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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
Q

Succinylcholine (Anectine) Indication

A

-Paralysis

*Does not decrease pain

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26
Q

Succinylcholine (Anectine) Risk

A

-Hyperkalemia
-muscle pain
-malignant hypothermia

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27
Q

Succinylcholine (Anectine) Intervention

A

-peaks 1 min, fades in 4-10 minutes

*Give with intubating

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28
Q

Succinylcholine (Anectine) Nursing Management

A

*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)

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29
Q

Acute Coronary Syndrome Types

A

-Stable angina
-Unstable angina
-Acute MI

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30
Q

Acute Coronary Syndrome Causes

A
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31
Q

Stable angina Causes

A

Most common
-chest pain with exertion

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32
Q

Stable angina Treatment

A

rest and nitroglycerin

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33
Q

Unstable Angina Causes

A

-chest pain with exertion
-DOES NOT resolve w/ rest or meds

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34
Q

Non-ST (NSTEMI) Acute MI

A

-MI w/out changes to EKG
-partial occlusion of artery
-Less permanent damage than STEMI

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35
Q

ST (STEMI) Acute MI

A

-complete occlusion
-EKG changes

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36
Q

Acute Coronary Syndrome Causes

A

-Artherosclerosis (build up of fats and cholesterol)
-Emboli
-Blunt trauma
-Spasms

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37
Q

Acute MI Assessment

A

-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

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38
Q

Acute MI Labs

A
  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
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39
Q

Acute MI 12-lead Diagnosis

A

-ST elevation followed by Q wave (Tombstones)
-ST depression

N-STEMI does not have EKG changes

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40
Q

Acute MI Management

A

-Pain relief: morphine, nitroglycerin
-Oxygen
-Antiplatelets: aspirin/plavix
-PCI ( coronary cath, fibrinolytic therapy)
-Beta blockers
-ACE inhibitor

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41
Q

Nitroglycerin

A

Nonselective vasodilator

42
Q

Nitroglycerin side effects & when to NOT give

A

-headache
-hypotension (synscope)

DO NOT GIVE WITH:
-right sided MI
-Viagra
-increased ICP
-pericardial tamponade

43
Q

Nitroglycerin Interventions

A

-Obtain baseline ECG (before/after)
-Check current meds (no viagra)
-monitor HR, BP, Chest pain

44
Q

Aspirin

A

-NSAID
-Irreversible platelet aggregation inhibition

45
Q

Aspirin Risk

A

-Severe bleeding risk
-GI bleed

46
Q

Aspirin Nursing Interventions

A

-monitor for bleeding
-infusions
-activated charcoal
*no antidote

47
Q

Lethal Rhythms

A

-V tach
-PEA
-Asystole

48
Q

V tach

A

-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
Q

V tach identification/causes

A

-myocardial ischemia, infarction
-Decreased K, Mg
-hypoxia
-acid-base imbalance

50
Q

Asystole

A

-Flat line
-NO P, QRS, or T

51
Q

Pulseless Electrical Activity (PEA)

A

-Causes: H&Ts
-Electrical activity but no pulse
present muscles doesn’t work

52
Q

Code Equipment

A

-Defibrillator
-Code Cart
-BVM

53
Q

Defibrillator

A

-Delivers external electrical current
-depolarizes
-disrupts impulse causing dysrhythmia

54
Q

Defibrillator Indications

A

-V fib
-Pulseless V tach

55
Q

Defibrillator Considerations

A

-Clear before delivery (Hands off and Oxygen)
-Remove everything from pt
-Dry skin
-wax hair off

56
Q

Code cart

A

-ACLS drugs
-AED

57
Q

Non-shockable Rhythms

A

-Asystole
-PEA

58
Q

Epinephrine Indications

A

Cardiac arrest
all rhythms: V fib, V tach, asystole, and PEA

Administer at 15 compressions

59
Q

Epinephrine Dosing

A

-1mg rapid IV push
-repeat ever 3 minutes

60
Q

Epinephrine Cautions

A

-Potent vasoconstrictor
-do not give w/ sodium bicarb in same line bc alkaline solution can inactivate

61
Q

Atropine Indications

A

Symptomatic bradycardia

62
Q

Atropine Dosing

A

1mg rapid IV push
-repeat every 3-5 minutes
-Max dose of 3mg

63
Q

Atropine Cautions

A

-decreases vagal tone, do not push slowly
-using during MI can worsen ischemia

64
Q

Adenosine Indications

A

-Stable tachycardia
-SVT

65
Q

Adenosine Dosing

A

-6mg rapid IV push followed by rapid flush of 20 mL NS
-A repeat of 12mg may be given 1-2 minutes later

66
Q

Adenosine Cautions

A

-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
Q

PR Interval times

A

0.12-0.20 seconds

68
Q

QRS complex times:

A

0.06-0.11 seconds

69
Q

QT Interval:

A

0.32-0.50 seconds

70
Q

P wave

A

represents atrial depolarization

71
Q

QRS complex

A

ventricular depolarization

72
Q

ST Segment

A

Time between ventricular depolarization and repolarization
-flat, isoelectric

73
Q

T wave

A

Ventricular repolarization

74
Q

Sinus Rhythm

A

60-100bpm, upright

75
Q

Sinus Tachycardia

A

> 100-150bpm

76
Q

Sinus Tachycardia Causes

A

-Hyperthyroidism
-hypovolemia
-heart failure
-anemia
-exercise
-stimulants
-fever
-fear
-pain
-anxiety

77
Q

Sinus Brady

A

<60bpm

78
Q

Sinus Brady Causes

A

-vagal, drugs, ischemia, disease of nodes, Increased ICP, hypoxemia, athletes

79
Q

Sinus Brady Treatment

A

Atropine

80
Q

A Fib

A

-Erratic impulse formation in the atria
-No P wave
-Irregular rate

81
Q

A Fib Characteristics

A

-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
Q

A fib Treatment

A

1. Cardioversion (150J)

#2. Meds: diltiazen, amiodarone
#3. Cardiac ablation

All need anticoagulant and heparin/coumadin

83
Q

Supraventricular Tachycardia (SVT)

A

General term
-regular rhythm
-Narrow QRS (<.12)
-No P wave, too fast to see
-HR >160bmp

84
Q

SVT Treatment

A

1. Vagal maneuver

#2. adenosine
#3. cardioversion

85
Q

PVC

A

-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
Q

V Fib

A

Pt is clinically dead
-chaotic pattern
-no discernible P, Q, R, S, or T waves
-no cardiac output
-no pulse
-no BP

87
Q

3rd Degree AV Block

A

-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
Q

Cardizem (Diltiazem)

A

Calcium channel blocker

*use for A fib

89
Q

Cardizem (Diltiazem) Dose

A

-0.25mg/kg given slowly over 5min
-Than begin infusion 10-20mg/hr

90
Q

Cardizem (Diltiazem) Risk

A

hypotension
heart block
renal failure

91
Q

Cardizem (Diltiazem) Interventions

A

Labs
monitor rhythm
BP, VS, output

92
Q

Amiodarone

A

Use for unstable V tach or A fib

93
Q

Amiodarone Dose

A

1st dose 300mg IV push followed by 150mg IV push

*DO NOT GIVE IV PUSH TO ALIVE PERSON

94
Q

MONA

A

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
Q

V tach pt’s

A

-Stable, no symptoms
-Stable, symptomatic
-Unstable, symptomatic
-Dead

96
Q

What are the s/s of low CO?

A

-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
Q

V tach Unresponsive Treatment

A

Call for help! Start CPR!
Place pads asap

98
Q

V tach unstable treatment

A

Amiodarone

99
Q

MAP minimum

A

60

100
Q

Noninvasive BP and ABP difference

A

No more than 10

Complex Care (10 decks)

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