CJE Benchmark Flashcards

MI patho

Blocked artery → no oxygen → heart muscle dies

STEMI

FULL blockage (think: "pipe fully clogged"

NSTEMI

Partial blockage

ST elevation priority action

O2 (restore oxygen) + aspirin (reduce clot) + nitro (improve blood flow) NOTE: act immediately!

Chest pain priority action

MONA (morphine, oxygen, nitro, aspirin)

V-fib

"chaotic" electrical activity → no cardiac output → de-fib (think: v-fib, de-fib)

Asystole

No electrical activity → no perfusion/contraction → CPR + epinephrine

Shock _________, medicate __________

Chaos, silence (ex. Shock v-fib, medicate asystole)

Wide QRS

Ventricular

PVC

SINGLE early wide beat

V-tach

A "run of PVC's", deadly, decreased cardiac output

A-fib

Atria quivers → blood pools → clot formation → stroke risk

A-fib priority action

ABCD's → synchronized cardioversion (for unstable patients)

Heart Failure

Weak pump → fluid backup

HF priority action

Oxygen + elevate HOB + diuretics

Left-sided HF

Fluid in lungs → hypoxia

Left-sided HF priority action

Oxygen + diuretics

Right-sided HF

Fluid in "rest of body" → edema

Right-sided HF priority action

Monitor fluid retention, daily weights

Beta-blockers

"-lol", decrease HR and BP (reduces workload)

When to hold beta-blockers?

HR <60, SBP <100

"Don't block a dying heart"

ACE Inhibitors

"-peril" - Decrease RAAS → vasodilation → decreased workload

Note: LOWERS aldosterone and INCREASES potassium

Important to monitor for ACE inhibitors

Potassium (K+) and BP, angioedema, dry cough

When to hold ACE inhibitors?

When potassium (K+) is HIGH, or if BP is LOW

Digoxin

Increases contractility, lowers HR (heart becomes SLOW but STRONG)

What should you always check before giving digoxin?

Apical pulse

When should you hold digoxin?

When HR is <60

What is an outcome of digoxin toxicity?

Low K+ → arrhythmias

What should you monitor with digoxin?

Monitor K+, key signs (nausea/vomiting, halos)

Lasix (furosemide)

Diuretic → fluid and K+ wasting (think "Lasix = lose K+")

What should you monitor with Lasix?

K+ levels and urine output

Nitroglycerin

Vasodilator → decreases preload → reduces chest pain

What should you check before giving nitroglycerin?

Check BP

When do you hold nitroglycerin?

Hold if SBP <90

Anticoagulants

Prevent clot formation

What should you monitor when giving anticoagulants?

Monitor labs (aPTT, INR), monitor for bleeding

What does potassium do?

Controls heart conduction (remember: like a battery!)

High K+ (hyperkalemia)

Increases excitability of the heart → SLOW deadly arrhythmias (Brady → asystole) think: overcharged battery

What are the priority actions for hyperkalemia?

Protect the heart (calcium gluconate), shift K+ (insulin), monitor ECG

What to note about giving calcium gluconate?

If the patient is on digoxin, it can INCREASE the chance of digoxin toxicity

Low K+ (hypokalemia)

Decreased conduction stability → FAST deadly arrhythmias (V-tach, v-fib, PVC's)

What does sodium (Na+) do?

Controls brain function, think "brAiN"

Hyponatremia risk?

Brain swelling → seizures (think: ""sponge soaked up too much water")

What precaution should someone with hyponatremia have?

Seizure precautions

Hypernatremia

Brain is dehydrated (think: "dried raisin")

Priority action for hypernatremia?

Give fluids (dehydrated brain!)

Calcium controls what?

Muscle + nerve control

Hypocalcemia

Increases excitability → tetany (spasms)

Priority actions for hypocalcemia

Give calcium, initiate seizure precautions

Hypercalcemia

DECREASED excitability → weakness

Priority nursing actions for hypercalcemia

IV fluids (keep hydrated), monitor for kidney stones

What does magnesium do?

CNS regulator (think: on/off button!)

Hypomagnesemia

Increased excitability → risk for arrhythmias → replace Mg

Hypermagnesemia

DECREASED CNS → respiratory depression

Priority action of hypermagnesemia?

STOP Mg, give calcium gluconate STAT (protect the heart), monitor ECG

Hypoxia

DECREASED oxygen to tissues

Oxygen is what priority?

FIRST priority (ABC's)

PaO2 < 60 means

Respiratory failure → oxygen or ventilate

COPD retains what?

CO2

ARDS is caused by

Fluid filled alveoli

There is no _____ in ARDS

Gas exchange

What do ARDS patient need?

Ventilation

If the vent alarm is going off…

BAG the patient

Shock

DECREASED perfusion → organ failure

What's the goal for a shock patient?

Restore perfusion

Hypovolemic shock

DECREASED volume → give fluids FIRST! Think: "tank is empty"

Septic shock

Presents as: high HR, low BP

What is the priority action for septic shock?

Give fluids and antibiotics

If the MAP <65…

The patient is in organ failure → increase perfusion to organs (fluids)

If urine is < 30mL/hr

Kidney failure

Stroke

DECREASED blood flow → brain death

What's the priority action for a stroke patient?

Patent airway, then CT

ICP

Increased pressure, DECREASED perfusion

Priority action for ICP patient?

Elevate HOB to relieve pressure

AKI

DECREASE in filtration → toxin buildup

Priority action for AKI?

Monitor urine output + labs

What does dialysis do?

Remove toxins from the body

GI bleed

Blood loss → shock

What is the priority for GI bleed patients?

Have IV access (2 IV's), give fluid + blood (if indicated)

DKA

No insulin → body burns fat → ketones → metabolic acidosis

What's the priority action for DKA?

Fluids FIRST → insulin → potassium

What's the danger of untreated DKA?

Potassium drop → arrhythmias

HHS

Extreme hyperglycaemia → severe dehydration (NO ketones)

HHS priority action?

Fluids FIRST

Hypoglycemia

Low glucose → brain has no fuel

Priority action for hypoglycemia?

Give glucose immediately

Magnesium symptoms are the OPPOSITE of…

Calcium (ex. Hypercalcemia = "slow and sleepy", so HYPERmagnesemia is the OPPOSITE)

If you see QRS depolarization it's…

Ventricular

If you see P-wave depolarization it's…

Atrial

If it's "chaotic" it's…

Fibrillation

If it's "bizarre" it's…

Tachycardia

"Saw tooth"

Flutter

You can remember "DKA" because it stands for…

Dehydrated, Kussmaul, Acidosis

How do you easily read acid/bases? (ABG's)

If pH and HCO3- (bicarbonate) are in the SAME direction, it's metabolic. Think: "ROME" - Respiratory OPPOSITE, metabolic EQUAL

What happens in metabolic acidosis?

Decreased HCO3- → body becomes acidic → body tries to "breathe it off" → deep, fast breathing

What happens in metabolic alkalosis?

Too much HCO3- → body is too basic

What to remember about metabolic alkalosis?

"Lose ACID (ex. Vomit) → alkalosis"

Pulmonary embolism

Blood clot in lung → DECREASED oxygenation