GNP 4 Final Exam

what is the treatment for someone with sinus bradycardia?

first assess them for symptoms, then give atropine IV push

what is the treatment for sinus tachycardia?

treat the underlying cause, like hypovolemia or infection

what is the treatment for atrial fibrillation?

drug therapy consists of amiodarone to convert the patient back to NSR and anticoagulation therapy. If that doesnt work, then cardioversion

why do you want to give your patient with A fib anticoagulants?

because A fib has a very high risk of stroke and prophylactic anticoagulants can help

what is the treatment for someone who just went into PSVT or SVT?

stimulate the vagal nerve either by coughing or bearing down. If that doesnt work, then administer adenosine

what is the treatment for someone having PVC's ?

replacing electrolytes, mostly potassium

what is the treatment for someone with v tach with a pulse?

cardioversion

what is the treatment for someone with v tach without a pulse?

CPR and defibrillation

what is the treatment for someone with v fib?

CPR and defibrillation

what is the treatment for someone who is going into asystole?

CPR

what is the normal level for CVP?

2-6

what is the normal level for cardiac output?

4-8

what is the normal pap systolic and diastolic?

20-30 systolic and 5-15 diastolic

what are the reasons someone would require a pulmonary artery catheter?

MI, cardiogenic shock, pulmonary htn or heart failure

what do you want to make sure you assess/watch out for with someone who has a pulmonary artery catheter or arterial line placed?

LOC, color, temperature, vitals, pulses and UOP

what are some complications of having a pulmonary artery catheter?

infection, sepsis, air embolus, pulmonary infarction, dysrhythmias

what would an air embolus look like?

low BP, dizziness, breathlessness, loss of consciousness

what would hypovolemic shock look like?

decreased BP, CVP, SV, UOP. but increased HR and RR

what is the treatment for someone in hypovolemic shock?

stop the fluid loss and replace it with either blood transfusion or fluids IV

what would septic shock look like?

increase in CO, decrease in SVR, and UOP. Confusion, SOB, and tachycardia, fever, cool clammy skin

what would treatment for septic shock look like?

first get a lactate, then get blood cultures, administering antibiotics, then administer pressors like norepi, and then begin fluid resuscitation, in that order!

what would cardiogenic shock look like?

increase in HR, RR and low BP and LOC, sweating and restlessness

what is the treatment for someone in cardiogenic shock?

reoxygenate the body by treating the hypoxia, administer an inotrope like dopamine to increase contractility of the heart

what does neurogenic shock look like?

hypotension, bradycardia, sweaty, cool clammy skin, labored breathing, dizziness, anxiety

what is the treatment for neurogenic shock?

administer drugs to increase the HR, that would be dopamine or atropine

what are the antiarrythmatics and what are they intended to do to the body?

amiodarone, diltiazem, lidocaine, metoprolol. Intended to suppress abnormal rhythms of the heart and convert it back to NSR

what are the inotropes? and what are they intended to do to the body?

dobutamine, milrinone, dopamine, digoxin. Intended to increase myocardial contractility, thus increasing the BP

what are the vasopressors and what are they intended to do to the body?

dopamine, epinephrine, norepinephrine, vasopressin. Intended to increase vascular tone by contracting the vessels to raise the HR and BP

what are the vasodilators and what are they intended to do?

nicardipine, nitroprusside, nitroglycerin. intended to dilate the blood vessels to decrease the HR or BP

what are some of the ways that you care for someone with ARDS?

prone positioning, oxygenate the patient, pursed lip breathing, and mechanical ventilation if necessary

what is the treatment for someone in respiratory acidosis?

increase the respiratory rate to blow off the CO2

what is the treatment for someone in respiratory alkalosis?

decrease the respiratory rate to keep more of the CO2 in

what is the treatment for someone in metabolic acidosis?

give the patient potassium and treat the underlying causes

how can someone get metabolic acidosis?

excessive diarrhea

why would you be concerned for hypokalemia in a patient in metabolic acidosis what the treatment is to give them potassium?

hyperkalemia will occur as potassium shifts out of the cell, as the acidosis is being corrected potassium will go back into the cell causing rebound hypokalemia

not only do you have to watch for potassium levels with metabolic acidosis, but what other electrolyte should you make sure you watch out for?

serum calcium levels because they can be lower with chronic metabolic acidosis

what is the treatment for someone with metabolic alkalosis?

give the patient chloride because this will help excrete the bicarb from the body

how does someone get metabolic alkalosis?

excessive vomiting because youre throwing up all the acid in your stomach leading to all the base (bicarb) left in there

what are the 3 modes of mechanical ventilation?

AC ventilation, SIMV, and pressure support

what makes AC ventilation and SIMV different?

AC ventilation delivers a specific tidal volume once the patient initiates a breath, SIMV will deliver a specific tidal volume at a specific rate that the patient is spontaneously breathing at

what is a high pressure alarm and what could be going on thats causing it?

some blockage in the tubing, either from the patient biting the tubing or there is a build up of secretions in the tubing

what is a low pressure alarm and what could be going on thats causing it to happen?

this is where there is a leak in the system either from a hole in the system, the patient is talking or the balloon isnt inflated enough

when assessing someone with a pulmonary embolism what should you use to assess them?

you must complete a spiral CT scan with contrast

what is something that you should do for your patient if they are going down for a spiral CT scan regarding a PE?

check for allergies to shellfish for the contrast and also check the patients creatinine clearance to make sure they can excrete the contrast when finished

what is the test that you can do if they patient has an allergy to shellfish and theres concern for a PE?

ventilator perfusion scan

what is the one medication that your patient needs to be on if there is a diagnosis or concern for PE?

heparin or warfarin to prevent further complications d/t blockage

what are the antidotes for heparin and warfarin?

protamine and vitamin K

what are some other ways you can help care for your patient with a diagnosis of a PE?

sequential compression devices and early ambulation

what do you want to make sure you watch out for with a patient who is fresh off a CABG?

bleeding, anemia, fluid and electrolyte loss, infections and cardiac tamponade

what is one cardiac rhythm that you should watch out for with a patient who is fresh off a CABG?

atrial fibrillation

what kind of therapy would a patient need if they got an artificial heart valve replacement?

life long anticoagulation therapy

what are the signs and symptoms fo left sided heart failure?

SOB, fatigue, cyanosis, tachycardia, restlessness

what are the signs and symptoms of right sided heart failure?

chest pain, sweating, swelling in legs, distended jugular veins

why does coronary artery disease cause fluid excess in the body?

because the coronary arteries supply the heart with the blood and energy that it needs to pump blood efficiently, when that is compromised the body doesnt have enough force to pump that blood to the lungs and then the rest of the body causing it to back up into the SVC and IVC leading to fluid overload

for a patient who is fresh off a coronary artery angioplasty, or a CABG, how do you want to position this patient in bed?

position them flat so that their incision sites can heal properly, sitting them up can cause them to have complications at either the midsternal or femoral artery

for someone with a ruptured AAA, what should you do?

first get them to to operating room asap, then manage their pain afterwards

what are some of the symptoms of left sided stroke?

impaired speech, language, slow performance cautious and impaired comprehension of language

what are some symptoms of right sided stroke?

paralyzed left side, left sided neglect, spatial or perceptual deficits, and impulsive behaviors

what is the drug therapy for someone following an ischemic stroke?

TPA to reestablish blood flow to that artery

what is the drug therapy for a patient following a hemorrhagic stroke?

NO ANTICOAGULANTS, treat the patients HTN

management of a stroke patient includes what?

cardiac status, respiratory status, neuro checks regularly, motor functions and assessing for DVT risk

with someone who is suspected of having DKA, what are some of the telltale signs of DKA?

acidosis, positive for ketones, and glucose over 300 and kussmal respirations

if someone is suspected of having HHS, what are some of the things that would point you to HHS?

glucose levels above 600

what is the treatment for DKA and HHS and where does it differ?

treatments are both very similar consisting of fluid resuscitation and IV regular insulin drip. however, when fluid resuscitating, you stop the NaCl and switch to dextrose when DKA hits 200-250 and HHS hits 300 blood glucose

when dealing with a patient who is experiencing DKA or HHS, what is an important assessment you should be very regularly?

daily weights because these patients will be fluctuating non stop with the amount of fluids theyre receiving

who are the most likely people to get meningitis?

college students

how should you care for someone who has meningitis?

put them in a dark room with no distractions and seizure precautions

for a patient with a GI bleed how will you know where the bleed is coming from?

if the liquid looks like coffee grounds it means that it has touched the digestive track, if its bright red, that means that it has not reached there yet

how will you assess a patient with a suspected GI bleed?

first look at their abdomen, then listen, then palpate their abdomen in that order. then you can assess their pan afterwards

what are some interventions that you should make sure you do for someone experiencing a GI bleed?

push fluids, oxygenate, lay the pt flat, feet up, and take vitals routinely

for a patient receiving a blood transfusion you should verify with how many people?

2 RN's

before giving the patient a blood transfusion you should ask them what questions?

if they have ever had a transfusion before, and if they are allergic to anything?

who do you see first when there is a disaster?

those that are critically ill, that or the red banded patients

what are the important assessments with a patient suffering a spinal cord injury?

ABC's and immobilizing the patient so they dont cause any more damage, and DVT prevention as well

what are the three things you need to make sure you manage with a patient who suffered a spinal cord injury?

bowel, bladder and temperature

If a patient has a worsening headache in the morning and projectile vomiting, what does the patient most likely have?

cerebral edema

what is the most important assessment for a patient suffering a head injury?

glascow coma scale

what are the two big drugs given to patients following an organ transplant?

cyclosporine, tacrolimus

what are some side effects of cyclosporine and tacrolimus?

tremors, seizures, abnormal kidney function, high blood sugar and cholesterol

what are the three things that you need to make sure you remember with someone taking immunosuppresive drugs?

never skip a dose or stop taking medication, avoid grapefruit juice, do not take NSAIDS

what is a common side effect of mycophenylate mofetil?

decreased WBC and platelets leading to risk for infection

if a patient is pronounced dead with loss of heart and respiratory function what can they donate?

corneas, heart valves, skin and long bones

if a patient is ventilator dependent and there is loss of brain function what organs can they donate?

heart, lungs, liver, pancreas, intestines, kidneys and tissues

what are the 6 scenarios that yield a donor discussion?

brain dead, non-survivable nature of injury, family mentions donation, donation mentioned not by gift of life, pt is hemodynamically unstable, decision to withdrawal or limit therapies

what does an acute MI yield in an EKG strip?

ST elevation meaning ischemia

if an MI happens on leads II, III, aVF where is the MI on the heart?

inferior

if an MI happens on leads V1, V2 where is the MI on the heart?

septal

if an MI happens on leads V3, V4 where is the MI on the heart?

anterior

If an MI happsn on leads I, aVL, V5, V6 where is the MI on the heart?

lateral

what are the interventions for someone following an MI?

12 lead EKG, chewable aspirin, and getting labs like troponin, cardiac enzymes, CBC, BNP, PT INR, PTT

what are some complications of an MI?

dysrhythmias r/t ischemia, cardiogenic shock and dressler syndrome

what is the worst kind of burn?

second degree because its very painful and affects the tissues but isnt deep enough to kill the nerve endings

what are the characteristics of a third degree burn?

painless, loss of feeling, hairless, dry leathery look to the skin

what is the collaborate care for a patient suffering a burn related incident?

fluid resuscitation, ABC's and stopping the burning process

what is an effective way to stop the "burn process"

wrapping the affected area in a dry towel/blanket. NEVER PUT ON ICE

where would you check for an air leak in a chest tube set up?

in the water chamber

how do you know if the suction is on for a chest tube?

the orange piece is floating in the space that says suction

for patients with a pacemaker, what should you make sure your patient does NOT do?

no lifting arm over head, monitoring site for infection and bleeding

what are some important teaching points for someone with a pacemaker?

follow up appointments are key, avoid direct blows to chest, no MRI's unless compatable, make sure to carry pacemaker card and medic alert card at all times

Where should the transducer be placed for accurate measure of pressure regarding ICP?

at ear level