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Block 4 Exam 1 > Tx/mgmt > Flashcards

Tx/mgmt Flashcards

1
Q

FVD

A

Oral best
No LR if alkalosis
IO, weight
Prevent vomiting and bleeding and other ways of losing fluid

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2
Q

FVE

A

Diuretics
Salt and fluid restriction
Dialysis
IO, weight
Lung sounds
Promote rest

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3
Q

Hyponatremia

A

Slowly give salt
Water restriction
Look at diet
Are they taking lithium?
Are they on diuretics?
SIADH?

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4
Q

Hypernatremia

A

Slowly give hypotonic or D5W
Diuretics
H2O
Are they taking OTC meds with salt? (Alka Seltzer)

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5
Q

Hypokalemia

A

Diet (banana, spinach, potatoes, orange, nuts, grapefruit)
Oral or
IV (unless oliguria - establish good UPO, don’t slam)
ECG, bowel sounds, ABG, dig tox?

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6
Q

Hyperkalemia

A

ECG, apical pulse
Diet
Kayexelate
Bowel sounds
IV Dectrose 50% Insulin, diuretics, Ca gluconate, bicarbonate, albuterol

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7
Q

Hypocalcemia

A

IV calcium gluconate with D5W (for emergency, watch for extravasation)
Seizure precautions
Oral calcium with vitamin D
Lift weights
Diet

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8
Q

Hypercalcemia

A

Underlying cause (cancer?)
IVF, furosemide, phosphates, calcitonin, Bisphosphonates
Increase mobility
Fluids
Fiber for constipation (not Tums)

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9
Q

Hypomagnesemia

A

Mg sulfate IV (have calcium gluconate on hand in case Hypermagnesemia occurs)
Oral Mg salts (may cause diarrhea)
Seizure precaution
Green leafy, nuts, beans, lentils, PB
Speech therapy and monitor dysphagia

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10
Q

Hypermagnesemia

A

Redraw - might be hemolyzed
IV calcium gluconate
Vent for resp depression
Assess DTR and LOC
Hemodialysis
Loop, NS, LR
OTC meds? (milk of mag)

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11
Q

Hypophosphatemia

A

Oral or IV (watch for extravasation)
Burosumab
Monitor levels of phosph, Ca, and Vitamin D
Milk, beans, liver, nuts, fish, poultry
Gradually increase calories if malnourished

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12
Q

Hyperphosphatemia

A

Phosphate binding agents (watch for hypercalcemia)
Limit vitamin D
Loops
IV NS
Dialysis
Diet
Observe SS of low Ca

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13
Q

Hyperchloremia

A

Hypotonic IV
LR (will increase bicarbonate)
Sodium bicarbonate
Diuretics
Monitor neuro, resp, cardiac

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14
Q

Hypochloremia

A

IV NS or 1/2 NS
Ammonium chloride
LOC
Foods to try: tomato juice, banana, egg, milk, cheese
No tap water
DC diuretics

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15
Q

Metabolic acidosis

A

Bicarbonate
Dialysis

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16
Q

Metabolic alkalosis

A

Fluids
NaCl
K
PPI to decrease HCl in stomachs
Carbonic anhydrase inhibitors to decrease bicarbonate

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17
Q

Respiratory acidosis

A

Improve their ventilation
Fluids

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18
Q

Respiratory alkalosis

A

Breathe into bag
Anxiolytics

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19
Q

D and E in primary survey

A

Disability and Exposure

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20
Q

Emergency tx and assessments for intra-abdominal injuries

A

Assess referred pain
Dx peritoneal lavage
Imaging
ABC, immobilize C collar
Document all wounds
Cover protrusions with moist sterile dressing
NPO, NG aspiration
Prophylactic tetanus and Abx

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21
Q

Heat stroke

A

ABC
Reduce temp ASAP
Cool sheets/towels/sponge
Ice neck, groin, chest, axillae
Cold bath
Monitor temp, VS, ECG, CVP, LOC, I/O
IVF
Labs (look for DIC and rhabdo/CK)
Dialysis if AKI

Meds: anticonvulsants, K, sodium bicarbonate, benzo

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22
Q

Hypothermia

A

ABC
Remove wet clothing
Rewarm with warm fluids, warm humidified oxygen, warm peritoneal lavage, blankets, heaters

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23
Q

Ingested poison

A

Emetics if not corrosive
Gastric lavage
Activated charcoal
Antidote
Diuresis
Dialysis
Hemoperfusion

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24
Q

Carbon monoxide poisoning

A

Fresh air
100% O2
CPR

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25
Q

Goals for treating drug OD

A

Respiratory and cardiac function
Enhance clearance

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26
Q

ETOH intoxication

A

Rule out other causes like hypoglycemia or head injuries
ABC, monitor hypotension
Sedation if belligerent

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27
Q

Essential components of EOP

A

Activation response
Communication plan
Coordinated patient care
Security plans
External resources
Traffic flow
Data management
Demobilization response
Corrective plan
Practice drills
Mass casualty planning
Education plan

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28
Q

Anthrax

A

Penicillin, ciprofloxacin, levofloxacin, doxycycline
Erythrocin
Cremate
6 dose vax

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29
Q

Smallpox

A

Abx
Vax
Negative pressure room
Airborne and contact precautions

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30
Q

Radiation decontamination

A

Isolation precautions
Seal air vents
Cover floor
Double bagged and labeled
Water resistant gowns
Double glove
Caps
Goggles
Masks
Booties
Dosimeter
Soap and water
Collect patient belongings
Catharsis and lavage if internal
Collect samples of their excretions plus nasal and throat swab

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31
Q

Antidote for cyanide

A

Nitrite

32
Q

Antidotes and drugs for nerve gas

A

Atropine to decrease secretions
Pralidoxime
Benzo for seizures

33
Q

Antidote for acetaminophen OD

A

NAC

34
Q

Antidote for benzo OD

A

Flumazenil

35
Q

Drugs for meth OD

A

IV diazepam/haloperidol

36
Q

Drugs for antidepressant OD

A

Sodium bicarbonate drip
IV magnesium for torsades
Vasopressors
Benzo for seizure

37
Q

Near drowning

A

CPR
Mgmt hypoxia/acidosis/hypothermia
ABG, PEEP
O2 if breathing spontaneously
ET if not breathing spontaneously
Assess for cerebral injury
Closely observe for vom and aspiration

38
Q

Snake bite

A

Cover with light sterile dressing
Immobilize
Poison control
Vasopressors
Measure circumference
Labs
Fluids IV
Antivenom with Benadryl slowly with 1/2 to 1 L NS

39
Q

Bites

A

Soap and water
Abx
Tetanus

40
Q

Brown recluse

A

Soap and water
Debridement

41
Q

Black widow

A

Ice
Elevate
Tetanus
Benzo
Analgesics
Antivenom if severe

42
Q

Requirements for zeroing A-line

A

Supine
Transducer at phlebostatic axis (nipple line, 4th intercostal space)
Open valve
Tap screen
Squeeze, close, hit zero
Square wave test

43
Q

Priority actions with crush injury

A

Apply clean dressing to protect wound
Elevate to decrease edema
Splint to decrease motion

44
Q

Cricothyroidotomy for these patients

A

Extensive facial trauma
Laryngeal edema
Obstructed larynx
Cervical spine injury
Hemorrhage into neck tissue

45
Q

Atelectasis

A

Turn
Cough
Deep breath
Early mobilization
Incentive spirometer
Manage secretions
Oral care
HOB
MDI

ICOUGH: IS, cough and deep breathe, oral care, understanding, get out of bed 3x/day, HOB

CPAP/BiBap
Bronchoscopy
CPT
ET, mech vent PEEP
Thoracentesis if pleural effusion

46
Q

COVID Hypoxia

A

Intubation
Mech vent
Remdesivir, roids, bamlanivimab
Prone
Suction
ECMO

47
Q

Acute respiratory failure

A

Underlying cause
O2
Bronchodilator
Intubation, MV
Nutrition (enteral)
Reduce anxiety
Provide communication
Prevent complications: turn, ROM, mouth, skin

48
Q

Indications for noninvasive positive pressure ventilation

A

Respiratory arrest
Dysrhythmia
Cognitive impairment
Head/facial trauma

49
Q

MV- enhancing gas exchange

A

Analgesics- but don’t suppress respiratory drive
Frequent repositioning
Assess edema, IO, weights
Meds for primary disease

50
Q

MV- effective airway clearance

A

Lung sounds q2-4h
Suction
CPT
Position
Promote mobility
Bronchodilators
Mucolytics

51
Q

MV- preventing injury

A

Infection control
Tube care
Cuff management (q6-8h)
Oral care
HOB

52
Q

MV- other interventions

A

ROM
Communication
Stress reduction
Involve family
Nutrition
Monitor hemodynamic stability
Monitor neuro
Monitor for synchrony and distress
Monitor for barotrauma/pneumothorax

53
Q

ARDS

A

Underlying cause
Intubation, MV, PEEP to keep alveoli open
Tx hypovolemia
Prone, frequent reposition
Enteral feedings or TPN
Sedation, paralysis, analgesics
BNP to rule out HF
Inotropes and vasopressors to increase BP
Circulatory support and adequate fluid volume

54
Q

Nursing for pt undergoing renal testing

A

Encourage fluids unless contra
Sitz, relax
Analgesics, antispasmodics
Assess voiding and edu

55
Q

Nephrosclerosis

A

HTN tx

56
Q

Glomerular disease / acute nephritic syndrome

A

Diet (Na and K restrictions, lots of carbs)
For post strep glomerulonephritis you should limit the protein
Roids
Abx
Immune suppressants
Lower BP

57
Q

Polycystic kidney disease

A

Tolvaptan to slow
Genetic counseling

58
Q

Nursing for renal patients

A

Fluid status and restrictions
Oral hygiene
Nutrition status, restrictions on salt, potassium, phosphate
Meds with meals

59
Q

Nursing and assessment for hospitalized patient on dialysis

A

Don’t use HD arm for BP
Bruit and thrill q8-12h
Monitor fluid, IO, IV, infection
Monitor for uremia, electrolytes
Monitor cardiac and respiratory status
Hold CV meds before HD
Carefully monitor med doses
Restrictions on salt, potassium, phosphate, fluids
Keep protein at 1.2 g per kg
Skin care
CAPD catheter care (sterile, mask, gloves)

60
Q

Post intubation assessment and interventions

A

Bilateral chest movement
Breath sounds
ETCO2 and O2
CXR
Skin color
Cuff pressure 20-25
SS aspiration
Ensure humidity
Set up tube: FiO2, tape and mark, cut if too long, bite block, suction

61
Q

What to do if ET tube dislodged

A

Immediate bag mask and call for help

62
Q

What can cause the vent alarm for increased peak airway pressure to go off and what do we do about it?

A

Due to coughing/secretions or biting
We can increase sedation, check tubing, bite block, suction, reposition

63
Q

What the heck is an IVC filter for?

A

For pulmonary embolism- to strain out the clot

64
Q

The 3 principals of HD

A

Diffusion
Osmosis
Ultrafiltration

65
Q

What’s a manometer for?

A

To measure inspiratory force- useful for coma pts to see if MV needed

66
Q

Initial MV settings

A

Vt 6-10 mL/kg
Lowest FiO2 to get 92 sat / PaO2 >60
Keep IP less than 35
Sigh 1.5x Vt 1-3/hr
Sensitivity IF 2 mm Hg
Adjust based on ABG

67
Q

Stop wean if…

A

HR spike of 20
Syst BP spike of 20
O2 < 90
RR <8 or >20
Arrhythmias
Fatigue, panic, cyanosis, paradoxical chest

68
Q

Prevent VAP by…

A

Good HOB
Daily sedation vacations
Daily extubate readiness assessment
PUD prophylaxis
DVT prophylaxis
Daily oral care with chlorahexadine

69
Q

Chest trauma

A

Airway
Fluids
Drainage
Occlude wounds
Correct low CO and volume

70
Q

Chest tube hose and suction for pneumothorax plus other chest tube things

A

28 Fr at 2nd intercostal
32 Fr at 4/5 if hemothorax
20 mm Hg suction
Abx
Keep low
Gentle bubbling
Gentle rising of ball in chamber
No tidaling could mean issue resolved (no more pneumothorax etc)

71
Q

Pulmonary embolism

A

Immediately give enoxaparin - keep giving for 5 days/ til INR >2
Warfarin for 3 months
TPA for unstable
Increasing fluids will increase fluid volume and reduce risk of DVT
DVT prophylaxis (activity, stockings, SCDs)

72
Q

Things to prevent AKI

A

Early identification and tx sepsis and other infections
Tx hypovolemia
Hydration
Catheter care
Caution with NSAIDs
IVF and mucomyst before contrast dye

73
Q

Some drugs to consider for PD

A

Prophylactic abx (prevent pericarditis)
KCl to prevent hypokalemia
Heparin to prevent clotting
Stool softener to promote good bowel habits/prevent hernia

74
Q

Things to assess when determining if ready for extubation

A

Low RSBI (getting regular nice deep breaths with little help)
Secretions
Hemodynamic stability (still on lots of pressors?)
Mental (able to lift head)
Underlying condition

75
Q

These patients need daily dialysis

A

Increase metabolic rate leading to increased waste due to…
Surgery
Corticosteroids
Bleeding disorders
Infection
TPN

Block 4 Exam 1 (3 decks)

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