Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 2501 > Critical Care Environment > Flashcards

Critical Care Environment Flashcards

1
Q

first line drug for all emergency situations Giving a drug to treat a disorder brought on by hypoxemia without effectively correcting the cause of hypoxemia is ineffective - O2 sat >96%

A

Oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Nitrate Dilates peripheral vessels decreasing preload and afterload, reduces blood pressure ; Also dilates coronary arteries- used for chest pain  Continuous blood pressure and heart monitoring  SE: Hypotension, headache

A

Nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

narcotic analgesic to treat chest pain associated with MI and acute PE  Relieves pain and reduces anxiety, dilates venous vessels and reduces cardiac workload  SE: Respiratory depression, hypotension  Narcotic antagonist naloxone (Narcan)

A

Morphine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anticholinergic to treat bradycardia, heart block and asystole  Inhibits vagus nerve  Cardiac and blood pressure monitoring needed  SE: dysrhythmias, increased HR, ischemia, restlessness, anxiety, mydriasis, thirst, urinary retention

A

Atropine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Beta-adrenergic  To increase heart rate - temporary measure while waiting for transcutaneous pacemaker  Increases myocardial oxygen consumption, therefore, myocardial ischemia is a concern  Tachycardia, ventricular fibrillation may occur

A

Isoproterenol (Isuprel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

antidysrhythmic to treat paroxysmal supraventricular tachycardia (PSVT)  Slows conduction through AV node, interrupts dysrhythmia producing re-entry pathways and can restore NSR  Cardiac monitoring and vital signs  SE: hypotension, dysrhythmias, short period of asystole following injection

A

Adenosine (Adenocard)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • antidysrhythmic to treat supraventricular tachydysrhythmias (SVT)  Calcium channel blocker - (negative chronotropic & inotropic) - also used to treat angina  Monitor HR and BP  SE: headache, bradycardia, hypotension
A

Verapamil (Calan, Isoptin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

antidysrhythmic to treat PSVT, A-fib/flutter (with increased rate)  Calcium channel blocker - (negative chronotropic & inotropic) - also used to treat angina  Monitor BP and HR  SE: myocardial depression, bradycardia, can increase digoxin levels

A

Diltiazem (Cardizem, Dilacor XR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

antidysrhythmic to treat ventricular dysrhythmias  A fast sodium channel blocker, class 1B  Local anesthetic effect on heart; ↓myocardial irritability  Monitor cardiac and assess for S/S toxicity (confusion, drowsiness, hearing impairment, conduction defects, myocardial depression, muscle twitching, seizures)  Metabolized in liver

A

Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

antidysrhythmic to treat atrial, ventricular and supraventricular dysrhythmias  A fast sodium channel blocker, class 1A  SE – severe ↓BP, heart block, rhythm disturbance & cardiac arrest  Excreted via kidneys

A

Procainamide (Procan; Pronestyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

to correct body depletions and dysrhythmias  Works with Na+-K+ ATPase pump  Physiologic effects similar to Ca++ channel blockers with neuromuscular blocking effects  If Mg++ ↓ - atrial & ventricular dysrhythmias  Uses - ↓Mg levels; refractory VT & VF & life threatening dysrhythmias associated with digoxin toxicity and tricyclic antidepressants, torsades de pointe  SE - ↓BP, mild ↓HR, flushing, sweating

A

Magnesium sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

sympathomimetic to treat profound ↓HR, asystole, pulseless ventricular tachycardia and ventricular fibrillation (VF & VT)  Catecholamine with alpha & beta adrenergic effects  Improves perfusion of heart and brain in cardiac arrest  Requires cardiac & hemodynamic monitoring  Do not give at same site as sodium bicarbonate

A

Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

to treat metabolic acidosis  Monitor ABGs  Do not administer epinephrine, norepinephrine, or dopamine in same site

A

Sodium bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

osmotic diuretic to treat edema of CNS and other conditions  Highly irritating to veins, use filter needle  Assess neurological status, labs, serum osmolality, I/O

A

Mannitol (Osmitrol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • glucocorticoid to treat edema of CNS and other conditions  Stabilizes Na+/K+ pump – thus no excess H20 crosses cellular membrane  SE – transient ↑BP, ↑BS
A

Methylprednisolone (Solu-Medrol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

opiate antagonist  Competitively binds to opiate receptor sites  Shorter duration than many opiates, may need to repeat dosing  Can precipitate withdrawal symptoms  SE – Potential for pulmonary edema and cardiovascular collapse in some OD patients

A

Naloxone (Narcan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Reversal agent for the respiratory depressant and sedative effects of benzodiazepine medications (Valium, Versed, Librium)

A

Flumazenil (Mazicon, Romazicon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

to treat poisoning  absorbs ingested toxins in GI tract & prevents absorption body

A

Activated charcoal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

drugs should not be used to correct the hypotension associated with this condition → administer fluids or blood products

A

hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

to treat hypotension; low dose ↑urine output  Sympathomimetic  SE - ↑HR, dysrhythmias, myocardial ischemia, N/V  Assess IV site hourly for S/S of drug infiltration, extravasations causes tissue necrosis, treat extravasations with phenotolamine (Regitine) 5-10mg diluted in 10-15cc NS

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

to treat shock states with ↓CO (↑BP D/T ↑CO – no vasoconstriction)  Sympathomimetic with beta-1 adrenergic activities; beta-1 effects (↑force of contraction, ↑HR)  Requires cardiac & BP monitoring, assess for ischemia  Adverse effects are dose related – myocardial ischemia, ↑HR, dysrhythmias, headache, nausea, tremors

A

Dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

to treat hypotension  Catecholamine with potent vasoconstrictor (alpha adrenergic) effects  Requires cardiac and BP monitoring, assess for ischemia, nursing care is similar to dopamine  Additional effects – myocardial ischemia, dysrhythmias, impaired organ function; extravasation causes tissue necrosis

A

Norepinephrine (Levophed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

to treat anaphylactic shock  Bronchodilator and maintains blood pressure due to vasoconstrictive effect, also ↑cardiac performance  SE - ↑HR, dysrhythmias, ↑BP, angina

A

Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

antihypertensive to treat hypertensive crisis  Rapid acting vasodilator, acts on the smooth muscle of the vessels  Protect from light- keep wrapped with aluminum foil, medication has a faint brown color, increases cyanide levels (measure cyanide and thiocyanate levels every 24 hours)

A

Sodium nitroprusside (Nipride)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

loop diuretic  Diuretic effect  Depletes Na+ and K+ - assess electrolyte levels

A

Furosemide (Lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Indications for Arterial line

A
  1. Monitor blood pressure ( 5-15 mm Hg higher than manual ) 2. Obtain blood specimen and arterial blood gases 3. Administration of vasoactive medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A-line : insertion points

A

Radial, brachial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A-line : measurements - waveforms

A
  1. Systolic (top waveform) , diastolic( bottom ) and mean arterial pressure ( min 60 - to perfuse vital organs) * Dicrotic notch - closure of aortic valve

Small, wavy , dampened - obstruction or inducer imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

A-line : complications

A
  1. Bleeding 2. Infection 3. Thrombosis 4. Neurovascular impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Phlebostatic axis ( R atrium level ) - Level and calibrate transducer Q8hrs , when pt bed or position is changed

A

4th intercostal space on the R sternum - to the side of the pt chest midway between ant and post chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PA catheter : indications

A

for patients with complicated fluid balance conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PA catheter : measurements

A
  1. CVP - right atrial pressure 2. PAP - pulmonary artery pressure 3. PCWP - pulmonary capillary wedge pressure 4. CO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CVP

A

1-8 mmHg

34
Q

PAP

A

15/5- 25/15 mmHg

35
Q

PAWP

A

indirect measurement of left atrial pressure + left ventricular and diastolic pressure 4-12 mmHg; High - left ventricular failure , hypervolemia

36
Q

PA catheter insertion

A

jugular or subclavian veins

37
Q

PA catheter complications

A
  1. Infection 2. Air embolism 3. Pulmonary infarction or rupture 4. Ventricular arrhythmias
38
Q

Cardioversion

A

deliver a synchronized shock during QRS wave

39
Q

Cardioversion: indications

A

for unstable atrial and ventricular dysrhythmias ( pulse is present - fast rhythm) - A-fib, A-flutter, V-tach

40
Q

Cardioversion: sedate

A

IV Valium, Versed if awake ; consent

41
Q

Cardioversion : pad placement

A
  1. Upper right chest, just under the clavicle, next to the sternum 2. Left lower chest, just lateral to the precordium
42
Q

Cardioversion : monitor

A
  1. Maintain airway 2. Monitor VS & LOC
43
Q

Defibrilation

A

asynchronous electric shock

44
Q

Defibrilation : indications

A

Pulseless ventricular rhythms - Vtach & Vfib

45
Q

Defibrilation : procedure

A
  1. Biphasic -start at 200 joules ( mono - 360) 2. Perform within 15-20 sec of the onset or arrhythmia 3. CPR - Shock 4. Two minutes of CPR between shocks
46
Q

IABP - intra-aortic balloon pump - purpose

A

increased coronary perfusion - increases CO by as much as 40 % - decreases LV work and myocardial oxygen requirements

47
Q

IABP - insertion

A

through the femoral artery , threaded into the descending aorta

48
Q

IABP - diastole

A

Ventricles are filling - balloon inflates ( blocking the aorta ) - blood forced into coronary artery

49
Q

IABP - systole

A

balloon deflates when ventricles contract - creates a vacuum affect ( reduces afterload) - improves LV ejection + CO

50
Q

IABP - indications

A
  1. Failure to wean from cardiopulmonary bypass 2. Cardiogenic shock 3. HF 4. MI
51
Q

IABP - complications

A
  1. Vascular injuries 2. Displacement of balloon 4. Peripheral nerve damage + thrombus formation 5. IABP destroys platelets - thrombocytopenia 6. Infection 7. Improper timing - can increase afterload ( decrease CO ) 8. Pt is relatively immobile - HOB less than 45 ; cant flex leg
52
Q

VAD - ventricular assist device

A

TX of end stage heart failure - improve CO

53
Q

VAD used …

A

short term - bridge while waiting for a heart transplant long term - when unresponsive to medication or surgery

54
Q

VAD for L ventricular heart failure

A

more common - Tube pulls blood from left ventricle into a pump - sends blood to the aorta

55
Q

CO

A

4-7 L/min

56
Q

Amount of blood pumped from the LV each minute

A

CO

57
Q

Preload = CVP = Right atrial pressure

A

how much the myocardial fibers are stretched at the end of diastole just before the next contraction

58
Q

Amount of blood ejected with each contraction

A

SV

59
Q

Pressure or resistance the heart must overcome to eject blood through the semilunar valves during systole

A

Afterload

60
Q

Locus of control

A

degree of control : * inner ( decisions ) & external ( fate, luck ) or combination

61
Q

Respiratory failure

A

PaO2 < 60 mm Hg & PaCO2 > 50 mmHg

62
Q

Endotracheal tube - verify placement

A
  1. check end-tidal CO2 levels - use CO2 detector 2. listen for bilateral breath sounds 3. X-ray
63
Q

Hemodynamic monitoring consists of

A
  1. Catheter 2. Infusion system 3. Transducer 4. Monitor 5. Pressure bag
64
Q

Pressure bag - A-line & PA catheter

A
  1. NS or D5W 3-10 ml/hr - prevent back up of the blood and oclusion 2. 300 mmHg - maintains pressure
65
Q

Allen’s test

A

prior to insertion of A-line - 1. patency of the ulnar & radial artery 2. adequacy of collateral circulation

66
Q

Central venous pressure cather ( CVP line ) - measures and provide

A
  1. RA pressure - preload - monitor pt fluid status
  2. Venous access for fluids and blood sampling
67
Q

CVP line inserted

A

subclavian, jugular, femoral veins ; catheter tip - superior vena cava

68
Q

CVP readings - high & low

A

High - fluid overload - decrease IV rate, IV diuretics

Low - hypovolemia - increase IV rate

69
Q

PA catheter : balloon

A
  1. wedged briefly 8-15 sec - get reading - remove - risk for pulmonary infarction
70
Q

CVAD

A
  1. PICC lines ( long term IV TX - vesicant ; 1 year)
  2. Non-tunneled CVAD ( few weeks )
  3. Tunneled CVAD ( years )
  4. Subcutaneous ports ( non - coring needle ; years )
71
Q

CVAD complications

A
  1. Infection
  2. Bleeding
  3. Pneumothorax and hemothorax
  4. PE
  5. Cardiac tamponade
72
Q

AED

A

Automatic external defibrilator ; * “ All clear “

73
Q

ICP catheters - Infection !!! - strict aseptic technique

A
  1. Epidural ( easy, low risk )
  2. Intraventricular ( most invasive, drainage + sampling of CSF )
  3. Subarachnoid ( easy )
74
Q

Quinton catheter

A

double lumen dialysis catheter ; jugular or subclavian veins; for ARF or CRF ( while waiting for fistula to mature)

75
Q

Sengstaken-Blakemore tube

A

TX bleeding esophageal varices ( last resort ); two ballons ( one -stomach; second - esophagus) ; pt is intubated on mechanical ventilator

76
Q

Parenteral nutrition - PPN & TPN

A
  1. PPN ( peripheral parenteral nutrition) - peripheral IV - lower osmolarity
  2. TPN ( total parenteral nutrition ) - central IV - higher osmolarity
77
Q

Paternalism

A

restriction of one’s freedom ( autonomy ) to protect the pt from harm (making decision for pt )

78
Q

Beneficence

A

prevent harm

79
Q

Nonmaleficence

A

do no harm

80
Q

Fidelity

A

keep promises

81
Q

Veracity

A

tell the truth

82
Q
A

NURS 2501 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions