Critical Care Final Exam

what to do for post op cardiac angiography patients

check pulses, cap refill, and neuro vascular status of affected limb distal from the insertion site.

what to do for a post-op CABG patient

give pain meds to facilitate cough and deep breathing, teach sternal precautions, monitor for bleeding and ectopy.

post MI patient after stent placement

can be susceptible to AKI due to hypoperfusion and contrast dye

manifestations of a patient presenting with an acute myocardial infarction

chest discomfort, shortness of breath, and pain in other parts of the body like the arms, jaw, neck, back, and stomach.

priority treatment of MI patient

IV access, 12 lead EKG, troponin, chemistry panel, CBC, PT/INR, O2 if oxygen less than 92%, opioids, nitroglycerin, aspirin

dobutamine for heart failure

will increase BP

sign of increased perfusion

increase in urine output

findings of left sided heart failure

dyspnea, crackles, pulmonary edema, fatigue, S3 gallop

findings for right sided heart failure

peripheral edema, JVD, hepatomegaly, ascites, weight gain from fluid retention

hyperkalemia on an ECG

will show as peaked T waves

post intubation assessment

listen to gastric and bilateral breath sounds, chest ETCO2 either waveform or colorimetric and chest x-ray

what to do if a patient becomes hypoxic while suctioning endotracheal tube

stop and hyper oxygenate before continuing

prevention of ventilator associated pneumonia

HOB 30 degrees or greater, pantoprazole (PPI) administration, NG/OG tube, reposition endotracheal tube, deep oral suction, and oral/teeth care

presentation of flail chest

severe chest pain, respiratory distress, paradoxical chest wall movement, visible chest wall trauma/bruising, crepitus, hypoxia

post extubation

watch patient closely and monitor for airway or breathing complications

respiratory acidosis

elevated carbon dioxide, know what type of patient may have elevated carbon dioxide such as COPD patient, a patient hypoventilation

ARDS patient position to improve oxygenation

prone

patients who are at risk for pneumonia and main findings

older patients and confusion

symptoms of disequalibrium syndrome post dialysis

headache, nausea, restlessness, confusion, muscle cramps (severe: visual changes, seizures, coma, death)

lab findings in AKI

elevated creatinine, BUN, hyperkalemia, metabolic acidosis

what to check before administration of furosemide or other diuretics

creatinine and potassium

findings for acute pancreatitis

elevated lipase and amylase, patient will be NPO initially

what to monitor for a patient with cirrhosis

they may have bleeding issues. Monitor INR and if elevated they might need vitamin K

initial action of a patient who has hypotension after vomiting blood

give IV fluid first and then obtain blood from the lab

acute appendicitis pain

most likely RLQ (McBurney’s point)

post abdominal surgery

monitor for infection at surgical incision

peptic ulcer complaint of a perforation

sudden onset abdominal pain

GI bleed

coffee ground emesis

know what ICP is and what is needed.

intracranial pressure: pressure within your skull exerted by brain tissue, blood, and cerebrospinal fluid. CT scan may be necessary. O2 sat >92%.

causes of autonomic dysreflexia in spinal cord injured patients

most likely cause constipation or distended bladder

SIADH manifestation

low urine output/oliguria

priority actions in a stroke

ABC. Glucose, head CT

signs of hemorrhagic stroke

thunderclap headache or sudden onset of worst headache of my life

basilar skull fracture

look for racoon eyes and battle signs. No NG, and check for CSF leak- check nasal drainage for glucose, metallic taste, continuous postnasal drip.

cushing syndrome

patient presents with moon face, alopecia, purple striations, buffalo hump

Addison’s disease

rare disorder where the adrenal glands don’t produce enough hormones, especially cortisol and aldosterone

medications that would be given during an Addisonian crisis

steroids

hypothyroidism

elevated TSH, low T3 and T4. Cold, hypotension, lethargy, bradycardia. Med of choice levothyroxine

myxedema

really bad hypothyroidism. Signs and symptoms include profound fatigue, cold intolerance, weight gain, and distinct skin changes like puffiness, dryness, and thickening, especially in the face and lower legs.

post-op thyroidectomy patient

watch for tingling around the mouth/extremities, tremor in hands, temperature increase, have patient in semi fowlers, monitor for stridor

hyperthyroid or Grave’s disease

low TSH, elevated T3 and T4

patient with burns to his face, chest, abdomen, and upper arms

monitor airway and breathing closely

Know parkland formula

BSA% of burns as a whole number x weight in kilograms x4 gives you total amount of fluid. ½ of this amount is given in the first 8 hours, the other ½ is given over the next 16 hours

adequate fluid replacement for burn patients

urine output of 0.5 ml/kg/hour or greater and decreased heart rate

nursing care after removal of a catheter for a patient who has thrombocytopenia

hold pressure for longer

actions during initiation of a blood transfusion

check vitals before and every 15 minutes for first hour, have at least a 20-gauge needle, and check blood type and expiration with a second nurse. Use 0.9NS for priming the line.

signs of hemolytic reactions

fever, chills, back/flank pain, nausea, dark (bloody) urine, flushing, and a rapid heart rate. If there is a respected or known reaction, stop the blood immediately.

DIC patient

will have excessive thrombosis and bleeding with prolonged PT/PTT/INR

signs and symptoms of carbon monoxide poisoning

vertigo, headache, and flushed skin

MVC patient with suspected cervical spine injury

use the jaw thrust maneuver to open airway

emergent/trauma assessment

airway, breathing, circulation (IV), disability (GCS), exposure

who should be triage officer during a disaster?

a nurse or other emergency medical personnel

triage assessment priorities

identifying immediate life threats using the ABCDEs, assessing respirations, perfusion, and mental status, and prioritizing acute, unexpected findings over chronic issues.

signs of PTSD

Re-experiencing, avoidance, negative changes in thinking/mood, and hyperarousal (being easily startled, sleep problems)

anaphylactic shock first line medication

IM epinephrine

sepsis priorities

measure lactate level, administer 30ml/kg IV fluid bolus, obtain blood cultures and administer broad spectrum antibiotics

hypovolemic shock manifestations

rapid, weak pulse, fast/shallow breathing, confusion, cool/clammy/pale skin, low blood pressure, decreased urination, extreme thirst, dizziness, weakness, and fainting