4.6 Adverse Events

what measures should be avoided if a pt has orthostatic hypotension?

• sudden postural changes

• prolonged recumbency 

• hot environments

• alcohol

• large carbohydrate meals

• straining during defecation or micturition

what are standard pharmacological treatments of OH?

• fludrocortisone

• midodrine

• combination of the two

what measures should be tried for pts with OH?

• head up tilt during sleep

• high salt intake (improves preload)

• physical maneuvers (crossing legs, squatting, ankle pumps)

• compression stockings

• small, frequent meals

• exercise 

what should you do if an IV, central line, or PICC line gets pulled out?

• elevate and hold pressure

• if in neck, elevate head of bed and hold pressure 

• then call the nurse

what should you do if an A line is pulled out?

• have pulsatile, squirting of blood

• elevate and hold pressure

• hold for a minimum of 10 minutes and very firm pressure

• then call nurse

what should you do if an NG tube is pulled out?

• if feeding is still running, concerned about aspiration

• stop it from running (green hold button)

• if not completely pulled out, hold it in place and call the nurse 

• if it moves over a centimeter during treatment, call the nurse 

what should you do if a foley catheter is pulled out?

• non life-threatening but you will have traumatic bleeding from urethra

• call the nurse

what should you do if a hemovac is pulled out?

• put towel around incision

• call the nurse

what should you do if an endotracheal tube is pulled out?

• usually no bleeding associated but can damage the airway and vocal cords

• in ICU, there will be an RT with you most likely so they will take care of it

• if pt stops breathing, call a code 

• don’t hit the call light, scream for help 

what should you do if a pt has a drop in O2 sats?

• assess appearance to verify reading is real

• instruct in pursed lip breathing to see if pt will improve

• if doesn’t improve quickly, may need to reapply O2/titrate O2 up for activity (if they did not have O2 before, call the nurse)

• need O2 sats to improve >88% before further activity

• if doesn’t improve within 5 minutes, return to supine and call the nurse

what should you do if your pt passes out?

• lay pt on back

• elevate legs to restore blood flow to the brain

• loosen tight clothing

• try to revive person; shake, yell, or sternal rub

• if pt doesn’t respond, call 911 or the nurse

• if pt isn’t breathing, start CPR

what should you not do when a pt passes out?

• don’t give pt food or drink 

• slap face or splash water to try to retrieve pt 

• leave pt alone 

what button should you push if a pt passes out?

staff assist

what are signs/symptoms of a stroke?

B- balance

E- eyes

F- face

A- arms

S- speech

T- time

what button should you push if a pt has stroke symptoms?

rapid response

what are the criteria for calling the rapid response team?

• HR <40 or >140 bpm

• RR <8 or >28 breaths per minute

• SBP <90 or >180 mmHg

• O2 sat <90% despite supplemental O2

• acute change in mental status

• urine output <50cc over a 4-hour period

• MAP <65 or >130 mmHg

what are the do’s of seizure precautions?

• note time and duration of seizure

• maintain patent airway

• loosen tight clothing

• place bed in lowest position

• provide privacy

• move sharp edges and furniture away and put padded side rails up

• turn to side-lying position

• cushion head with pillow

• administer PRN meds as ordered

what are the dont’s of seizure precautions?

• restrain the pt 

• force the jaw open

• place anything in the mouth 

• leave pt unattended 

• move the pt (unless imminent danger)

what button should you push for a seizure?

rapid response

what button should you push for cardiac arrest?

code blue