Midterm T7 Flashcards
Tell tale sign for Type 1 Diabetes in children
a. dizziness
b. blurred vision
c. frequent urination
d. nausea?
c. frequent urination
Priority intervention for a child who had a seizure 4 weeks ago and has a history of something neurological?
a. call provider
b. 360 check
c. comfort mom
d. something else
b. 360 check bc of seizure precautions?
What scale do you use for someone who is sedated with propofol?
Richmond Agitation-Sedation Scale (RASS)
Continous bubbling in the water chamber of a chest tube
bubbles can indicate a leak
After giving skittles to a kid for low blood glucose, what do you give?
a. crackers and cheese
b. water
c. saturated and unsaturated fats
a. crackers and cheese
dosing for a bolus for peds
20ml/kg
You perform the faces scale for a peds patient that is post laparoscopic appendectomy, they show an 8/10, what do you do?
a. morphine
b. Tylenol
c. albuterol sulfate
c. something else
a. morphine
What drug do you give first for pulseless v tach?
epi then amiodarone (anti-arrythmic)
Sorting question for what is indicated vs contraindicated for someone with a seizure
indicated: turn on side, suction, decrease stimulation, suction, oxygen
contraindicated: BP cuff, rubbing back to stop sezire, placing the patient in high fowlers, one more
What will help ensure an accurate reading of BP with an arterial line?
Maintaining the device stopcock at the phlebostatic axis will help ensure a proper reading
PICC line is not flushing SATA
b. Check for kinked or clamped line
c. Call provider if still not flushing
d. Change dressing
e. Another one i think
what part of the rhythm is ventricular depolarization
QRS complex represents ventricular depolarization
Restraints SATA
a. Report how many times they go to the bathroom
b. Monitor circulation
c. Readiness for discontinuation
d. Check IV lines
e. Maybe something else
What is the first thing you do if someone needs CPR?
compressions immediately, then get the pads on and then meds
What pain assessment tool do we use in the critical care setting?
CPOT (Critical Care Pain Observation Tool)
What pain assessment tool do we use for sedation?
RASS
For AFIB, when do you use medication vs cardioversion?
Stable = medications
Unstable = cardioversion
Blood pressure is the determining factor of stabilitiy
If you have a patient in AFIB and their blood pressure still looks good, which medication are you going to give?
amniodarone
If you have VFIB and VTACH without a pulse, what do you do?
first thing is chest compressions, then defibrilliation, then meds
wyd for asystole
epi and compressions, DONT SHOCK
wyd for a STEMI
MONA: morphine, oxygen, nitro, asprin
(not in that order, nitro and asprin first and morphine last)
How many nitros can you give and how often?
you can give nitro 3 times every 5 minutes, for a total over 15 minutes
before each dose, retake bp and rate pain
what does STEMI stand for?
ST elevated myocardial infarction
When would we do vagal maneuvers vs medication?
vagal maneuvers when they are stable, if blood pressure is trending down then we would give medication
How do you give adenosine?
stopcock method, tell patient they are going to feel funny for a second (bc it stops the heart)
Examples of vagal maneuvers
ice on face, blow in straw, take rectal temp for peds
SVT med
adenosine
What causes high ventilator alarms?
biting on the tube, resistance, occlusion from secretions
What causes low ventilator alarms?
leaks, deflated cuff, extubation
Where is the best position for an arterial line to get the most accurate measurement of blood pressure?
phlebostatic axis, 4th intercostal space midaxillary line
what is important to maintain with central lines?
sterility and patency
What is the most common and preferred sedation drug?
propofol
What is the preferred number for RASS scoring (generally)?
0 to -2
What is the #1 thing a nurse must be assessing with restraint use?
circulation and skin integrity
seizures nursing interventions
-turn on side
-dont put anything in their mouth
-time it
-pad rails
-loosen or remove tight clothing
-minimize stimulation
-call for help
-02
-make sure suction is working
-lorazepam or benzos
what is the first drug we give in the cardiac arrest algorithm?
epi
when is epi given?
for asystole and cardiac arrest
hypoglycemia chief complaints
cold, clammy, shaking, dizzy, tachycardia, anxiety, hungry, irritable
CHILDREN = “i have a bad headache”!!!
How do you treat hypoglycemia if they’re awake?
15 grams of fast-acting carbs (juice, dextrose) then complex carbs to maintain glucose and recheck sugar
what do you give for RSV?
RSV is VIRAL not bacterial, you do not give antibiotic treatment
-supportive treatment: suction, oxygen, fluids
asthma treatment
bronchodilators (albuterol), no antibiotics
What is the first thing we do when a patient has trouble breathing?
sit them up
if its RSV or pt has congestion then suction before sitting up
What fluid for dehydration do we use for peds?
0.9% NS
Prevention of infection in the hospital setting
-hand hygiene
-scrub the hub
-foley care
-following precautions
-wear PPE appropriately
-don and doff appropriately
patient comes in with symptoms of a heart attack- radiating arm pain, abd pain, etc) and you do MONA and they still have chest pain that is not resolving. What do they most likely have?
STEMI
SATA interventions for RSV and bronchiolitis
a. encourage feeding Q4H?
b. suction
c. cluster care to allow for rest
NOT ANTIBIOTICS
What would you tell a 12 year old who is asking why they nee d to count carbs
edu on long term effects of poor glucose control
propofol MOA
inhibits GABA A receptors and causes rapid sedation
sedation med
epinephrine MOA
acts on alpha-1 receptors and induces increased vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal spinster muscle contraction
neurotransmitter/hormone (adrenaline)
insulin MOA
promotes glycogen synthesis (glycogenesis) and inhibits gluconogenesis
amniodarone MOA
blocks potassium ion channels (prolonging repolarization), sodium ion channels, and alpha and beta adrenergic receptors
antiarrythmic
dopamine MOA
increases heart rate and cardiac contractility
catecholamine neurotransmitter/hormone
heparin MOA
binds to and activates antithrombin III
antithrombotic, decreases clotting ability of blood
nitroglycerin MOA
nitroglycerin converts to nitric oxide (NO) which converts guanosine triphosphate to guanosine
treats angina/chest pain
albuterol MOA
acts on B2-adrenergic receptors, inducing bronchial smooth muscle relaxation
bronchodilator
keppra (levetiracetam) MOA
antiepileptic/anticonvulsant
potassium MOA
treats and prevents low potassium levels, treats high blood pressure, and prevents stroke
electrolyte
adenosine MOA
slows conduction time through the AV node and can restore normal sinus rhythm in patients with SVT
What do you do for SVT if the patient is stable with a good blood pressure?
What do you do if they are stable but their blood pressure is trending downwards?
What do you do if they are unstable?
stable w good bp: vagal maneuver
stable w decreasing bp: adensoine
unstable: cardiovert
What is the difference between cardiovert and a defibrilator?
cardiovert uses less joules
what is in a trach kit emergency kit?
2 trachs (1 normal size and a smaller size) + pulse + suction
What is the first thing you do after suction?
re-assess
never ____ through an art line
push meds
only draw blood and flush with normal saline
How long do you have to clean a CL for? a peripheral line?
-30 seconds for a CL and 15 for a peripheral
Why would a child get an enteral/g-tube?
bc they have failure to thrive
palliative care vs hospice care
palliative = treatment of chronic condition and maintain quality of life
hospice = terminal illness and pain management
insulin target glucose scale question
0.1 kg
Many people live with chronic conditions, what type of care do they need?
palliative
