Cardiac and chest tube Flashcards
What do Calcium Channel Blockers (CCB) do? What do they end in?
Slow and relax the heart (negative inotrope, chronotrope, and dromotrope)
-DIPINE (plus diltiazem)
What do CCB treat?
Antihypertensives
AntiAnginal drugs
AntiAtrialArrythmia
A, AA, AAA
What are the SE of CCB? What should you measure prior to giving it?
Headache and Hypotension
Check BP and hold if SBP is less than 100
QRS depolarization means….
P wave means….
QRS depolarization means ventricular
P wave means atrial
P wave in the form of saw tooth
Atrial flutter
Chaotic P Wave pattern
atrial fibrilation
Chaotic QRS complexes
ventricular fibrillation
Bizzare QRS complexes
Ventricular tachycardia
Periodic wide bizarre QRS complexes? When are these a low priority? When are they a moderate priority? When are they a high priority?
PVC
PVCs after an MI is common and is a low priority
Only a few
6 or more PVCs in a minute
More than 6 PVCs in a row
R on T phenomenon (a PVC falls on a T wave)
Never a high priority
What are the 2 lethal rhythms? Why?
Asystole and V-fib
Both are not giving very low or no CO –> confusion and death
What is a potentially lethal cardiac arrhythmia?
V-tach but only potentially b/c it has CO
When the pulse is present there is…. when the pulse is not present there is….
When the pulse is present there is CO, when the pulse is not present there is not CO
What is the treatment for PVCs and V-tach?
Amiodarone
What is the treatment for supra ventricular/atrial arryrthmias?
ABCDs
Adenosine - push in less than 8 seconds followed by 20 mL NS
Beta-blockers
CCBs
Digoxin/Lanoxin
What are the 2 treatments for A, AA, AAA?
CCB
BB
Both do the same thing with the same side effects
What is the treatment for V-fib?
Defib for V-fib
What is the treatment for Asystole?
Epinephrine FIRST then Atropine
The purpose if a chest tube is to..
Reestablish negative pressure in the pleural space so that the lung expands when the chest wall expands
A chest tube will remove what in a pneumothorax? Hemothorax? Hemopneumonthorax?
Removes air in a pneumothorax
Removes blood in a hemothorax
Removes air and blood in a hemopneumonthorax
An apical chest tube removes… and a basilar chest tube removes…
Apical (top) - removes air therefore should bubble
Basilar (base) - removes blood or fluid therefore should not bubble
If the question does not specifically state that it is unilateral or bilateral what do you assume?
ALWAYS assume it is unilateral
If a closed drainage device (JP, hemovac, pneumovac, ect..) gets knocked over what do you do?
Ask the patient to take a few deep breaths
NOT a medical emergency so DONT call the Dr
If the water seal of the chest tube breaks you should? How fast does this need to get done?
Clamp with rubber tooth double clamps, cut the tube, submerge tube in sterile water, unclamp
Needs to be done within 15 seconds b/c tube cannot be clamped for longer than that
If the chest tube gets pulled out what is the first thing you should do? What is the priority if a chest tube gets pulled out?
Take a gloved hand and cover the opening (first step)
Take a sterile Vaseline gauze and tape 3 sides (best step)
When should the water seal chamber bubble in a chest tube?
Should bubble intermittent
If there is a continuous bubble then there is a leak. Find it and tape it
When should the suction control chamber bubble in a chest tube?
Should bubble continuously
If intermittent then suction is too low so increase it on the wall
If a congenital heart defect is TRouBLe then that means you tell the parents..
Needs surgery now/soon to live
Has slowed/delayed growth and development (failure to thrive)
Has a shortened life expectancy
Parents will experience a lot of grief, financial and emotional stress
Pt is likely to be discharge home on a cardiac monitor
After, birth, pt will be in the hospital for weeks
Pediatrician or pediatric nurse will likely refer pt to a pediatric cardiologist
A TRouBLe congenital heart defect will shunt blood _____ to _____ leading to ______
A TRouBLe congenital heart defect will shunt blood right to left leading to blue/cyanosis
All TRouBLe heart defects start with the letter…
T
Tetralogy of Fallot
Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia
Totally anomalous of pulmonary vasculature (TAPV)
If a congenital heart defect does not start with a T, then what does that mean?
It is not trouble and it is a left to right shunt
Whether or not a child has a TRouBLe congenital heart defect or a no TRouBLe congenital heart defect they will ALWAYS have what 2 things?
A Murmur d/t shunting of blood
An echocardiogram need to be done to find out the cause of the murmur
What are the 4 defects of Tetralogy of Fallot?
Pulmonary artery stenosis
RVH (right ventricular hypertrophy)
Overriding aorta
VSD (ventricular septal defect)
Ways to remember: PROVe, VarieD, PictureS Of A RancH
What diseases are on contact precautions?
Anything Enteric (GI/fecal/oral) - C.Diff, Hep A, E.Coli, cholera, dysentery
Staph
RSV (transmitted via droplet but pt touches object then mouth)
Herpes including herpes zoster (shingles)
What is the PPE for contact precautions?
Private room preferred but can be in same room based on culture result NOT based on s/s
Disposable supplies like paper plates
Dedicated equipment (BP cuff, stethoscope)
Gown, gloves, hand wash
What diseases are droplet precautions?
Anything traveling on large particles from coughing or sneezing less than 3 feet
Meningitis
H. influenza B (lead to epiglottis where nothing should be put down the throat)
What is the PPE for droplet?
Private room preferred but can be in same room based on culture result NOT based on s/s
Handwashing, mask, goggle/face shield, gloves
Disposable supply
Dedicated equipment
Patient wear mask when leave room
What diseases are airborne precautions?
MMR
TB
Varicella (chickenpox)
Air MTV
What is the PPE for airborne precaution?
Private room preferred but can be in same room based on culture result NOT based on s/s
Handwashing, N95 respirator, goggle/face shield, gloves
Disposable supply - not essential
Dedicated equipment - not essential
Patient wear mask when leave room
Negative airflow room
Order of putting on PPE
Gown
Mask
Goggle
Gloves
What is the order of removing PPE?
Gloves
Goggle
Gown
Mask
