Cardiac/ chest tubes/ infection precautions Flashcards
1
Q
calcium channel blockers (CCB) are like a
A
depressant
2
Q
uses of CCB
A
- they are negative inotropics, negative dromotropics, and negative chromotropics meaning they calm the heart
- weakens, slows down, and depresses the heart
3
Q
what do CCB treat
A
- A, AA, AAA
- anti hypertensive (relaxes heart and blood vessels = decreased BP)
- anti angina = Decreases 02 demand by relaxing heart
- anti atrial arythmia: treats everything atrial related (including SVT- s= above, v= ventricles, T = tachycardia)
4
Q
side effects of CCB
A
- headache due to the vasodilation in the brain
- hypotension
5
Q
CCB names
A
- dipine
- your dipping in the calcium channel
- verapamil and cardizem (continous IV drip)
6
Q
what to watch when on CCB
A
- BP
- monitor intermittenly
- if systolic is below 100 hold
- if on a drip and systolic is 98 you would titrate it down
7
Q
normal sinus rhythm
A
- evenly spaced top of the QRS
- P for every QRS
- P wave evenly spaced
8
Q
V fib
A
- this is number one priority
- no pattern (chaotic and lethal)
- there is no CO= no brain perfusion
- you need to d fib
9
Q
V tach
A
- potentially life threatening (especially with a pulse) but they still have CO and brain perfusion
- if a pulse cardiovert them
- pattern, bizzarre
- amioderone
10
Q
A flutter
A
- saw tooth
11
Q
a systole
A
- # 1 priority
- flat line (lack of QRS)
- no cardiac perfusion = no brain perfusion
- lethal, flat, give Epi
- epi then atropine if epi doesnt work (give in this order)
12
Q
SVT
A
- TX: ABCD’s
- Adenosine- push fast (normal to see asystole but they will come out of it you just have to wait and see)
- Beta blockers: “lol”- these are just like CCB with same treatment and same side effects
- CCB: better for arrhythmia’s
- Digoxin/digitalis (aka lanoxin)
13
Q
PVC
A
- never high priority
- moderate priority if you have a bunch of PVC’s (its like a short run of v tach): if more than 6 PVC’S in a minute or row and/ or if PVC falls on the t wave of the previous beat
14
Q
QRS depolarization always means
A
- ventricular
15
Q
P wave always means
A
- atrial
16
Q
lack of p wave
A
- answer is always ventricular
17
Q
chaotic =
A
fibrillation
18
Q
bizarre =
A
- tachycardia
19
Q
potentially life threatening
A
- v tach with a pulse
20
Q
lethal priority
A
- this will kill you in 8 minutes or less
- asystole, no pulse
- v fib, no pulse
21
Q
ventricular use
A
- lidocaine or amioderone
22
Q
Atrial use
A
- ABCD
23
Q
v fib use
A
- d fib
24
Q
asystole use
A
- epi and atropine
25
what do chest tubes do
- reestablish negative pressure in pleural space so the lung can expand when the chest wall moves
26
Pneumothorax
- chest tube that removes air
- report no bubbling in 2 locations
27
hemothorax
- chest tube that removes blood
- report no drainage
28
pneumohemothorax
- chest tube that removes blood and air
29
chest tube location for air
- apical (up high)
30
chest tube location for blood
- basilar (bottom of lung)
31
placement of chest tubes
- place apical and basilar on the same side of surgery
- always assume chest injury is unilateral unless specified as bilateral
32
troubleshooting chest tube: what if its knocked down
- set it back up and tell the pt to take a deep breath
- not an emergency
33
troubleshooting chest tube: water seal broken
- EMERGENCY
1. clamp the water seal
2. cut it away
3. submerge in sterilized water
4. unclamp because we reestablished the water seal
34
troubleshooting chest tube: chest tube dislodged (pulled out)
- cover it!
- FIRST: cover with gloved hand
- BEST: cover with vaseline gauze
35
troubleshooting chest tube: bubbling`
1. ask yourself where and when
a. water seal: intermittent bubbling good so document it, continuous bubbling is bad and there is a leak so tape it (if you have a good seal it shouldnt always bubble)
b. suction chamber: intermitent is bad (turn suction higher), continuous is good so document it
36
rules for clamping tubes
- never clamp for more than 15 seconds w/o DR order
- use rubber tip double clamps
37
if heart defect starts with T
- TROUBLE
38
what congenital heart defects are bad
- ones that start with a T (this is a right to left shunt so there is cyanosis- blue)
39
what congenital heart defects are not bad
- anything that doesnt start with A T: these are Left to right shunts and there isnt an oxygen issue
40
tetralogy of fallout
" VarieD PictureS OF A RancH"
1. ventricular defect
2. pulmonary stenosis
3. overriding aorta
4. right hypertrophy
41
why is right to left shunt bad
- the right side of the heart has deoxygenated blood and needs to go to the lungs
- if it bypasses the lungs and goes to the left side of the heart, this deoxygenated blood will get pumped to the body (no use for it because it isn't oxygenated)
- this is bad and needs surgery to live, short life expectancy, delayed growth and development, exercise intolerance, financial difficulties, pediatric cardiologist
42
All heart defects have
- murmor and echo done
43
IV drip rate formula
volume x drop factor divided by time in minutes
44
Contact precautions
- anything enteric
- C DIFF
-Hep (anything with vowel comes from bowel)
- herpes
- staph
- RSV (TRANSMITTED DROPLET BUT ON CONTACT)
- needs private room
- PPE: gloves, gown, disposable supplies
45
Droplet precautions
- PIMP (pertussis, influenza, meningitis, pneumonia)
- sneezing/coughing
- H-flu
- private room
- lumbar puncture for cultures for meningitis
- PPE: gown, gloves, mask, goggles, disposable supplies, pt wear mask when leave room
46
Airborne precautions
- MTV
- Measles
- Mumps
- rubella
- TB
- Varicella
-private room
- gloves, N95, gown, negative airflow room
47
Don PPE
- outside the room
- reverse ABC
- gown, mask, goggles, gloves
48
Doff PPE
- inside room except for mask
- gloves, goggles, gown, mask
- ABC order or reversed from don
