exam 2 Flashcards
ICU drug of choice for agitation?
Propofol
Glasgow coma scale indicating severe brain damage?
3-8
8 we intubate.
Signs that indicate brain death?
o Coma
o absence of brain stem reflexes
apnea
Early signs of ICP
o CUSHINGS TRIAD-
Systolic htn: widening pulse pressure.
Bradycardia: full and bounding pulse
Irregular respirations
ICP Ocular Signs:
o Dilation of pupil of same side (ipsilateral)
o Unequal pupils in any form/side
o Ptosis (droopy lid)
o Diplopia
o Doll’s Eye (tip back, eye go back instead of opposite direction)
o Sluggish/Blurred
Baclofen medication teaching?
o do not stop taking suddenly.
o do not drink alcohol
Mild concussion discharge instructions?
Return if you have:
persistent headache
lethargy
changes in behavior
shortened attention span.
change in intellectual abilities.
Closed Head Injury- worsening assessment:
o Battles signs (behind ear)
o Raccoon eyes (under eyes)
o CSF leak (rhinorrhea, otorrhea): risk for meningitis
o ** glucose test; halo sign (tests spinal fluid leak)
Which order would you question for an incontinent spinal cord patient injury?
o No foley cath
o ** pt at risk for bladder issue in future
Symptoms of autonomic dysreflexia
o (EMERGENCY) ** head of bed up
blinding headache
increase BP.
bladder full get spasms.
Spinal cord injury at T5 level? What are things the patient should not do?
o Avoid raising knees.
o ** @ risk for DVT
Dilantin Patient teaching?
o Headache
o Nausea/Vomiting
o Constipation
o Trouble sleeping
o Need back up oral BC.
Posturing that happening in ICP patients?
o Decorticate (flexor)
o Decerebrate (extensor)
What drug is used to decrease cerebral inflammation?
o corticosteroid
Dantrolene (used to manage muscle spasms) teaching
o severe hepatic impairment (liver testing needed)
o diarrhea
o anorexia
o nervousness
o hyperkalemia
What to do to prevent complications from a traumatic brain injury TBI
nutrition
o monitor I&O
o monitor: glucose, Na, K, Mg
o protect from injury.
DIC lab values
o LOW platelet
o LOW fibrinogen
o HIGH d-dimmer
o HIGH aPTT
o HIGH PT
What would you not want to inject into a DIC patient?
o Vitamin K
What sign in a critically ill pt would indicate they could be developing DIC?
o petechiae
o bleeding mucus membranes
o tachycardia
o hypotensive
o low temp
What pt are at highest risk for developing DIC?
o sepsis
o abruptia placenta
o trauma
o malignancy
o shock
o toxins
o allergic reactions
What is DIC?
o Inflammatory response (trigger) initiates a process of inflammations and coagulation
(clotting)
o ** result = bleeding/clotting condition
Characteristics of cardiac tamponade?
o sudden chest pain
o SOB
o tachypnea
o dyspnea
o JVD
o hypotension
o pulses paradox
Interventions for cardiac tamponade?
o ** quick removal of paracardial fluid!!
o Pericardiocentesis (needle & small cath into the pericardium)
Abdominal Aortic Aneurysm assessment findings?
o abdominal pain
o persistent or intermittent low back or flank pain
o pulsating abdominal mass
o systolic bruit
Abdominal aortic aneurysm surgery……?
o Not required always
o Monitor until 5cm large.
Postop care for client with endovascular graft repair of a AAA?
o ALWAYS check pt pedal pulses
3.5cm thoracic aneurysm education?
o Pt needs ultrasound every 6 months.
Activity allowed/not allowed for an open AAA 4 hours post op?
o Cannot move side to side until 6hr post op
o Lie supine for 6hrs post op and @ 45 degree angle for 2 hrs
o Resume presurgical diet
o Encourage fluids
Hypertensive crisis pt weighs 77 kg and needs sodium nitroprusside 50mg/250 ml to infuse at
0.5mcg/kg/min. What is the hourly rate in ml/hr for this pt? Round to the nearest tenth.
o 77kg x 0.5 = 38.5mcg/min
o Convert 38.5mcg to mg = 0.0385 mg
o 0.0385 mg / 50mg x 250 = 0.1925ml/min
o 0.1925 x 60 = 11.55 ml/hr or 11,6
Gestational hypertension medication that is contraindicated?
o Vasodilators!!!
Enalapril teaching:
o use w/ caution with diuretic therapy
o monitor potassium levels
Beta Blocker (propranolol) teaching
o do not stop abruptly
o adm as prescribed
o hold if systolic BP <100 or pulse <60
Amlodipine dietary modifications?
o NO GRAPE FRUIT JUICE!
Diagnostic test needed to confirm thoracic aneurysm?
o CT scan to confirm aneurysm
Describe the action of amlodipine for hypertension?
o Slows movement of calcium into smooth muscle cells, resulting in arterial dilation and
decreased blood pressure
Captopril teaching?
o Take 1 hr before meals
o Monitor BP
o Monitor Angioedema
Prazosin 1st time dose for postop aneurysm repair?
o 1st dose syncope
o **take at bedtime (makes u tired)
Digoxin teaching?
o Apical Pulse <60 hold
o Levels between 0,8-2.0
Description of a second degree heart blood, Type 1 (Wenckebach)
o long, Longer, LONGEST, gone
Defibrillation first attempt unsuccessful… what medication should be administered?
Epinephrine
Why order a TEE for a patient with A-fib scheduled for cardioversion?
o not as invasive (don’t go down throat) can show clotting first
Where are the “wire” of a pacemaker tunneled into the heart?
o tunneled subcutaneously from generator of external jugular vein, into the apex of the
right ventricle
Contraindications for the use of sotalol?
o bradycardia
o asthma
o heart failure
o bronchospasms
Description of a “fixed or asynchronous” pacemaker?
o constant no matter what
Discharge teaching for permanent pacemaker?
o no raising arm above shoulder 2 weeks
o lead dislodgement can happen
o fall precautions.
o cell phone of opposite side of pacemaker
o airport detector excuse from MD
o no MRI
o medical bracele
Patient recovering from an MI needs medication for a HR of 44 degrees but they have a history of
glaucoma, what medication is contraindicated?
o Atropine contraindicated!!
