Tx/mgmt Flashcards
Principles of hospice care
<6 months to live
Accepted
Pain and symptoms must be managed
Interdisciplinary team
Bereavement are to family
Ongoing research and edu
4 levels of hospice care, covered by Medicare and Medicaid
Routine home care
Respite care
Continuous care for crisis
General inpatient hospice (acute pain or ss mgmt, 24h care)
NURSE communication
Name the emotion
Understand the emotion
Respect and praise patient
Support the patient
Explore the emotion
QSEN competencies
KSA (knowledge, skills, attitudes)
Patient centered
Teamwork
EBP
Safety
Informatics
Aspects of 1991 Patient Self Determination Act
Advanced directives
Living will
ID of HC representative
POLST
Roles of State Board
Standards (Nurse Practice Act)
Examines applicants
Provides interstate endorsement
Renews licenses
Disciplinary
Rules for revocation
Regulates specialty practice
Standards for curriculum
5 rights of delegation
Task
Circumstance
Person
Direction/communication
Supervision/evaluation
Meds in palliative comfort kits
Acetaminophen for fever
Benzo for anxiety
Morphine for pain and SOB
Dyspnea assessment in palliative
Assess intensity
Interference with activities
Lung sounds
Fluid balance
Edema
Abdominal girth
Temperature
Skin color
Sputum
Cough
Dyspnea mgmt in palliative care
Conserve energy, decrease activity
Anxiety management
Bronchodilator
Corticosteroids
Opioids
O2
Blood products for anemia
Diuretics
RT, PT, OT, social worker, psychologist, yoga, acupuncture
Tripod, pursed lips
Cool air
Nursing for anorexia/cachexia
Meds and side effects
Oral assessment- thrush, ulcer
Anti emetics
Laxatives
Remove bad odors
HOB to help gastric emptying
Mouth care
Nursing for hospice confusion
Gentle reorient
Edu that this is normal
Spiritual guidance
Music
Haloperidol
Lorazepam
8 domains of National Consensus Project for palliative care
Structure and process (interdisciplinary)
Physical aspects (pain, symptoms)
Psychological
Social aspects
Spiritual
Cultural
EOL care (bereavement support)
Ethical and legal
Meds to control secretions
Atropine
Glycopyrrolate
Scopolamine
Hyoscyamine
Assessment for altered LOC
Eyes, Verbal, motor
Alertness
Respiratory
Reflexes
Goals for altered LOC
Airway
No injury
Fluid balance
Skin
Cornea protection
Thermoregulation
No DVT, ulcers, contractures
Interventions for altered LOC
Underlying
30-45 HOB, suction, CPT
MV, LS q8h, ABG
Skin checks
ROM, PT
Eye drops
Oral care
Fans/blankets/Tylenol
Bowel and bladder
Day night cycle
Turning, splints, boots
Padded rails
Goals for increased ICP
Airway
Cerebral perfusion
No infection
No complications (DI, SIADH, herniation)
Nursing for increased ICP
Respiratory status (LS, O2, ABG)
Head neutral, HOB 30
No hip flexion, valsalva, abdominal distention, high PEEP
Low stimuli
NGT
Monitor fluid status carefully (fluid restriction will increase the blood concentration thus pulling water out of brain; however we also want good CO so don’t overdo it)
Space out care - no cluster!
Aseptic technique with ICP monitor
CSF drain
Fever prevention
Prep for surg
Meds: mannitol, loop diuretics, 3% NS, dexamethasone if tumor, sedatives to decrease metabolic demand
Intracranial surgery preop mgmt
Baseline neuro assessment
Imaging
Meds for cerebral edema (mannitol, diuretics, 3% NS, steroids)
Abx
Diazepam for anxiety
Intracranial surgery post op care
Monitor hemodynamics and resp
Prevent cerebral edema (mannitol) and seizures
MV, art line
Pain management
ABG, VS, GCS, labs, drainage, fluid status, BG with roids
Monitor dressing for bl and CSF
Turn q2h, head straight
Avoid fever or shiver
Atelectasis, PNA, stress and pressure ulcer, DVT prophyl
Sudden neuro change can mean clot
Salty taste = CSF leak
Nursing for intracranial surgery (recovery period)
Maintain cerebral perfusion - resp, neuro, VS, reduce cerebral edema, ICP control, head still, 30 degrees
Temp - Tylenol, fans, blankets
Turn q2h, humid O2
Announce presence and calm environment
Decrease infections
I/O, weights, lytes
Epidural hematoma
Decrease ICP
Remove clot
Stop bleeding
Burr holes, craniotomy
Respiratory support
Intracerebral hemorrhage
Control ICP
Fluids, lytes, antiHTN meds
Craniotomy, craniectomy
Mgmt pt w head injury
Neuro and physical exam
Imaging
Assume spinal injury
Stabilize resp and CV
Control hemorrhage
Surgery
Monitor ICP
Seizure, NGT, f and lytes, nutrition, pain, anxiety
TBI
Airway (HOB 30, suction, no cough, ABG, MV)
CPP
Body temp
Skin
I/O weights
Lytes
Decrease stimuli
Sleep
Avoid opioids (can effect pupils and respiration)
Ambulate TID
Fluids and pressors to keep good BP and CPP without increasing ICP
No valsalva + other ICP considerations
Increase calories and protein
Seizure prevention
Autonomic dysreflexia
Immediate sitting position
Cath, topical anesthetic and remove fecal mass, find cause
Hydralazine
SCI assessment
Respiratory and breathing (LS and cough)
Motor and sensory
Assess for spinal shock
Temp (may be elevated due to inability to sweat)
SCI goals and mgmt
Breathing, airway (suction with caution, O2, CPT, MV)
Mobility (body alignment, boots and rolls, PROM QID)
Skin
Urine and bowel (cath, NGT, stool softeners)
High cal, high protein, high fiber
Pain
Auto dys and other comps (DVT, pressure ulcer, spasticity)
ECG
MAP above 85 to prevent spinal shock
MS goals and mgmt
+ drugs
Bowel and bladder
Speech and swallow
Memory aids
Activity and rest
Mobility and injury prevention: Gait training and ambulatory aids
Avoid extreme temps
Interferon B1A and B1B
Prednisone
Glatiramer
Mitoxatrone
For spasticity: baclofen, benzo, Tizanidine, Dantrolene
For fatigue: Amantadine, premoline, dalfampridine
For ataxia: BB, Gabapentin, benzo
For bowel and bladder: Anticholinergic, antispasmodic, alpha Adrenergic blockers
MG drugs and procedure
Therapeutic plasma exchange
Thymectomy
Cholinergics (pyridostigmine)
IVIG
Prednisone
Mgmt MG crisis (acute critical care tx)
MV
I/O weights
Lytes
NG feedings
Avoid sedatives
IVIG, plasma, then back on Cholinergic
GBS
IVIG
Therapeutic plasma exchange
Assess for DVT, resp failure, dysrhythmia (ECG), PE
Alpha Adrenergic blockers for high HR and BP
MV, IS, CPT
Mobility
IV nutrition
Turn q2h
SCD
Swallow and gag assessment
Cath for urine retention
G tube if no swallow
Depressed skull fractures
Surg
Elevation
Debridement
Spasticity drugs
Botox
Baclofen
Diazepam
Dantrolene
Tizanidine
Clonidine
Meningitis
Culture CSF
Meningococcal vax
Prophyl rifampin, cipro, cef if exposed
IV Abx (penicillin and ceph)
Dexamethasone
Protect from injury rt altered LOC
Compensatory shock nursing
Underlying
Cultures before Abx
Fluids
O2
Decrease anxiety to decrease metabolic demands (sedation, pain meds)
Maintain BP and perfusion
MAP >65
Passive leg raising
Progressive shock nursing
Underlying
Fluids
Respiratory support/oral care for MV
Nutrition (3000 cals/day)
Rest and decrease stress, prevent PICS
Insulin to get G around 180
Antacids, H2 blockers, PPI
Thermoregulation
Hypovolemic shock
Fluid (3 ml for every ml blood lost)
At least 2 large bore IVs
Blood
Underlying
Vasoactive meds
O2
Cardiogenic shock
Prevent, underlying (Thrombolytic, CABG, lyte imbalance, tx of pneumothorax/tamponade/effusion)
First line tx: O2, morphine, art line, fluids (slowly), inotropes and vasodilators (dobutamine, nitro), anti arrhythmics
Decrease load and increase contractility
IVBP (ensure NV checks at legs)
Furosemide, dopamine, NE, nitro
Neurogenic shock
Restore sympathetic tone via…
Stabilize spine
Proper position
Anaphylactic shock
Remove antigen
Fluids
Epinephrine and Benadryl
CPR
Albuterol
Intubation
Considerations with vasoactive meds
VS q15m til stable
Central line to prevent necrosis
CLABSI prevention for central line
Titration based on MAP
Taper down- don’t stop abruptly
Inotropes- what do they do? Give some examples
Increase CO, stroke volume, and contractility
Epinephrine, dopamine, dobutamine, milrinone
Vasodilators- what do they do? Give some examples
Decrease O2 demand
Decrease pre and after load
Drop BP
Nitro
Vasopressors- what do they do? Give some examples
Increase BP via vasoconstriction
NE
Epinephrine
Dopamine
Angio 2
Phenylephrine
Vasopressin
On the scene burn care
Remove from source
Stop the flame
Cool the burns
Irrigate chemical burns
ABC
O2 and IV
Remove restrictive
Cover wound
Remove diapers
Primary assessment
Assume SCI with electrical
Emergent/resuscitative burn care
100% O2
Fluids with TBSA > 20% (central line for large volumes)
Foley
NGT
ECG for electrical
IV pain meds
Stabilize and monitor
Bronchodilator and mucolytics
Looks for polytrauma (TBI, SCI)
Remove restrictive clothes and jewelry
Monitor temp
Tetanus prophylaxis
Cover with clean sheets
Escharotomy
Burn center criteria
Partial at least 10%
Face, hands, feet, genitalia, peri, major joints
3rd degree
Electrical, chemical, inhalation
Pre existing condition
With trauma
Kids if no peds in facility
Those needing long term rehab
Fluid resuscitation for burns
UOP 0.5 to 1 mL/kg/hr (75-100 for electrical)
Keep sodium normal
ABA (2 ml LR x kg x TBSA)
4 for electrical
1/2 in 8 hrs, 1/2 in 16 hrs
Parkland (4 mL x kg x TBSA)
Hypertonic saline formula (first hour = 0.5 x kg x TBSA)
Adjust each hour based on UOP
Inverse titration UOP and fluids
Acute/intermediate phase burn injury
Prevention of infection (includes precautions like no flowers or fruit)
Wound care
Pain mgmt
Early mobility, DVT prophylaxis
Increased calorie demands, increased protein, increased carbs
Monitor f and lytes, GI, renal, temp, respiratory, circulatory
Oxandrolone and propranolol
VAP prevention if MV
Septic shock
Cultures, Abx, labs (lactic), fluids, O2 within 1 hour
Nutrition (3000 cals/day)
Within 1 hour
Find cause of infection- remove lines/start new ones, collect labs and cultures, change urine cath, drain abscess, debridement
Abx
Fluids, pressors, PRBC, sedation
DVT prophylaxis
Nutrition
SOFA score (VS, labs, mental)
Thermoregulation (Tylenol for fever)
Monitor albumin for protein requirements
Prevent PICS via…
Early weaning and ambulation
Delirium mgmt
Sleep
Limit stress
Electrical burn
Fluids til pee isn’t red
Bicarbonate to alkalize urine
Surgical debridement
Assume SCI
Autograft mgmt
Protect
Immobilize
Avoid pressure
Elevate
Start exercises 5-7 days post op
Infection prevention at graft site and donor site (donor site will heal 7-14 days)
Nursing and antidote for ischemia r/t vasoactive medications
Be alert for numbness and paresthesia
Q1h pulse checks
Phentolamine mesylate 5-10 mg in 10 mL NS
