synthesis exam 1 need to know

care hypovolemic shock

lower the head of bed, IV fluids 0.9, maintain map ≥ 65

cardiogenic care and meds

DO NOT AGGRESIVELY FLOOD WITH FLUIDS, meds are dopamine, dobutamine, vasopressors

renal function during shock

low renal blood flow and GFR causes oliguria (<30ml/hr)

signs of post op shock

early signs: tachycardia, cool clammy skin, restlessness, late: hypotension, LOC changes

PCA care & when to stop

when RR is 10-12, ongoing assessment q1-4h risks of resp depression

if decomp on PCA

stop PCA, administer O2, give nalaxone

left side heart failure key finding

pink frothy blood-tinged sputum, paroxysmal nocturnal dyspnea

right side HF care

weigh daily monitor for weight gain, fluid restriction

HF meds

ACE Inhibitors, switch to ARBS if dry cough, Beta blockers but cause fatigue, Diuretics, Digoxin, Calcium Channel Blockers (rate control for Afib)

HF care and teaching

daily weight, report sudden weight gain, fluid restriction 1.5-2L/day, left side elevate with pillows while sleep, right side elevate legs, low sodium diet

Digoxin toxicity side effects

yellow hallows, anorexia, nausea, bradycardia

arterial disease presentation

intermittent claudication pain, absent/weak pulses, no edema, cool extremities (pallor), round smooth sores with no drainage on toes/feet, paresthesia, risk for necrosis/amputation

vascular disease presentation (venous)

dull achy pain, lower leg edema, pulses present, sores with irregular borders on ankles, yellow slough or ruddy skin

MI pain presentation

chest pain radiating to jaw/left arm

what is Lanoxin

digoxin

when do you hold lanoxin

if <60 bpm

diltiazem (Cardizem)

CCB for rate control in A fib

Dopamine

vasopressor/inotrope for hypotension and shock

AAA priority care

prevent rupture

AAA presentation

flank/back pain, pulsating abdominal mass, abdominal bruit. Rupture sign: sudden severe back pain, hypotension, tachycardia, syncope, Grey Turner sign, Cullen Sign

what is Grey turner sign

flank bruising

what is Cullen sign

umbilical bruising

How is AAA diagnosed

CT/ultrasound

AAA care

control BP with antihypertensives, avoid lifting straining, give stool softeners, control lipid levels

CABG post op care

monitor respiratory function may be ventilated 3-6 hrs post op, ICU stay for 1-2 days after. Chest tube drainage >100 cc/hr is reportable to HCP, apply wrist restraints to prevent self extubating, early ambulation

How to manage chest tube in CABG

milk drainage every 1-2 hours

complications of CABG

cardiac tamponade/becks triad, also a fib

what is becks triad

hypotension, muffled heart sounds, JVD

How to treat becks triad (cardiac tamponade emergency)

dobutamine, dopamine, pericardiocentesis, mediastinal drain

vtach

check pulses, if pulseless immediate CPR and defibrillation, with pulse = vagal maneuvers, synchronized cardioversion

vfib

IMMEDIATE CPR and defib, if vfib then defib

causes of mitral stenosis

rheumatic fever, chronic inflammation, aging

tx for mitral stenosis

diuretics, beta blockers, CCB, anticoagulants for A-fib, balloon valvuloplasty or balloon replacement

safety w/ mechanical ventilation

prevent VAP, HOB 30-45, oral care q2h, daily sedation, suctioning, vented patients cannot speak; indicated cuff leak, high pressure alarm=obstructions,secretions,coughing, low pressure=disconnection/leak

early hypoxia presentation

restlessness + tachypneic

CO2 retention presentation

drowsy + slow breathing

COPD findings

thin appreance (wasting), chronic productive cough,

COPD complication

Cor pulmonale = right sided heart failure

ICS teaching

swish with water, can develop to thrust/oral candiasis if not in which you would need nystatin

pneumonia findings

productive cough with yellow/green/rusty/bloody sputum, infiltrates on CXR (filled with fluid, pus, blood, or cells)

pneumonia meds

outpatient: amoxicillin, azithromycin, doxycycline, inpatient: ceftriaxone +azithromycin; penicillin broad spectrum

inhaler teaching

shake inhaler, spacer, wait 1 min between puffs

small cell carcinoma

hyponatremia due to ectopic ADH production, SIADH, anemia, elevated liver enzymes, hypercalcemia

suction chamber

gentle continuous bubbling

water seal chamber

Intermittent bubbling; tidaling

report about fluid collection chamber when

drainage is >100 cc/hr

if chest tube dislodge

cover 3 sides with bio-oclussive dressing

what to do suctioning

hyper oxygenate before and after

tb finding

chronic productive cough, night sweats, hemoptysis, pleuritic chest pain

rifampin

causes orange secretions

isoniazid/INH

give vit b6/pyridoxine

ethambutol

causes optic neuritis and red-green color blindness

All TB meds

first three are hepatotoxic, RIP, E hurts eyes

TB skin testing

>15 is positive for general public, >10 for healthcare workers, IV drug users, recent immigrants, >5 for HIV, TB, immunocompromised

how to confirm TB

CXR and 3 sputum specimen collected on different days

dx for DM

fasting glucose ≥ 126, a1c ≥ 6.5, goal for DM is <7

DKA findings

>240, ketones in urine, kussmaul respirations, hyperkalemia, fruity acetone breath

sick day DM teaching

continue insulin, test glucose q4h, check ketones, stay hydrated

hypoglycemia signs

shaky, diaphoretic, tachycardia, late: confusion, coma, slurred speech

hypothyroidism labs

high tsh, low t3, t4

levothyroxine med teaching contraindication

take in the morning on an empty stomach, contra with iron/calcium, do not stop abruptly

myxedema coma

complication of hypothyroidism, treat with IV hormone

hypermagnesium antidote

calcium gluconate

Parathyroidectomy complication

hypocalcemia

hypocalcemia signs

Trousseau's sign, Chvostek's sign, numbness tingling around mouth and fingers

Parkinson's stages

stage 1: one side, stage 2: both sides, stage 3: loss of balance, stage 4: needs assistance with ADL's, severe: stage 5: bedridden/wheelchair, 24/7 care

Parkinson's meds and teaching

carbidopa/levodopa, carbidopa prevents breakdown, levodopa converts into dopamine. Causes dark brown urine/sweat, orthostatic hypotension, dyskinesias, hallucinations. High protein decreases absorption

other parkinson teaching

aspiration precautions bite food, rock side to side before walking, fall precautions

status epilepticus and meds

>5 minute seizure, IV Benzos: diazepam, lorazepam

phenytoin sides and toxicity

sides: gingival hyperplasia (good oral hygiene required), steven Johnson rash, suicidal ideation, Toxicity: nystagmus, ataxia, slurred speech (range = 10-20)

What is preferred long term for seizures

levetiracem(Keppra)

seizure meds teaching

same time daily, never stop abruptly

Meningitis signs and symptoms

nuchal rigidity, positive Kernig's and Brudzinski sign

meningitis precautions

droplet precautions, private room until 24 hrs after starting antibiotics

meningitis meds

broad spectrum: ceftriaxone, vancomycin, penicillin. Dexamethasone (reduces ICP/inflammation), antipyretics, Acyclovir if viral

Mannitol treats increased ICP

lumbar puncture care

Lie flat for 4-8 hours POST LP to prevent spinal headache. confirms CSF analysis (bacterial: high protein, low glucose, high WBC, cloudy)

ventriculostomy use

align transducer with tragus of ear at HOB 30, maintain sterile technique. If disconnected clamp immediately and notify HCP. drainage should be clear

Cushing's triad

1. systolic htn with widening pulse pressure

2. bradycardia

3. bradypnea

cirrhosis lab presentation

high ammonia (causes hepatic encephalopathy, give lactulose to excrete), high ALT/AST, high bilirubin, prolong PT/INR, low albumin and total protein, low sodium, low platelet/hgb/wbc

cirrhosis diet

low sodium, fluid restriction ≤1.5 L/day, small frequent high calorie meals

ETOH Withdrawal findings

tremors, diaphoresis, tachycardia, HTN, nausea, seizures

ETOH withdrawal complication and tx

Delirium tremens is life threatening, severe HTN, fever, hallucinations. Treat with benzos (lorazepam, oxazepam)

pancreatitis findings

severe epigastric pain radiating to back, improves sitting up or leaning forward, Cullen and grey turner sign when severe

pancreatitis care

NPO status, TPN, IV fluids, replace calcium, NGT low suction, pain control (morphine/dilaudid), risk for pneumonia

pancreatitis risk factors

the one related to ETOH abuse, gallstones

cholecystitis findings

RUQ pain or right shoulder pain radiating to back, worse after fatty meals, positive murphy sign, inspiration pain on RUQ palpation, clay stools, dark urine, leukocytosis, jaundice

cholecystitis risk profile

female, fat, forty, fertile, fair

cholecystitis care

NPO, IV fluids, cholecystectomy if severe, teach low fat diet, monitor bile leaks,

tpn care

check blood glucose q4-6h. never stop abruptly (taper to avoid severe hypoglycemia)

tpn infection control

sterile technique for insertion and dressing changes, scrub hub 15 seconds, has its own dedicated line change tubing and tpn bag every 24 hours. if infection suspected stop infusion, get cultures, notify HCP

colostomy care

empty bag when 1/3 to 1/2 full, change appliance q3-7 days, cut wafer 1/8 inch larger then stoma, teach client high fluid diet, chew thoroughly,

renal calculi findings

sudden, severe lower flank pain radiating to groin, hematuria

uti causes

e coli most common, improper wiping (back to front), enlarged PSA in men

uti tx

nitrofurantoin/Macrobid, Bactrim/trimethoprim-sulfamethoxazole (check sulfa allergy/rash) Fluoroquinolones. Increase fluid intake

blood transfusion care

2 nurse verification(pt name, MRN, blood type, unit number, expiration date). Baseline vitals. Stay with them for first 15 minutes. Infuse only with 0.9% saline. start within 30 minutes of blood bank

tranfusion reactions signs

fever, chills, low back/flank pain, chest pain, dyspnea, hypotension. Stop transfusion immediately, new tubing and normal saline, assess vitals, notify HCP and blood bank, return blood bag and tubing to bank