Tx/mgmt Flashcards
DI
Fluid deprivation test
Vasopressin
SIADH
Neuro assessments
Lasix
3% NS
Addison
IV fluids
IV hydrocortisone
Corticosteroids
Vasopressors
Recumbent/legs elevated
Abx if due to infection
(Must have supplemental steroids when undergoing stress)
Cushing (procedures and tests)
Dx 2/3 must be positive (serum cortisol, urine cortisol, low dose Dexamethasone suppression test)
Surgery if tumor
Adrenalectomy
DKA and HHS
IV fluids
IV insulin
Restore pH and lyte balance
Potassium
Components of hemodynamic monitoring system
Disposable flush system
Pressure bag (300 mm Hg, prevents clotting and backflow)
Transducer (to show electrical signal)
Amplifier/monitor
Nursing role with hemodynamic monitor
Ensure no air bubbles
Stopcock at phlebostatic axis
Zeroed out
What the heck does a CVP monitor do? What’s a normal value?
Where do you stick it?
Measures pressure at vena cava/R atrium and the preload at the right ventricle
Normal 2 to 6 mmHg
At subclavian vein
What the heck does a PAP monitor do?
What are some considerations?
Monitors pulmonary arterial pressure at the left ventricle
Don’t fill balloon with fluids - only fill with 1.5 mL air to measure PAWP (L vent preload) for 15 seconds max
Sinus bradycardia
Pacemaker
Underlying
Atropine, dopamine, Epi
Sinus tachycardia
Synchronized cardioversion
Vagal, cold stimulation
IV BB
CCB
Ablation if all else fails
Atrial flutter
Cardioversion
Catheter ablation
Drugs (see other f card)
Afib
Cardioversion
Ablation
Maze with cyoablation
LAAO (left arterial appendage occlusion with Watchman for stroke prevention)
Drugs (antiarrhythmics and antithrombics) - see other f card
V Tach
Cardioversion
Defibrillation if pulseless/unresponsive
Antiarrhythmics (see other f card)
ICD for long term tx
V fib
CPR, ACLS
Defibrillator
Epi, amiodarone
Asystole
CPR
IV access
Find cause (Hs and Ts)
Epi, atropine
PEA
CPR
Intubation
IV epinephrine
Underlying cause
Anemia
Underlying
PRBC
Diet
Iron, folate, B12
Immunosuppressive therapy
Education for neutropenia to decrease infection risk
Mask
Avoid crowds
Healthy diet and lifestyle
No fresh fruit or flowers
Handwashing and overall hygiene
Notify provider if infection
IS/deep breathe
Bleeding disorders
Platelet transfusion
Aminocaproic acid
Limit injury
DIC
Underlying
Correct tissue ischemia
Fluid and lytes
Maintain BP (vasopressor)
Replace coagulation factors
Heparin, LMWH
Do not use aminocaproic acid
Avoid bleeding
Avoid increasing ICP
Polycythemia Vera
Phlebotomy
Chemo to suppress bone marrow
Mgmt atherosclerosis
Meds (see other f card)
Lupus
Prevent loss of organ function
Avoid sun
Prevent infections
Manage fatigue, impaired skin integrity, osteoporosis
Smoking cessation
Skin integrity
Sickle cell
Stem cell
Hydroxyuria
Daily folic acid
Corticosteroids
Transfusions
Vax up to date
Pain mgmt
Fatigue management
Infection prevention
IVF, O2
Hydration, nutrition, rest and activity
Hereditary hemochromatosis
Phlebotomy
Avoid iron and vitamin C supplements
Decrease ETOH
AV block
IV atropine
Pacemaker
Sick day rules for DM
Normal insulin/anti diabetic
Test BG and ketones q3-4h
Take additional insulin if needed
Soft foods 6-8x/day
Liquid q30-60m
HF
Meds (see other f card)
Lifestyle
O2
ICD
Heart transplant
Bed rest when acute
30 minute of activity
Avoid extreme temp
Good HOB
Manage fluid volume, low salt
Pulmonary edema
Nonrebreather
Furosemide and nitro
Dangle feet
I/O
POND: position/PVV, oxygen, nitro, diuretics
Anaphylaxis
O2, intubation, CPR
Epi
IV Fluids
Take to ER
Monitor for rebound in 4-8 hours
Postexposure prophylaxis for HC worker
ART within 72 hours
2-3 drugs for 28 days
HIV testing after 6 weeks, 12 weeks, and 6 months
Hematologic assessment includes looking for…
Fatigue
Delayed clotting
Family history
Bruising and bleeding
Abdominal pain
Joint pain
Abnormal blood cell counts
Illness
Dyspnea
Diet low in B12, iron, folate
Skin discoloration (ruddy, pallor, bronze, rash, jaundice)
Swollen tongue
Occult blood
Ascites assessment
Girth and weight daily
Look for striae, distended veins, umbilical hernia
Percuss for dullness
Monitor for f and l imbalances
Ascites tx
Low sodium diet
Diuretics (spironolactone)
Bed rest
Paracentesis
Albumin
TIPS
Hepatic encephalopathy assessment
EEG
LOC
Fluid, lyte, ammonia levels
Monitor for seizures and fetor hepaticus
Hepatic encephalopathy mgmt
Underlying
Lactulose
IV glucose to decrease protein metabolism
Flumazenil
1.2 g protein/kg/day
Reduce ammonia via suction, enema, oral abx
Dc sedatives
Tx comps and infections
Rifaximin, neomycin, metronidazole to decrease ammonia forming bacteria in colon
Esophageal varices
Shock tx, O2
IVF, lytes, volume expanders, blood products
Vasopressin, somatostatin/octreotide to decrease bleeding
Nitro with vasopressin
Propranolol and nadolol
Balloon tamponade
Endoscopic sclerotherapy
Banding ligation
TIPS
Surg - bypass, devasc and transaction
HAV
Hygiene
Safe water
Vax
IG
Bed rest
Nutrition
HBV
Antivirals ETV and TDF
Bed rest
Nutrition
Vax
Screen blood products
HCV
Number one cause for liver transplant
Stop etoh
Antivirals
Avoid hepatotoxic meds
Needle safety
Cirrhosis
IO
Small frequent
High calorie low sodium
1.2 g protein/kg/day
Vitamins
Skin
Prevent injury
Cholelithiasis
ERCP
Low fat
Ursodeoxycholic acid 6-12 months
Chenodeoxycholic acid
Laparoscopic cholecystectomy
Interventions for gb surg includes
Low Fowler
NG/NPO til bowel sounds
Progress to soft low fat/high carb
Biliary drainage system
Pain mgmt
Splinting, cough, db
Ambulation
Pancreatitis
Pain mgmt (PCA)
Resp care
Biliary drainage
NPO, rest, NGT
Surg
Nutrition (low fat, low protein)
Skin
F and lytes, combat shock/MODS/pancreatic necrosis
