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Complex Care > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Delirium Mnemonic

A

D: Dementia, dehydration
E: electrolyte imbalances, emotional stress
L: lung, liver, heart, kidney, brain
I: infection, ICU
R: Rx drugs
I: Injury, immobility
U: untreated pain, unfamiliar environment

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2
Q

Delirium

A

Acute changes in mental status

-some elderly delirium will never clear
*Not severe depression (psychosis), or dementia

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3
Q

Delirium Interventions

A

-Environment so pt can sleep
-pt safety (pulling tubes, near nursing station)
-avoid antipsychotics
-reorient as much as possible

*Avoid restraints

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4
Q

Delirium Assessments

A

-CAM-ICU

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5
Q

Pain Assessment Tools

A

FLAAC
C-CPOT

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6
Q

C-CPOT

A

Critical Care Observation Tool

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7
Q

FLACC

A

Behavioral Scale
*any-age that cannot communicate pain

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8
Q

Morphine Assessment

A

reassess pain after 15-30 min

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9
Q

Percocet Assessment

A

reassess pain after 60 minutes

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10
Q

Fentanyl

A

Fastest onset

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11
Q

Morphine

A

Longest duration
*Assess pain after IV 15-30 min

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12
Q

Hydromorphone (Dilaudid)

A

*1mL Dilaudid = 7mL Morphine

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13
Q

Opiod Concerns

A

-Respiratory Depression (most severe)
-Constipation (Most common): Increase ROM, stool softeners, fluids
-hypotension
-CNS Depression
-hallucinations
-geriatrics

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14
Q

PCA pt’s

A

-Elective surgery
-large surgical or traumatic wounds
-normal cognitive function
-normal motor skills

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15
Q

Sedation Assessment Tools

A

RASS
RIKER

*Both measure agitation and sedation

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16
Q

Four types of sedation

A
  1. Anxiolysis
  2. Moderate sedation
  3. Deep sedation
  4. Anesthesia

*DO NOT REDUCE PAIN

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17
Q

Anxiolysis

A

-Pt awake and responsive
-Minimal sedation
-anxiety relieved

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18
Q

Moderate Sedation

A

-Pt responds with verbal commands only or light touch
-Maintains own airway

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19
Q

Deep Sedation

A

-Pt asleep
-MAY need assistance with airway and ventilatory effort

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20
Q

Anesthesia

A

-loss of sensation
-cannot maintain airway

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21
Q

Sedation Purpose

A

Reduce agitation and anxiety

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22
Q

Diazepam (Valium) Indications

A

-anxiety
-acute alcohol withdrawal
-pre-op skeletal muscle relaxent

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23
Q

Diazepam (Valium) Risk

A

-CNS Depression
-Confusion
-Drowsiness
-Resp depression
-orthostatic hypotension

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24
Q

Diazepam (Valium) Nursing implications

A

-do not dilute
-give into large vein over 3 minutes
-assess vitals before, during, and after
-assess CNS and LOC

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25
Succinylcholine (Anectine) Indication
-Paralysis *Does not decrease pain
26
Succinylcholine (Anectine) Risk
-Hyperkalemia -muscle pain -malignant hypothermia
27
Succinylcholine (Anectine) Intervention
-peaks 1 min, fades in 4-10 minutes *Give with intubating
28
Succinylcholine (Anectine) Nursing Management
*Pt can't move, talk, blink, pee -Foley -Eye lubrication -Reposition & ROM exercises(DVT prevention) -Oral care -Vitals and assessment Q1hr -Daily Labs (BUN, CREAT, GFR)
29
Acute Coronary Syndrome Types
-Stable angina -Unstable angina -Acute MI
30
Acute Coronary Syndrome Causes
31
Stable angina Causes
Most common -chest pain with exertion
32
Stable angina Treatment
rest and nitroglycerin
33
Unstable Angina Causes
-chest pain with exertion -DOES NOT resolve w/ rest or meds
34
Non-ST (NSTEMI) Acute MI
-MI w/out changes to EKG -partial occlusion of artery -Less permanent damage than STEMI
35
ST (STEMI) Acute MI
-complete occlusion -EKG changes
36
Acute Coronary Syndrome Causes
-Artherosclerosis (build up of fats and cholesterol) -Emboli -Blunt trauma -Spasms
37
Acute MI Assessment
-Midsternal chest pain -> radiates to left arm in men -pale, diaphoretic -dyspnea -hypotension -syncope (loss of consciousness) -Sweating and vomiting out of nowhere Women: -jaw pain -back/shoulder pain -severe indigestion Elder: -epigastric pain
38
Acute MI Labs
1. Troponin: cardiac protein released after damage to the myocardium -Rises within 4-6 hrs -Peaks 10-24 hrs -detected up to 10-14 days 2. Cardiac Biomarkers: TKMB -not common -confirms troponin 3. Myoglobin -not common
39
Acute MI 12-lead Diagnosis
-ST elevation followed by Q wave (Tombstones) -ST depression N-STEMI does not have EKG changes
40
Acute MI Management
-Pain relief: morphine, nitroglycerin -Oxygen -Antiplatelets: aspirin/plavix -PCI ( coronary cath, fibrinolytic therapy) -Beta blockers -ACE inhibitor
41
Nitroglycerin
Nonselective vasodilator
42
Nitroglycerin side effects & when to NOT give
-headache -hypotension (synscope) DO NOT GIVE WITH: -right sided MI -Viagra -increased ICP -pericardial tamponade
43
Nitroglycerin Interventions
-Obtain baseline ECG (before/after) -Check current meds (no viagra) -monitor HR, BP, Chest pain
44
Aspirin
-NSAID -Irreversible platelet aggregation inhibition
45
Aspirin Risk
-Severe bleeding risk -GI bleed
46
Aspirin Nursing Interventions
-monitor for bleeding -infusions -activated charcoal *no antidote
47
Lethal Rhythms
-V tach -PEA -Asystole
48
V tach
-impulse coming from ventricles -Wide QRS complex (>.12) -Looks like mountains -3 pvs in a row -no P wave -rate >100 (usually 110-250 bpm) -MUST defibrillate before anything else
49
V tach identification/causes
-myocardial ischemia, infarction -Decreased K, Mg -hypoxia -acid-base imbalance
50
Asystole
-Flat line -NO P, QRS, or T
51
Pulseless Electrical Activity (PEA)
-Causes: H&Ts -Electrical activity but no pulse present muscles doesn't work
52
Code Equipment
-Defibrillator -Code Cart -BVM
53
Defibrillator
-Delivers external electrical current -depolarizes -disrupts impulse causing dysrhythmia
54
Defibrillator Indications
-V fib -Pulseless V tach
55
Defibrillator Considerations
-Clear before delivery (Hands off and Oxygen) -Remove everything from pt -Dry skin -wax hair off
56
Code cart
-ACLS drugs -AED
57
Non-shockable Rhythms
-Asystole -PEA
58
Epinephrine Indications
Cardiac arrest all rhythms: V fib, V tach, asystole, and PEA Administer at 15 compressions
59
Epinephrine Dosing
-1mg rapid IV push -repeat ever 3 minutes
60
Epinephrine Cautions
-Potent vasoconstrictor -do not give w/ sodium bicarb in same line bc alkaline solution can inactivate
61
Atropine Indications
Symptomatic bradycardia
62
Atropine Dosing
1mg rapid IV push -repeat every 3-5 minutes -Max dose of 3mg
63
Atropine Cautions
-decreases vagal tone, do not push slowly -using during MI can worsen ischemia
64
Adenosine Indications
-Stable tachycardia -SVT
65
Adenosine Dosing
-6mg rapid IV push followed by rapid flush of 20 mL NS -A repeat of 12mg may be given 1-2 minutes later
66
Adenosine Cautions
-Do not give with 2nd or 3rd degree block- Slows conduction through AV node -Do not give to pt w/ asthma or emphysema -can cause rep. destress -Expect slowing or loss of rhythm(moment of asystole), pt may feel flush, or short of breath
67
PR Interval times
0.12-0.20 seconds
68
QRS complex times:
0.06-0.11 seconds
69
QT Interval:
0.32-0.50 seconds
70
P wave
represents atrial depolarization
71
QRS complex
ventricular depolarization
72
ST Segment
Time between ventricular depolarization and repolarization -flat, isoelectric
73
T wave
Ventricular repolarization
74
Sinus Rhythm
60-100bpm, upright
75
Sinus Tachycardia
>100-150bpm
76
Sinus Tachycardia Causes
-Hyperthyroidism -hypovolemia -heart failure -anemia -exercise -stimulants -fever -fear -pain -anxiety
77
Sinus Brady
<60bpm
78
Sinus Brady Causes
-vagal, drugs, ischemia, disease of nodes, Increased ICP, hypoxemia, athletes
79
Sinus Brady Treatment
Atropine
80
A Fib
-Erratic impulse formation in the atria -No P wave -Irregular rate
81
A Fib Characteristics
-no P wave -narrow QRS -loss of atrial kick (less blood pushed from Left Atrium to Left Ventricle) -irregular ventricular rate ( can be fast, slow, or normal rate) -high risk for pulmonary or systemic emboli -increased risk of blood pooling in L atrial appendix
82
A fib Treatment
#1. Cardioversion (150J) #2. Meds: diltiazen, amiodarone #3. Cardiac ablation All need anticoagulant and heparin/coumadin
83
Supraventricular Tachycardia (SVT)
General term -regular rhythm -Narrow QRS (<.12) -No P wave, too fast to see -HR >160bmp
84
SVT Treatment
#1. Vagal maneuver #2. adenosine #3. cardioversion
85
PVC
-Single or double beat -not rhythm -No P wave -Wide QRS (>.12) -T wave opposite of QRS complex (on lead 2 its inverted) 2 PVCs = Couplet 3 PVCs = V tach
86
V Fib
Pt is clinically dead -chaotic pattern -no discernible P, Q, R, S, or T waves -no cardiac output -no pulse -no BP
87
3rd Degree AV Block
-P-P regular -R-R is regular -More waves than QRS complexes -No relation between the P and QRS -Wide QRS -Av node blocked so perkinje fibers take over (20-40bpm)
88
Cardizem (Diltiazem)
Calcium channel blocker *use for A fib
89
Cardizem (Diltiazem) Dose
-0.25mg/kg given slowly over 5min -Than begin infusion 10-20mg/hr
90
Cardizem (Diltiazem) Risk
hypotension heart block renal failure
91
Cardizem (Diltiazem) Interventions
Labs monitor rhythm BP, VS, output
92
Amiodarone
Use for unstable V tach or A fib
93
Amiodarone Dose
1st dose 300mg IV push followed by 150mg IV push *DO NOT GIVE IV PUSH TO ALIVE PERSON
94
MONA
Morphine: low dose, mild vasodialator, pain control Oxygen: oxygen rich blood Nitro: vasodialator, *chest pain lowered Aspirin: chew it or rectal if they can't swallow *not in this order
95
V tach pt's
-Stable, no symptoms -Stable, symptomatic -Unstable, symptomatic -Dead
96
What are the s/s of low CO?
-Change in level of consciousness -Chest discomfort -Hypotension -Shortness of breath; respiratory distress -Pulmonary congestion; crackles -Rapid, slow, or weak pulse -Dizziness, Syncope -Fatigue, Restlessness
97
V tach Unresponsive Treatment
Call for help! Start CPR! Place pads asap
98
V tach unstable treatment
Amiodarone
99
MAP minimum
60
100
Noninvasive BP and ABP difference
No more than 10

Complex Care (10 decks)

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