General med-surg

Question 1

Intubation-ET tube

Answer 1

ET tube
assess BS bilaterally
tidal CO2 from purple to yellow
chest xray
cuff inflated

Question 2

Tracheostomy

Answer 2

inflate cuff always–> keeps from aspiration

on deflate if pulling tube

Question 3

ventilator

Answer 3

assess BS
suction secretions
LOC
-ET tube or trach
FIO2-> high to low based on ABG
alrms--> check PT first
-bag mask available
BS-> equal and bilateral
crackles indicate need for suctioning
oral hygeine
alt method of communication
can't speak with tube inflated
document last
-tube at lipline, secure, xray done, how pt tolerated, ventilator setting, FIO2 tidal volume

Question 4

CPR

Answer 4

• breathless, pulse-less, unconsious
• shake, shout, call help, open airway, look listen feel for breathing
• adult–> if witnessed AED first

Question 5

Croup

Answer 5

Assess:
bark like cough
dyspnea
cyanosis
inspiration stridor
losing fluids?
Implement:
steamy shower
sudden exposure to cold air
cool air or hot steamy air
Hospital
trach at bedside
mist tent (cotton)
O2 with humidity
IV
tylenol
prop w pillow under mattress
HR and hypoxia

Question 6

MI

Answer 6

Assess:
chest pain radiating to arms, jaw, neck
dyspnea
indigestion
apprehension
low grade fever
elevated WBC, ESR, CK-MB, LDH, troponin
women: epigastric
men: mid sternal chest pain
elderly: fatigue
Implement:
streptokinase, tpa (clot busters) do not give if surgery last two weeks, pregnancy
bedrest
beta blockers
morphine--> decreases myocardial O2 consumption
dysrhythmics
anticoags

Question 7

rhythm disturbances

Answer 7

assess:
sycope, chest pain
palpitations (heart racing)
abnormal HS, pulse rate
dyspnea (backing up of fluids in lungs)

Question 8

Premature atrial contractions (PAC)

Answer 8

<160 BPM

start in atria

Question 9

Paroxysmal atrial tachycardia (PAT)

Answer 9

160-250 BPM

huge decrease in CO

Question 10

Atrial flutter

Answer 10

-ectopic focus
-250-400 BPM
paliptations
heart racing
-decreased CO
-cyanosis, anxiety, low vascular perfusion, confusion

Question 11

Atrial Fib

Answer 11

• no definiitve P wave
• dizziness, confsuion,
• most common
• common casues: HTN, MI, Chronic lung disease
  treat: aticoagsa, cardioversion

Question 12

PVC

Answer 12

-ischemia, electrolyte imblances (esp hypokalemia)
-treat underlying,
lidocaine

Question 13

V-tach

Answer 13

-3+ PVC’s in a row (muscular irritabitlty)
-140-250 BPM
-pulse or pulseless
adult feel for carotid, babay->brachial
pulseless–>treat like VFIB-> defib, CPR
pulse–>cardioversion or cough CPR

Question 14

V-Fib

Answer 14

• most serious
• no CO/input
• defib/CPR

Question 15

Heart blocks

Answer 15

Bundle: mi or dig toxicity left bundle is most serious

1st: AV coduction slow
2nd: AV junction does not conduct all: dropped QRS or longer PR interval
3rd: atria and ventricles are not in synch, no CCO, trat w paver

Question 16

Dx tests

Answer 16

EKG
ABG
Holter montior 12-24 hr
cardiac cat--> look for occlusion (invasive)
echo--> use U/S to look at heart
stress tests (drug induced or treadmill)

Question 17

EKG

Answer 17

P wave= atrial
QRS= vent
T wave= repolarization of ventricles
small box=.04
large box=15 large=3 second strip
PR=.12-.2
QRS=.04-.12

Question 18

Pacemakers

Answer 18

fixed=constant

demand=HR drops below set rate it turns on

Question 19

Defib

Answer 19

VFIB, pulseless Vtach
3 attempts:
200 joules
200-300 joules
360 joules
charge
clear
check for rhythm between shocks other than above

Question 20

Cardioversion

Answer 20

-usually get consent, elective
unstable tachy 250-400 BPM example
-low BP, low pulse Ox
-prpeare with valium IV 
-synch on
-avoid R on T phenmoenom,
-selct Joules 25-360
-deliver (shock not instant)

Question 21

Sinus brady

Answer 21

• atropine
• if not effective, then pacer (non-invasive)
• monitor for hypotn