CEN BOOK REVIEW Flashcards by Kelly Linskey

What is the first priority?

Airway unless pt is bleeding out or on fire

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MAP Formula

Systolic + (2 x Diastolic) / 3

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Pulse pressure formula

Systolic pressure minus diastolic pressure

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What kind of pulse pressure is seen in early septic shock? What kind of pulse pressure is seen in early hypovolemic shock?

Septic = widened

Hypovolemic = narrowing

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What kind of pulses indicate shock states?

Weak peripheral + strong central

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Formula for acceptable systolic BP in kids <10yo

70 + (age x 2)

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What kind of patients are always an emergency and should not be put back in the waiting room?

neutropenic patients

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Primary + Secondary Survey

A: airway
B: breathing
C: circulation
D: disability
E: exposure/environmental
F: full set of VS/family
G: get adjuncts:
L: labs
M: monitor
N: NG/OG tube
O: oxygenation/ventilation
P: pain control
H: head to toe
I: inspect posterior surface (always check for pelvic injuries first!)

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Left-sided EKG lead placement:

Right-sided EKG lead placement:

Posterior EKG lead placement:

V1 & V2: b/l sternal borders 4th ICS

V3: b/t V2 & V4

V4: 5th ICS MCL

V5: 5th ICS b/t V4 & V6

V6: 5th ICS MAL

V4R: 5th ICS right MCL

V5R: 5th ICS b/t V4R & V6R

V6R: 5th ICS right MAL

V7: posterior axillary line, same plane as V5 & V6

V8: tip of scapula, same plane as V7

V9: left of vertebral column, same plane as V8

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Anterior MI affected artery

Left anterior descending - may cause left ventricular failure

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Lateral MI affected artery

Circumflex

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Posterior MI affected artery

Right coronary artery
S&S: bradycardia, heart blocks
Need posterior EKG (leads V7, V8, V9)

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Inferior EKG affected artery

Right coronary artery
S&S: heart blocks

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Right ventricular EKG affected artery

Right coronary artery
Possible right ventricular failure
Common with inferior MI
Need right-sided EKG if suspected

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4 symptoms of right sided HF

4 symptoms of left sided HF

Right = extremity swelling, ascites, hepatomegaly, JVD

Left = pulm edema, orthopnea, dyspnea, rales/crackles

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Hs (6) & Ts (6)

-Hypovolemia
-Hypoxia
-Hypo/hyperkalemia
-Hypothermia
-Hydrogen ions (acidosis)
-Hypoglycemia

-Thrombus (MI/PE)
-Tension PTX
-Tamponade (cardiac)
-Tablets (OD)
-Toxins
-Trauma

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flexion in upper extremities pulling to the core, damage to the core of the brain = above brain stem

Decorticate Posturing

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extension of the upper extremities, damage is lower in the brain in the midbrain and brain stem

Decerebrate Posturing

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3 symptoms of cushings response seen with increased ICP?

-widened pulse pressure
-bradycardia
-bradypnea

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One episode of decreased BP can be catastrophic in head injury pts. Maintain systolic BP above what?

100

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What 3 CN are responsible for EOM?

III (oculomotor)
IV (trochlear)
VI (abducens)

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What cranial nerve is responsible for the majority of parasympathetic activity? What will stimulation of this CN cause?

X vagus

Bradycardia and hypotension

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What CN is responsible for constriction of the pupil?

III oculomotor

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How many branches does CN VII have? What 2 things is it responsible for?

5 branches; facial movement and sensation

What should we not do to an infant to open the airway?

Hyperextend the neck

Name 7 S&S of respiratory distress in an infant

-nasal flaring -grunting -head bobbing -retractions -stridor -tachycardia -tachypnea

What can diarrhea in an infant cause?

Metabolic Acidosis

What med do we treat esophageal varicies with?

Octreotide (sandostatin)

What is the sequence of an abdominal assessment?

1- inspect 2- auscultate 3- percuss 4- palpate

Focused Assessment with Sonography for Trauma (FAST) is not considered positive for bleeding unless how many mLs are identified?

200mL

A FAST exam can product false negatives for what 2 things?

Hollow organs Retroperitoneal injuries

What does the os look like for a threatened abortion? An inevitable abortion?

Threatened = closed os Inevitable = open os

What bpm are normal fetal heart tones?

120-160

What drugs clear from the body quickly so specimens must be collected early?

date rape

What will morning after pills also need a prescription for?

antiemetic

Apgar score: Appearance (color)

0 = blue/pale 1 = acrocyanotic (bluish discoloration in extremities) 2 = completely pink

Apgar score: Pulse (HR)

0 = absent 1 = <100bpm 2 = >100bpm

Apgar score: Grimace (reflexes)

0 = no response 1 = grimace 2 = cry or active withdrawal

Apgar score: Activity (muscle tone)

0 = limp 1 = some flexion 2 = active motion

Apgar score: Respirations

0 = absent 1 = weak cry, hypoventilation 2 = good, crying

What complications of an eating disorder should we look for in the ER? (6)

-electrolyte disorders -cardiac dysrhythmias -esophageal rupture -Mallory-Weiss tears -pneumomediastinum -cardiomegaly

What is the treatment for an anticholinergic OD (TCAs)? Cholinergic OD (insecticides/sarin gas)?

Sodium Bicarb Atropine

Hypovolemic shock can occur as a result of acute blood loss and what other things?

relative loss of volume in situations such as burns, ascites, other cases of 3rd spacing

Suture removal times: Face ? Scalp ? Hands/Feet ? Joints ? Extremities ?

Face = 3-5 days Scalp = 7-10 days Hands/Feet = 7-10 days Joints = 14 days Extremities = 10-14 days

What 2 maxillofacial problems can become airway issues?

Ludwigs angina PTA

What is a normal IOP? What is it measured with?

10-21 tonometer

What EKG change is seen with hypothermia?

J-wave (small positive deflection b/t QRS and ST segments)

What kind of bites can cause DIC?

Brown recluse spider

Lyme disease can have what 5 long term effects?

-meningitis -AV blocks -cardiomyopathies -encephalopathies -psych problems

Is there a vaccine for Hep C? What can Hep C progress to?

No vaccine Can progress to cancer or cirrhosis

What should we avoid using when handling bullets?

Metal forceps - can change markings on the side of the bullet

What terms should be avoided when describing bullet wounds?

extrance/exit

What kind of bags must be used for evidence handling?

Paper

What should be avoided in GSW victims? What can we place over the hands to protect possible evicence?

Washing hands Paper bags

Ethical principle of nursing: personal freedom/providing education so patients can make their own informed decisions

Autonomy

Ethical principle of nursing: good actions are for the benefit of the patient and prevention of harm

beneficence

Ethical principle of nursing: doing no harm/avoiding harmful actions

nonmaleficience

Ethical principle of nursing: caring for all individuals the same/fairness

justice