variant Angina)?
medication that may make it worse?
Chest Pain at REST due to coronary vasospasm (stimulants).
Vasospasm is precipitated by stress.
Beta blockers may exacerbate vasospasm.
Patient with stab to left flank area, unable to MOVE left side and unable to FEEL the right side. These symptoms are associated with what type of incomplete spinal cord injury?
Brown-Sequard syndrome: incomplete cord syndrome with ipsilateral (same side) motor loss and contralateral (opposite) loss of sensation. It has a high rehab prognosis
suture removal time?
lips 3-5
eyebrow 4-5
scalp 7-10
extremities 10-14
joints +14
Placental Abruption sx
Painful Always. Priority Always = Fetus in distress- more emergent (detached not oxygenating)
which cardiac disorder is characterized by a short PR interval and a delta wave (slurred qrs on upstroke)?
WPW
cottage cheeselike vaginal discharge, vulvar burning, pruritis, dyspareunia (painful intercourse)
candidiasis
Right costal margin pain (Murphy sign)
RUQ pain radiating to right shoulder (often after eating fatty foods)
fever, and bloating…are all symptoms of?
cholecystitis
Pericardial Tamponade sx?
Beck’s Triad:
JVD
HYPOTENSION
MUFFLED HEART SOUNDS
other sx include: pulsus paradoxus (decreased BP & Pulse strength with inspiration), electrical alternans (low ekg amplitude)
Meds contraindicated in RV MI? and why?
Morphine, Lasix, Nitro because they decrease preload
Sx of Wernicke’s Encephalopathy?
Confusion and Confabulation
Gait ataxia
Nystagmus
Symptoms of cluster headache?
Tx?
unilateral headache
nasal congestion
excessive tearing/lacrimation
Tx: 100% Oxygen for 15 mins, intranasal lidocaine, calcium channel blocker- esp verapamil
Diverticulitis symptoms?
LLQ pain
Alternating episodes of explosive diarrhea & constipation
Often caused by low fiber diet
classic sign of diphtheria?
other sx?
Gray pseudomembranous coating in throat
Bark like cough, Fever, Headache
Crowded, unsanitary living conditions
unilateral vision loss (cutain shade going down), painless, sx of?
Central retinal artery occlusion (CRAO)
tunnel vision and halos around lights, sx of?
acute angle glaucoma
Flashes of light (photopsia) & eye floaters, sudden loss or decrease in vision, veil or curtain effect, sx of?
retinal detachment
= tear in retina, allowing vitreous humor to leak, reducing blood flow to retina = Occular Emergency!
prepare for surgical intervention
A hazardous vulnerability assessment is completed in watch phase of disaster management?
mitigation
A patient complains of sharp chest pain that worsens with inspiration and lying down.
Which sound is commonly heard in pericarditis?
pleural friction rub, Heard best when the patient leans forward
symptoms of digoxin toxicity?
yellow or green halos in vision, nausea vomiting, ventricular dysrhythmias
causes of priapism?
sickle cell, SCI, Antidepressants and leukemia
Which lab value is decreased in thyroid storm (hyperthyroidism)?
TSH decreases, T3 & T4 are elevated
which is the EARLIEST indicator of shock in PEDIATRIC patients?
TACHYCARDIA (the primary compensatory mechanism for low cardiac output)
HYPOTENSION is a LATE sign of shock in children
BRADYCARDIA is an ominous sign in children
your patient has a history of Addison’s disease which vital sign change would indicate ADRENAL CRISIS?
hypotension is seen in adrenal crisis due to hypovolemic shock from a lack of aldosterone
Side effects of antipsych and neuroleptics (Like Reglan, Phenergan, Thorazine, Haldol)?
may lead to?
watch for extrapyramidal sx (dystonic reactions)
involuntary repetitive movements… facial spasms/grimacing, tongue protrusion, lip smacking
Neuroleptic Malignant Syndrome: hyperthermia, muscle rigidity
infant with “barking” cough sign of what dx?
cxr may show?
Croup AKA Laryngotracheobronchitis (LTB)
Steeple Sign on CXR
Gradual Onset
What’s consent allows healthcare providers to treat an unresponsive patient who is unable to give consent?
Implied consent
After MVC, patient with: shortness of breath, bony crepitus, paradoxical chest wall movement, Dx?
Flail chest
Patient with severe head trauma diagnosed with syndrome of inappropriate antidiuretic syndrome (SIADH). The patient is most at risk for which complication?
SEIZURES, due to water retention…leading to dilutional hyponatremia
McBurney’s point
RLQ abdominal pain, seen with appendicitis
what vessel is typically involved in an epidural bleed?
Characteristic sign of epidural hematoma (EDH)?
MIDDLE MENINGEAL ARTERY is typically injured with a temporal lobe hit/(victim of violence)
A classic sign of EDH is unresponsiveness, a lucid period, than a 2nd loss of consciousness.
 Common injuries seen with lap restraint (seat belt)?
hollow organ injuries like duodenal rupture, pancreatic injury, and a lumbar “chance” fracture.
pelvic fracture is LEAST likely to occur
A patient with gestational hypertension is receiving IV magnesium sulfate. What is the most important vital sign to monitor?
Respiratory rate & oxygen saturation
magnesium may cause decrease in respiratory effort. If respiratory rate decreases, stop the magnesium and consider administering calcium gluconate (antidote to magnesium toxicity).
Classic symptom of compartment syndrome?
Nurses first action?
Pain out of proportion to the injury, and unrelieved by analgesia.
Keep injured leg in a NEUTRAL POSITION, monitor the compartment pressure, prepare for fasciotomy as needed (if >30mm Hg)
(Elevation contraindicated because it DECREASES ALREADY IMPAIRED BLOOD FLOW and narrows the arterial-venous pressure gradient)
Lab values seen in Rhabdomyolysis?
Treatment?
⬆️ CK, MYOGLOBIN, K+, BUN
Treatment: Aggressive IVF, Sodium Bicarbonate, & possibly dialysis…all to prevent acute kidney injury.
5th metacarpal fracture…also known as?
Treated with?
Boxers Fracture
Ulnar Gutter Splint

What is afterload?
resistance to ventricular emptying = the squeeze, the resistance the heart has to pump against (systemic vascular resistance)
when is afterload decreased?
Tx?
distributive shocks: Neurogenic septic and anaphylactic
Vasodilators
Treatment: Vasopressors like norepinephrine
when is afterload increased?
Tx?
hypertension, aortic stenosis, and other shock compensation
Treatment: Vasodilators like nitroglycerin
Beta Blocker medication examples?
metoprolol
labetalol
propranolol
ACE Inhibitor medication example? adverse effect?
LISINOPRIL
most common adverse effect: dry nonproductive cough
most severe: angioedema
Why nitro and phosphodiesterase inhibitors contraindicated?
Both vasodilators, can cause severe hypotension.
Don’t give nitro if sildenifil (or others) in last 24 hours.
What does Nitroprusside (Nitropress) do?
Used to treat?
IV nursing precautions?
used in hypertensive crisis, due to strong preload and afterload REDUCTION
*Has a RAPID ONSET = TITRATE SLOWLY = to avoid hypotension
Should have Art line if infusion started
Adverse effect of Vasopressors? Nurse should watch for? Tx?
Infiltration, Extravasation, Tissue Necrosis
Phenotolamin (Regitine) is the antidote for vasopressor extravasation (injected into the area, it is a vasodilator)
If ST DEPRESSION in leads V1 & V2, what is next action?
Get posterior EKG
ST DEPRESSION and/or INVERTED T WAVES are indicative of?
ischemia
ST ELEVATION (and/or) INVERTED T WAVE?
injury
Antiplatelets do what?
Medication Examples?
PREVENT platelets from clumping together, prevent clots from forming:
Aspirin
Clopidogrel (Plavix)
Ticagrelor (Brilinta)
clue to remember *APT
ANTICOAGULANTS do what?
Medication Examples?
Slow the clotting process
Heparin
Enoxaparin (Lovenox)
warfarin (Coumadin)
Apixaban (Eliquis)
Rivaroxaban (Xarelto)
dabigatran (Pradaxa)
HWL ARD
Defibrillation in pediatric vs adult patients, number of joules to use?
Pediatric: 2-4, then 4, then 4-10
Adults: Biphasic 120-200, Monophasic 200-360
When is Sodium Bicarbonate used in Cardiac Arrest?
dose?
For metabolic acidosis induced cardiac arrest.
 Sodium Bicarbonate Dose = 1mEq/kg
Anti arrhythmic medication used in cardiac arrest?
Dose?
Alternative med and dose?
Amiodarone 300mg
or Lidocaine 1-1.5mg/kg for refractory VF
Maternal Cardiac Arrest complications?
CPR adjustments?
Abruption, Eclampsia, DIC, Embolism
Provide chest compressions HIGHER and manually DISPLACE UTERUS to LEFT to prevent vena cava syndrome. Prepare for emergency C-section.
Stable Tachycardia (alert, normo-tensive) line of treatment?
vagal maneuvers for narrow complex tachycardia
Adenosine 6 mg (then 12) for narrow SVT or monomorphic wide complex tachycardia
calcium channel blockers (Cardizem) or beta blockers (labetalol) for stable SVT
Amiodarone 150 mg for stable ventricular tachycardia
Unstable Tachycardia (SVT or VT - has pulse, conscious but crashing) treatment?
Cardioversion
Medications that Prolong QT Interval?
A antiArrhythmics (sotalol amiodarone procainamide)
B antiBiotics (Fluoroquinolones macrolides aminoglycosides) Erythromycin levofloxacin ciprofloxacin
C antiCycotics (Haloperidol risperidone Thorazine Geodon) lithium
D antiDepressants (SSRI’s, TCA’s)
E antiEmetics (ondansetron Compazine droperidol)
Tosades de pointes treatment,
with pulse?
without pulse?
Pulse Present = Cardioversion and Magnesium sulfate
Pulseless = CPR, DEFIB, MAGNESIUM
Pregnant, suspect vena cava syndrome…Nursing Intervention?
Turn patient on side (Left preferred) to relieve pressure on superior and inferior vena cava (aortocaval syndrome)
Hemorrhagic hypovolemic shock, treatment?
Want to avoid what 3 lethal triad symptoms?
Transfuse BLOOD PRODUCTS (Do not dilute with normal saline it increases the risk of lethal triad)
Hypothermia
Acidosis
Coagulopathy
What is common after massive transfusion protocol?
 hypocalcemia
Diagnoses that cause stridor from upper airway obstruction?
Croup (LTB)
Epiglottitis
Anaphylaxis
Wheezing in lower airway, diagnoses?
Asthma
Bronchiolitis
CO2 poisoning, effects on oxygen saturation?
SPO2 is unreliable, arterial PaO2 is reliable
Carbon Monoxide poisoning = CO binds to hemoglobin and impairs the ability of hemoglobin to release oxygen = pulse oximeter can’t distinguish between carboxyhemoglobin and oxyhemoglobin = will give falsely high reading
Long Bone Fracture, risk of? hallmark sign?
Fat Emboli (typically seen 12-48 hours post fracture)
Hallmark Sign: Petechiae (chest and axillary), watch for hypoxia
Chest wall bruising, indicative of?
Pulmonary Contusion
Epidural Hematoma, attributes?
sudden LOC or
short period of unconsciousness followed by lucid. And subsequent deterioration
increased ICP: Cushings Triad
Increased ICP Treatment?
Mannitol or Hypertonic Saline = effective if urine output increases
Administer sedation and pain meds (especially prior to suctioning)
Head elevated at 30 degrees or flat, don’t flex knees
Maintain head in neutral midline position
Minimize external stimulation (minimal light and noise)
Monitor ICP: 5-15mmHg
Monitor CPP (Cerebral Perfusion Pressure: MAP minus ICP): 60-100mmHg
Keep SBP above 100 (to maintain cerebral perfusion pressure) may need vasopressors
Keep all these pressures in tight window = too much raises ICP & too little = may lead to ischemia
May need ventricular shunt to help drain CSF
Consider neuromuscular blockade if unresponsive to other treatment
Central cord, SCI, Symptom?
Loss of motor and sensory function, more pronounced in arms and legs.
Can walk to the table, but can’t eat.
Posterior cord SCI, symptoms?
loss of proprioception, vibration, fine touch, and find pressure. Intact motor function, pain & temp sensation.
Rebound tenderness in abdomen, fever, gaurding, can be a sign of?
peritonitis- Inflammation of the peritoneum from ruptured appendix, pancreatitis, penetrating trauma, or peritoneal dialysis
steady periumbilical pain (early), RLQ pain (later), rebound tenderness, nausea, sx of?
appendicitis
how do you diagnose an arterial clot?
tx?
ABI’s
Tx: Embolectomy
A patient who has chest pain and palpitations is given a dose of adenosine (Adenocard) by rapid IV push.
The optimal outcome is?
the supraventricular tachycardia resolves
A decrease in chest pain and an improvement in systolic blood pressure are benefits that can be derived from adenosine therapy in a patient with supraventricular tachycardia (SVT). However, resolution of the tachydysrhythmia is the desired endpoint and indicates drug effectiveness. A transient decrease in heart rate following adenosine administration, even frank asystole, indicates the drug has reached the heart, but this is not the endpoint of therapy. Adenosine (Adenocard) should be given until conversion occurs or maximum dose is given
Nitroglycerin reduces myocardial oxygen consumption because its primary effect is to?
reduce preload
By promoting vasodilation, nitroglycerin reduces blood return to the heart. The reduction in preload means that the heart does not have to work so hard. When the heart’s workload is decreased, myocardial oxygen consumption drops and cardiac output usually improves.
A patient admitted in hypertensive emergency is given a nicardipine (Cardene) drip.
Treatment has been effective if the patient’s mean arterial pressure decreases by?
20% to 25% over 1 to 2 hours.
The therapeutic intervention should be limiting the decrease in blood pressure to 25% within the first 2 hours of treatment. Rapid reduction of blood pressure slows the progression of end organ damage.
A trauma patient is in the emergency department with suspected cardiac tamponade. The nurse should prepare to treat this condition with?
pericardiocentesis.
Pericardiocentesis involves placing a drain (needle or catheter) through the chest wall and into the pericardial space in order to drain accumulated fluid. In a trauma patient, the involved fluid is blood. Blood can accumulate rapidly in the pericardial sac, a fairly nondistensible structure, causing the ventricles to both fill and empty poorly. This produces an acute decrease in cardiac output. Needle thoracostomy is indicated for the relief of tension pneumothorax (not a simple pneumothorax). Antidysrhythmic drugs treat dysrhythmias, and transthoracic pacing is for patients with inadequate conduction system activity.
When caring for a patient with a suspected blunt cardiac injury, the nurse should FIRST prepare to administer?
supplemental oxygen.
Blunt cardiac injury, formerly referred to as cardiac contusion or myocardial contusion, is best diagnosed with an echocardiogram and is treated symptomatically. The patient’s cardiac rhythm should be monitored, supplemental oxygen should be administered, and the patient’s musculoskeletal chest pain should be treated. Dysrhythmias (premature ventricular complexes) are common, but are rarely treated unless they interfere with hemodynamic stability.
Which is MOST characteristic of early left ventricular failure?
nocturnal dyspnea
Left ventricular failure causes blood to back up into the lungs. This can produce paroxysmal nocturnal dyspnea. The other findings listed are symptoms of right sided heart failure. In LATE left ventricular failure, the right heart will also fail and will then produce peripheral edema, jugular vein distention, and expiratory wheezing (cardiac asthma).
Chronic arterial insufficiency of the lower extremities is characterized by?
intermittent claudication.
Claudication is caused by poor tissue perfusion or ischemia due to gradual enlargement of atheromatous plaques.
The MOST beneficial action of morphine in the treatment of pulmonary edema is to?
decrease preload.
Morphine sulfate has several beneficial effects in the patient experiencing pulmonary edema, particularly pulmonary edema due to heart failure. Morphine reduces pain and anxiety but, most importantly, by increasing venous capacitance (through vasodilation), less blood is delivered to the lungs.
Which type of breath sounds would MOST likely be heard in a patient who has acute pulmonary edema?
bilateral crackles (rales)
Increased fluids in the lungs cause crackles, wheezes, and productive cough with frothy white sputum that may have a pink tinge to it. Stridor is a sign of upper airway obstruction.
Hypovolemic patients who require massive transfusions should be given warmed blood because cold blood?
increases the risk of myocardial dysrhythmias.
Rapid infusion of large amounts of cool or cold fluids results in iatrogenic hypothermia. The cardiovascular system is particularly sensitive to hypothermia. The cold heart becomes irritable. A variety of dysrhythmias may be seen.
Which drug is commonly used to treat symptomatic bradycardia?
atropine sulfate
Atropine sulfate is the drug of choice for the treatment of symptomatic bradycardia. Other therapies for bradycardia include pacing, sympathomimetic agents, and oxygenation (particularly in children).
A patient complains of chest pain that worsens with inspiration or lying supine and lessens by leaning forward. The nurse should suspect?
pericarditis.
Chest pain that worsens with inspiration or lying supine and lessens by leaning forward is a classic description of pericarditis. Costochondritis worsens with manual pressure against the anterior chest wall. Pleuritic pain is aggravated by deep inspiration. Endocarditis is generally painless but is often associated with systemic illness.
narrow complex tachycardia with a heart rate of 200 beats/min and a blood pressure of 90/60 mm, administer which medication?
adenosine
An infant in shock symptoms?
lethargic and have mottled skin and poor capillary filling.
Shock is inadequate tissue perfusion. As vital organ perfusion decreases, compensatory mechanisms shunt blood to the core resulting in cool, mottled skin and decreased peripheral pulses. Decreased perfusion to the brain may initially cause restlessness, but will ultimately cause lethargy as the shock state overwhelms the infant’s ability to compensate.
- A nebulized bronchodilator is administered to a 6-year-old child with severe asthma. Treatment may be deemed effective if the patient has which of the following?
a respiratory rate that has decreased to 14 breaths/min.
a prolonged expiratory phase.
diminished breath sounds bilaterally.
an increased peak expiratory flow rate.
Peak expiratory flow rate can be used in children over the age of 5 and is used to monitor response to therapy for an acute episode of asthma, but is not designed to be a diagnostic too. The hallmark of asthma diagnosis is spirometry before and after bronchodilator therapy to document reversibility of airway narrowing, usually by peak expiratory flow rates.
A patient who sustained major trauma has a blood pressure of 84/56 mm Hg, a heart rate of 124 beats/min, and respirations of 42 breaths/min. Breath sounds are absent on the left side, the trachea is deviated to the right, and the left thigh is deformed. The nurse should FIRST prepare to assist with?
needle decompression.
Following the ABC of assessment, the priority for this particular patient is breathing. This patient’s respiratory status is compromised due to a tension pneumothorax for which immediate needle decompression is indicated.
The MOST common finding (sx) in pulmonary embolism?
dyspnea
Appropriate nursing care for a child who has gastroenteritis includes instructing the parents to?
follow clear liquid diet
withhold dairy products.
Only clear fluids should be given until vomiting has ceased. Plain mashed potatoes are appropriate after the acute phase. Oral fluids should never be withheld from a child with gastroenteritis unless the patient is receiving an adequate amount of intravenous fluids.
A patient who has a serum potassium level of 2.6 mEq/L should be MOST closely monitored for?
weakness of the respiratory muscles.
Respiratory muscle weakness related to hypokalemia may lead to respiratory failure or death.
Polystyrene sulfonate resin (Kayexalate) is ordered for a patient who has a serum potassium level of 8.6 mEq/L because the drug?
exchanges sodium for potassium ions.
Kayexalate is used in the treatment of hyperkalemia because it is a cation exchange resin. Given orally or rectally, the resin is combined with potassium in the colon. The potassium is eliminated in the body through the feces.
Which IV solution is appropriate for INITIAL resuscitation of patients who have major burns?
lactated Ringer’s
or
0.9% normal saline
Replacement of intravascular volume is the priority intervention for the patient with a thermal injury.
Isotonic crystalloid solutions, such as lactated Ringer’s or 0.9% normal saline, are recommended for fluid resuscitation.
A patient who has ingested antifreeze is undergoing treatment.
An indication that further treatment is needed is?
metabolic acidosis
Ethylene glycol is metabolized to produce glycolic acid that results in metabolic acidosis.
differentiate tonsillitis from peritonsillar abcess/sx of peritonsillar abscess?
peritonsillar abcess involves deep soft tissue, narrowing the airway causing, muffled or “hot potato” voice
Normal fetal heart rate?
120-160
antidote for magnesium toxicity?
calcium gluconate
HELLP syndrome symptoms?
Associated with?
HELLP =
Hemolysis
Elevated liver enzymes
low platelets (DIC)
associated with preeclampsia
RUQ Pain
postpartum hemorrhage treatment?
fundal massage, oxytocin, blood products
Salicylate overdose sx?
tx?
Sx: tinnitus, hypoglycemia, N/V, abd pain, tachypnea to compensate for metabolic acidosis
Tx: sodium bicarb
S- sodium bicarb
A- abd pain/GI
L - low sugar
TI - tInnitus, tachypnea
antidote for benzos?
Flumazenil (Romazicon)
forgein body such as splinter, avoid?
soaking. remove vegetative material first, avoid soaking because it may cause swelling
Central retinal artery occlusion (CRAO) what is it? tx?
loss of perfusion to retina (may be d/t clot)
circulation must be restored within 60-90 minutes to prevent blindness (HIGH TRIAGE PRIORITY)
Tx: sublingual nitro to dilate vessel, digital massage, topical beta blocker, fibrinolytics
To maximize cardiac output & improve tissue perfusion during cardiogenic shock what medication is given (type and name of medication)?
Positive Inotrope = Dobutamine = Increases Contractility
Would also give:
NTG & Diuretics = Decrease preload
NTG or Nitroprusside = Decrease afterload
Nitroprusside (Nitropress) has a strong preload and afterload REDUCTION
*Has a RAPID ONSET = TITRATE SLOWLY = to avoid hypotension
Should have Art line if infusion started
most likely fracture associated with child abuse?
spiral fx
Child size ET tube?
5.5
cyanide poisoning sx?
smell bitter almonds
Heart Transplant Bradycardia Treatment?
Isoproterenol (Isuprel)
Atropine not effective d/t no vagus nerve
side effect of Tensilon, given to test for myasthenia gravis?
how to treat?
cholinergic crisis
treated with atropine
anthrax poisoning sx?
dry cough
fatigue
mediastinal widening
Medication to avoid durning thyroid storm?
Aspirin
Can displace thyroid hormones & make condition worse
TPA bolus dose percentage?
10% of total dose
Given over 1 minute
Diabetes Insipidus
What is it?
Sx?
Tx?
Lab Values?
Decreased ADH (vasopressin) = Kidneys Make a lot of urine = Dry Inside, Dehydrated
Sx: Drinking a lot (thirsty), Draining a lot (High Urine Output), Dehydrated skin/mucous membranes, Decreased BP,
Tx: Desmopressin (Synthetic ADH)
Labs: “High & Dry”, Hypernatremia, High Serum Osmolality, Low Urine Osmolality & Low Specific Gavity
SIADH
what is it?
Sx?
Tx?
Lab Values?
Excessive ADH Secretion = “SOAKED INSIDE”
Sx: Low or No Urine Ouput (sticky, thick urine), Seizures, Headache, Confusion, Severe Hypertension
Tx: Stop fluids (oral & IV) & give IV 3% Saline, Give Salt & Diuretics, Strict I&O, Daily Weights
Labs: Hyponatremia, Low serum osmolality, High Urine Osmolality & High Specific Gravity
Classes of Hemorrhagic Shock?
I: cool, pink, slightly anxious, normal BP/HR, 15% blood loss,
II: cool, pale, mildly anxious, normal BP, HR 100+, 15-30% blood loss
III: cold, pale, anxious/confused, low BP, HR 120+, 30-40% blood loss
IV: cold, clammy, cyanotic, confused, low BP, HR 140+, +40% blood loss
Obstructive Shock examples?
Resistance to ventricular fillling
Systemic vascular resistance (or afterload pressure) is INCREASED (HIGH)
ex. pericardial tamponade, tension pneumo, massive PE, supine vena cava syndrome, abdominal compartment syndrome
Distributive Shock
Maldistribution of blood
Systemic vascular resistance (or Afterload pressure) decreased (Low) due to Vasodilation
Examples: Neurogenic, Septic, Anaphylactic Shock
most common dysthymia with blunt cardiac injury?
sinus tachy with pvc’s
Serotonin Syndrome
caused by?
Sx?
from SSRI’s
Sx: Fever/Hyperthermia, Agitation, Hypereflexia (no rigidity)
SHIVERS: Shivers, Hyperreflexia, Increased Temp, Vital signs unstable, Encephalopathy, Restless/agitation, Sweating
St. Johns Wort can make worse
Rib Fractures
Most Common Thoracic Injury
1-2: Aortic Dissection. Highest Mortality (1-3).
4-9: Most frequently fractured. Pulmonary Contusion
9-12: Spleen, Liver, Renal (if posterior) Injuries
Labyrinthitis
Sx?
Tx?
severe dizziness/vertigo
unilateral nystagmus
decreased hearing on affected side
Tx: meclizine, phenergan, scopalomine
Nicardipine, Calcium channel blocker, used to treat?
Cerebral Aneurysm Rupture/Subarachnoid Hemorrhage
Ethylene Glycol (Anti-freeze) and Methanol (ex. windshield washer fluid, perfumes) ingestion Antidote?
Fomepizole (Antizol)
Methanol (ex. windshield washer fluid, perfumes) ingestion early sx?
visual disturbances (“snowfield”, “snow blindness”)
drowsy, headache, dizzy
Pericarditis EKG Findings?
Tx?
Global ST Elevation
Tx: Oxygen, NSAIDS, Steroids
SBO early sign during assessment of patient?
high pitched bowel sounds
Hyperosmolar Hyperglycemic Syndrome Sx?
Confusion
Decreased LOC
Diltiazem (Calcium Channel Blocker) Overdose Sx?
Tx?
Hypocalcemia —> facial twitching, muscle contractions/spasms, tetany, hyperactive deep tendon reflexes, numbness/tingling, prolonged QT
Tx: Calcium Gluconate
Right Ventricular MI patient becomes hypotensive, to increase preload administer?
Isotonic Fluid Bolus (0.9 NS, LR)
Adverse effect of morphine?
histamine release which causes rash and urticaria
Esophageal Varices Tx medication? (name 2)
Octreotide (sandostatin) = inhibits acid secretion & prevents dissolution of clots at bleeding site
or vasopressin (ADH) = vasoconstrictor
Hypothyroid tx?
Hypothyroid = Low levels of thyroid hormone
Tx: Levothyroxine, rewarming, monitor ABC’s
Cardiac Tamponade
As little as ______mL can have detrimental effect on cardiac output
100-150mL
Troponin,
elevated?
peak?
Cardiac Biomarkers
Troponin:
Elevated 3-12 Hours After Infarct
Peak: 10-24 Hours After Infarct
May stay elevated for 9 days
CKMB
elevated?
peak?
CKMB:
Elevated 4-12 Hours After Infarct
Peak: 10-24 Hours After Infarct
Should return to normal within 72 hours
Epididymitis
Sx?
may be caused by which STD’s?
Tx?
Gradual onset over a couple days
Scrotal pain relieved with elevation, urinary frequency, urethral discharge
Infection of epididymus, may be d/t std (chlamydia or gonnorhea)
Tx: Abx & NSAIDS
Gonnorhea
Sx?
Abx?
Itchy, Red Rash
Men = burning with urination
Tx: Cephtriaxone (Rochepin), Cefixime
Globe Rupture sx?
Teardrop shaped pupil, Vitreous Humor Leak
Pyloric Stenosis
Tx?
projectile non-bilious vomiting, continual hunger
Tx: IVF, prep for surgery to dilate pylorus
Myasthenia Gravis
Sx?
How you Dx? risk?
Hallmark Sign = Neuromuscular Weakness: Ocular (Ptosis), Facial, Neck, Upper Extremities
More Females
Typically Ages 20-30
Neuromuscular Disorder: Communication between nerve & muscle cells becomes impaired
Drug Tensilon given to test for disease, but a side effect of Tensilon is cholinergic crisis which is treated with atropine.
Meneires Disease
what it is?
Sx?
Tx?
Disorder of inner ear, fluid build up in Labyrinth
Sx: Vertigo, Tinnitus, Hearing loss
Tx: Meclizine-Antihistamines, Benzos, Anticholinergics (for N/V), Diuretics (to decrease inner ear volume)
Posterior Cord Syndrome
Loss of proprioception, vibration, fine touch, & fine pressure
Intact Motor Function, Pain & Temperature Sensation
Anterior Cord Syndrome (Opposite of Posterior)
Loss of motor function, pain, & temperature, but retains proprioception
Poor prognosis for rehabilitation
Generally, the result of a hyperflexion injury
Bells Palsy
cranial nerve?
can be caused by?
Temporary unilateral paralysis of facial nerve (VII)
Often the result of Herpes Simplex Virus
Frontal Lobe functions?
Short-term Memory
motor speech
personality
judgement
Basilar Skull Fracture Sx?
Sign = CSF in the ears or nose = halo sign (bloody drainage)
Periorbital Ecchymosis (Racoon’s eyes), Mastoid Ecchymosis (Battle’s sign)
Can cause injury to cranial nerve
Subarachnoid Hemorrhage (SAH)
characteristic complaint?
leading cause?
Tx?
Leading non-traumatic cause = Cerebral Aneurysm
“ Worst headache of my life”
Tx : Calcium Channel Blockers (Nicardipine)
Rare type of stroke (makes up only 3% strokes)
High rate of disability & mortality (about 50%)
Subdural Hematoma
Venous bleed
slower, steady decline in LOC
often: elderly on anticoagulants, alcoholics, shaken impact syndrome
Tension Headache
sx?
cause?
tx?
Most common type of headache
Dull ache or squeezing
Often caused by physical or emotional stress
Tx: identify causative factors, NSAIDS, Tylenol
Migrane Headache
Sx?
Tx?
Sx: Unilateral, Pulsating headache, Sensitive to light & sound
Tx: Sumatriptan, Dihydroergotamine (anelgesic nasal spray), Journal Triggers
Trigeminal Neuralgia
Sx?
Cranial nerve?
Sudden, unilateral, stabbing pain (brief, but recurrent)
Complications with Sensation to Scalp, Face, & Cornea
Cranial Nerve V
Temporal Arteritis
what is it?
sx?
dx?
tx?
Temporal arteries which supply blood to the head & brain become inflamed or damaged
Sx: Severe Throbbing Temporal Pain, May have Vision & Hearing loss, Palpable cordlike artery
Vision loss can occur d/t ischemic optic neuritis
Diagnosed: artery biopsy
Tx: Steroids (given immediately to prevent vision loss)
Pregnancy Considerations
Circulating blood volume?
Cardiac output?
Heart rate?
Blood pressure?
Circulating blood volume increases 40%
Cardiac output increases by 30%
Heart rate increases 15 to 20 beats a minute
Blood pressure decreases 15-20mmHg
Ectopic Pregnancy
Tx?
Tx: Methotrexate
tubal ovarian abscess sx?
pelvic pain
purulent vaginal discharge
Acute Adrenal Crisis
caused by?
Labs?
Sx?
May be caused from abrupt discontinuation of long term steroids due to decreased cortisol levels
Seen in Addison’s disease (Adrenal Insufficiency)
Labs: Hyponatremia, Hyperkalemia, Hypoglycemia
Sx: weakness, weight loss, fatigue, Orthostatic Hypotension, N/V/D or C
Tx: Hydrocortisone, Florinef (glucocorticoid), IVF, electrolytes
Hepatitis B
Body Fluids (Sex, IV drugs)
+Vaccine
Hepatitis C
Circulation (Blood)
Tx: chronic interferon
No Vaccine
Trichomoniasis
Sx?
Tx?
Sx: Vulvar Irritation
Painful Intercourse
UTI
discharge
Tx: Metronidazole (Flagyl)
Chlamydia Sx?
Can progress to?
75% Asymptomatic
Sx: Cervix Erythema
Can cause PID, Endometriosis, Cervicitis
Volvulus
Tx?
projectile bilious vomiting, visible peristaltic waves, abd distention
bowel malrotation, twisting, knotting resulting in strangulation
Requires immediate surgery
Intussuseption
Sx?
Tx?
Telescoping of bowel
Currant Jelly (red mucous) Stool
Vomiting
May palpate sausage shaped stool mass
Tx: if stable = air or barium enema, or may require surgery
