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Block 4 Exam 2 > Tx/mgmt > Flashcards

Tx/mgmt Flashcards

1
Q

Principles of hospice care

A

<6 months to live
Accepted
Pain and symptoms must be managed
Interdisciplinary team
Bereavement are to family
Ongoing research and edu

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2
Q

4 levels of hospice care, covered by Medicare and Medicaid

A

Routine home care
Respite care
Continuous care for crisis
General inpatient hospice (acute pain or ss mgmt, 24h care)

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3
Q

NURSE communication

A

Name the emotion
Understand the emotion
Respect and praise patient
Support the patient
Explore the emotion

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4
Q

QSEN competencies

A

KSA (knowledge, skills, attitudes)
Patient centered
Teamwork
EBP
Safety
Informatics

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5
Q

Aspects of 1991 Patient Self Determination Act

A

Advanced directives
Living will
ID of HC representative
POLST

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6
Q

Roles of State Board

A

Standards (Nurse Practice Act)
Examines applicants
Provides interstate endorsement
Renews licenses
Disciplinary
Rules for revocation
Regulates specialty practice
Standards for curriculum

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7
Q

5 rights of delegation

A

Task
Circumstance
Person
Direction/communication
Supervision/evaluation

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8
Q

Meds in palliative comfort kits

A

Acetaminophen for fever
Benzo for anxiety
Morphine for pain and SOB

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9
Q

Dyspnea assessment in palliative

A

Assess intensity
Interference with activities
Lung sounds
Fluid balance
Edema
Abdominal girth
Temperature
Skin color
Sputum
Cough

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10
Q

Dyspnea mgmt in palliative care

A

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

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11
Q

Nursing for anorexia/cachexia

A

Meds and side effects
Oral assessment- thrush, ulcer
Anti emetics
Laxatives
Remove bad odors
HOB to help gastric emptying
Mouth care

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12
Q

Nursing for hospice confusion

A

Gentle reorient
Edu that this is normal
Spiritual guidance
Music
Haloperidol
Lorazepam

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13
Q

8 domains of National Consensus Project for palliative care

A

Structure and process (interdisciplinary)
Physical aspects (pain, symptoms)
Psychological
Social aspects
Spiritual
Cultural
EOL care (bereavement support)
Ethical and legal

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14
Q

Meds to control secretions

A

Atropine
Glycopyrrolate
Scopolamine
Hyoscyamine

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15
Q

Assessment for altered LOC

A

Eyes, Verbal, motor
Alertness
Respiratory
Reflexes

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16
Q

Goals for altered LOC

A

Airway
No injury
Fluid balance
Skin
Cornea protection
Thermoregulation
No DVT, ulcers, contractures

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17
Q

Interventions for altered LOC

A

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

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18
Q

Goals for increased ICP

A

Airway
Cerebral perfusion
No infection
No complications (DI, SIADH, herniation)

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19
Q

Nursing for increased ICP

A

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

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20
Q

Intracranial surgery preop mgmt

A

Baseline neuro assessment
Imaging
Meds for cerebral edema (mannitol, diuretics, 3% NS, steroids)
Abx
Diazepam for anxiety

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21
Q

Intracranial surgery post op care

A

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

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22
Q

Nursing for intracranial surgery (recovery period)

A

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

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23
Q

Epidural hematoma

A

Decrease ICP
Remove clot
Stop bleeding
Burr holes, craniotomy
Respiratory support

24
Q

Intracerebral hemorrhage

A

Control ICP
Fluids, lytes, antiHTN meds
Craniotomy, craniectomy

25
Q

Mgmt pt w head injury

A

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

26
Q

TBI

A

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

27
Q

Autonomic dysreflexia

A

Immediate sitting position
Cath, topical anesthetic and remove fecal mass, find cause
Hydralazine

28
Q

SCI assessment

A

Respiratory and breathing (LS and cough)
Motor and sensory
Assess for spinal shock
Temp (may be elevated due to inability to sweat)

29
Q

SCI goals and mgmt

A

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

30
Q

MS goals and mgmt
+ drugs

A

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

31
Q

MG drugs and procedure

A

Therapeutic plasma exchange
Thymectomy
Cholinergics (pyridostigmine)
IVIG
Prednisone

32
Q

Mgmt MG crisis (acute critical care tx)

A

MV
I/O weights
Lytes
NG feedings
Avoid sedatives
IVIG, plasma, then back on Cholinergic

33
Q

GBS

A

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

34
Q

Depressed skull fractures

A

Surg
Elevation
Debridement

35
Q

Spasticity drugs

A

Botox
Baclofen
Diazepam
Dantrolene
Tizanidine
Clonidine

36
Q

Meningitis

A

Culture CSF
Meningococcal vax
Prophyl rifampin, cipro, cef if exposed
IV Abx (penicillin and ceph)
Dexamethasone
Protect from injury rt altered LOC

37
Q

Compensatory shock nursing

A

Underlying
Cultures before Abx
Fluids
O2
Decrease anxiety to decrease metabolic demands (sedation, pain meds)
Maintain BP and perfusion
MAP >65
Passive leg raising

38
Q

Progressive shock nursing

A

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

39
Q

Hypovolemic shock

A

Fluid (3 ml for every ml blood lost)
At least 2 large bore IVs
Blood
Underlying
Vasoactive meds
O2

40
Q

Cardiogenic shock

A

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

41
Q

Neurogenic shock

A

Restore sympathetic tone via…
Stabilize spine
Proper position

42
Q

Anaphylactic shock

A

Remove antigen
Fluids
Epinephrine and Benadryl
CPR
Albuterol
Intubation

43
Q

Considerations with vasoactive meds

A

VS q15m til stable
Central line to prevent necrosis
CLABSI prevention for central line
Titration based on MAP
Taper down- don’t stop abruptly

44
Q

Inotropes- what do they do? Give some examples

A

Increase CO, stroke volume, and contractility
Epinephrine, dopamine, dobutamine, milrinone

45
Q

Vasodilators- what do they do? Give some examples

A

Decrease O2 demand
Decrease pre and after load
Drop BP
Nitro

46
Q

Vasopressors- what do they do? Give some examples

A

Increase BP via vasoconstriction
NE
Epinephrine
Dopamine
Angio 2
Phenylephrine
Vasopressin

47
Q

On the scene burn care

A

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

48
Q

Emergent/resuscitative burn care

A

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

49
Q

Burn center criteria

A

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

50
Q

Fluid resuscitation for burns

A

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

51
Q

Acute/intermediate phase burn injury

A

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

52
Q

Septic shock

A

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

53
Q

Prevent PICS via…

A

Early weaning and ambulation
Delirium mgmt
Sleep
Limit stress

54
Q

Electrical burn

A

Fluids til pee isn’t red
Bicarbonate to alkalize urine
Surgical debridement
Assume SCI

55
Q

Autograft mgmt

A

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)

56
Q

Nursing and antidote for ischemia r/t vasoactive medications

A

Be alert for numbness and paresthesia
Q1h pulse checks
Phentolamine mesylate 5-10 mg in 10 mL NS

Block 4 Exam 2 (4 decks)

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