Mark Klimek Yellow Book

Are they overventilating or underventilating?

If overventilating, pick ________

If underventilating, pick _______

alkalosis; acidosis

If the patient has _____ _______ vomiting or suction, pick _____

prolonged gastric; metabolic alkalosis

Respiratory alkalosis means ventilator settings may be too ____

high

Respiratory acidosis means ventilator settings may be too ____

low

______ the denial in loss and grief. _______ the denial in abuse

support; confront

What is Wernicke's/Korsakoff's Syndrome?

form of dementia; psychosis induced by vitamin B1 (Thiamine) deficiency

Primary symptom of Wernicke's/Korsakoff's Syndrome?

amnesia with confabulation (making up stories to fill in memory gaps)

Characteristics of Wernicke's/Korsakoff's Syndrome?

preventable (take vitamin B)

arrestable

irreversible

What is dementia?

damage to the brain that is PERMANENT

i.e. NEVER PICK increase function, improve, cure

What is disulfiram?

aversion therapy

What is the onset and duration of disulfiram?

2 weeks (takes 2 weeks to get out of system)

What should you teach patients on disulfiram?

Avoid all forms of alcohol to avoid N/V and possibly death (i.e. insect repellants, mouthwashes, colognes and perfumes and aftershave, vanilla extract, vingeretts, elixirs, hand sanitizers, tinctures (alcohol for wounds that contain meds for the skin), alcohol prep pads)

What are the names of uppers?

1. cocaine

2. PCP/LSD

3. meth

4. caffeine

5. ADHD drugs

6. bath salts

What are the sings and symptoms of uppers?

1. diarrhea

2. dilated pupils

3. tachycardia

4. hyperreflexia

5. +4 pulse

6. hypertension

Every alcoholic goes through _____ within ______

Alcohol Withdrawal Syndrome within 24 hours of last drink

Only a minority of alcoholics get ______ within _______

Delirium tremens within 72 hours after last drink

(AWS/DTs) can kill you

DTs

Patients with (AWS/DTs) are not a danger to themselves or others

AWS

Patients with (AWS/DTs) are a danger to themselves and others

DTs

What type of room should an AWS patient have?

semi private room; anywhere

What type of room should a DT patient have?

private room near nurse's station

What type of diet should an AWS patient have?

regular

What type of diet should a DTs patient have? Why?

NPO or clear liquids; worried about aspiration

What type of activity order should an AWS patient have?

up ad lib

What type of activity order should a DTs patient have?

restricted bedrest; no BR privileges

You should restrain a (AWS/DTs) patient with ______. You should check them every _______. You should rotate them ______.

restrain DTs patient with vest or 2 point leather restraints; check every 15 minutes; rotate every 2 hours

Both AWS and DTs patients are on _______, ________, and _______.

Antihypertensives (BP is up; withdrawaling from a downer)

Tranquilizers (AWS- benzos- pams and lams; DTs -zines)

Multivitamin

What are the toxic effects of aminoglycosides?

ototoxicity and nephrotoxicity

What must you monitor with ototoxicity?

hearing, balance, tinnitus (ringing in ears)

What must you monitor with nephrotoxicity?

creatinine

What is the best indicator of fluid balance?

weight

What is the best indicator of dehydration?

BUN

When should you administer aminoglycosides?

every 8 hours

What is the route of administration for aminoglycosides?

Give IM or IV

When should you give PO aminoglycosides?

1. Hepatic encephalopathy (brain disease) aka Liver coma, ammonia-induced encephalopathy

2. pre-op bowel surgery (neo- and kan-)

Who can sterilize my bowel?

Neo- Kan- !

How do you draw trough and peak levels?

trough level

administer med

peak level

Sublingual, IV, IM, SQ, and PO trough level

30 minutes before next dose

Why do you draw trough and peak levels?

meds with narrow therapeutic window

When do you draw peak levels for sublingual med?

5-10 minutes after drug dissolves

When do you draw peak levels for IV med?

15-30 minutes after drug is FINISHED not hung

When do you draw peak levels for IM med?

30-60 minutes

When do you draw peak levels for PO med?

don't even try!

What is Category A Biological Agents?

STAPHB

Smallpox

Tularemia

Anthrax

Hemorrhagic fevers

Botulism

What is Category B Biological Agents?

everything that isn't Category A or C

What is Category C Biological Agents?

Nipeh- Virus

Hanta- Virus

How is smallpox transmitted? What kind of precautions?

inhaled transmission; on airborne precautions

How do people die from smallpox?

septicemia; there is no treatment (early detection and isolation is crucial)

What to look for in smallpox?

rash starts around the mouth first

How is tularemia transmitted? What kind of precautions?

inhaled transmission; on airborne precautions

How do people die from tularemia?

die from respiratory failure

How is tularemia treated?

streptomycin

How is anthrax transmitted? What kind of precautions?

inhaled transmission; on airborne precautions

What does anthrax look like?

respiratory flu

How do people die from anthrax contamination?

respiratory failure

How do you treat anthrax contamination?

cipro

PCN

streptomycin

How is plague transmitted? What kind of precautions?

inhaled transmission; on airborne precautions

What are signs and symptoms of the plague infected client?

Hemoptysis: coughing up blood

Hematemesis: vomiting blood

Hematochezia: bright red diarrhea

How do people die from plague?

respiratory failure and blood loss (DIC)

How do you treat the plague?

doxycycline

-mycins

Plague is ______ after ______ of treatment!

no long communicable after 48 hours

What are the primary symptoms of hemorrhagic illnesses?

petechiae

ecchymoses

How is Botulism spread?

ingestion

How do people die from botulism?

respiratory failure

What are the symptoms of botulism?

DESCENDING paralysis

fever

But the patient is ALERT

Symptom seen in patients that inhaled mustard gas?

blisters

Symptom seen in patients that are poisoned with cyanide? What do you use to treat it?

respiratory arrest; sodium thiosulfate IV

Symptom seen in patients that are poisoned with phosgine chlorine?

choking

What symptoms do you see when a patient is poisoned with sarin?

BBSLUDGE

Bronchorrhea (massive amounts of secretions)

Bronchoconstriction

Salivation

Lacrimation (crying)

Urinating

Diarrhea and diaphoresis

GI Upset

Emesis

*cholinergic crisis*

What does an anti-cholinergic effect look like?

dry mouth

bronchodilation

xerostomia (dry mouth)

oliguria

constipation

dry skin

not vomiting

Cholinergic crisis is when you ______ the ________ nervous system

over-do; parasympathetic

All chemical agents require only ______ except for Sarin, which requires ________

soap and water

bleach

When do you commonly give anti-cholinergics?

before surgery (dry mouth and prevent emesis)

What is the nursing role in biological warfare?

1. case finding

2. isolation

3. treatment with antibiotics

4. go home after titer

What is the nursing role in chemical warfare?

*evacuate everyone, decontamination*

1. go to decontamination center

2. remove clothing

3. incinerate clothing

4. shower

5. put on government issued clothing

6. housed in place until neighborhood considered safe

7. go home once environment is safe

What are the chemical agents?

mustard gas

cyanide

phosgine chlorine

sarin

calcium channel blockers are like _____ for your heart

valium

What do calcium channel blockers treat?

anti-hypertensives

anti-anginal

anti- atrial arrhymias

What are side effects of calcium channel blockers?

Headache

Hypotension

Bradycardia

Names of the calcium channel blockers

-zem

-dipine

Verapamil

"Verapamil saw -zem -dipine in the calcium channel"

"QRS" depolarization always refers to _____

ventricular (NOT atrial, junctional, or nodal)

"P wave" refers to _____

atrial

asystole

a lack of QRS depolarizations

flutter

rapid P-wave depolarizations in a saw-tooth pattern

atrial fibrillation

CHAOTIC P-wave depolarizations

ventricular fibrillation

CHAOTIC QRS depolarizations

DEFIBRILLATE

ventricular tachycardia

wide, bizarre QRS's

PVCs

periodic wide, bizarre QRS's

Be concerned about PVCs if

more than 6 per minute

6 in a row

PVC falls on the T wave of the previous beat

What are the lethal arrhythmias?

asystole

v fib

What is the potential life-threatening arrhythmia?

ventricular tachycardia

prioritize life-threatening arrhythmias?

1. asystole and v. fib

2. v. tach

3. a.fib and a.flutter

4. PVCs

Treat PVCs?

lidocaine and amiodarone (V finger trick)

Treat V tach?

lidocaine and amiodarone

Treat supraventricular arrhythmias? (atrial)

adenosine (need to IV push in 8 seconds or less)

beta blockers (end in -lol)

calcium channel blockers

digitalis (top 2 things dig treats is 1. CHF and 2. a. fib)

Treat v. fib?

defibrillation

Treat asystole?

1. epinephrine

2. atropine (anticholinergic)

The purpose for chest tubes is to re-establish _____ pressure in the pleural space

negative

In a pneumothorax, the chest tube removes ____

air

In a hemothorax, the chest tube removes ____

blood