Medication and Cardiac Monitoring

• Digoxin Medication Administration
  • Check Apical Pulse
  • Must check the apical pulse before administering Digoxin.
  • A "full minute apical pulse" must be obtained.
  • Apical pulse must show heart rate above $60$ bpm; if below, medication should be held.
  • Signs of Digoxin Toxicity
  • Digoxin toxicity is critical knowledge for exams.
  • Symptoms include low potassium, bradycardia (heart rate below $60$ bpm), and visual disturbances (e.g., yellow-green halos).

Medication Administration Guidelines

• Lasix Administration
  • Lasix is utilized for fluid overload (e.g., CHF patients).
  • Monitor Electrolytes: Watch for risks of hypocalcemia, hypomagnesemia, and hypokalemia with Lasix use.
  • Monitor for signs of arrhythmia associated with low potassium.
• Potassium Replacement
  • Administration Protocol:
  • Never administer IV push potassium.
  • Patients must have urine output before potassium is given.
  • Remember the phrase: "No pee, no K."
  • Administration Methods:
  • Can be mixed with saline if given through IV to reduce burning sensation.
  • Potassium should never be crushed; consult with a physician if a patient has a PEG tube.
  • Signs of Potassium Toxicity
  • Potassium can cause cardiac arrest when administered improperly (as in a lethal injection scenario).
  • Administer potassium via central line or peripheral line only if the patient can tolerate it.

Electrolytes and Cardiac Events

• Hypomagnesemia and Hypokalemia
  • Both conditions can lead to ventricular tachycardia (V-tach).
  • V-tach appears on telemetry as rapid oscillations resembling peaks and valleys (like a mountain).
  • Monitor patients for signs of arrhythmias when administering potassium following Lasix.

Preeclampsia and Magnesium Administration

• Symptoms of Preeclampsia: Elevated blood pressure, leg swelling, headaches, and proteinuria.
• Magnesium Sulfate is given to manage preeclampsia's symptoms.
• Magnesium Toxicity: Reduced respiratory rate (e.g., RR of $8$ indicates potential toxicity).
• Antidote: Administer calcium gluconate.

Calcium Management

• Low Calcium Levels
  • May arise post-thyroidectomy due to parathyroid gland damage.
  • Symptoms include twitching (tetany), Chvostek's sign, and Trousseau's sign.
  • Chvostek's Sign: Tap the cheek to observe twitching as a response.
  • Trousseau's Sign: Inflate the blood pressure cuff to observe finger spasms.

Anemia and Lab Values

• Symptoms of Anemia: Fatigue, shortness of breath, weakness, and pica (cravings for non-food items).
• CBC and MCV Values
  • Normal MCV value is between $80 - 100$ fL.
  • Below $80$ indicates iron deficiency anemia; above indicates folate or B12 deficiency.
  • B12 Deficiency: Results in glossitis, characterized by a beefy red or smooth tongue.

Stroke Management and tPA Protocol

• Assessment: When a stroke patient presents with slurred speech and unilateral weakness, inquire about the last known well time for tPA administration.
• tPA Administration: Time sensitivity critical (window of $3-4$ hours).
• Imaging: Administer a CT scan to distinguish between ischemic and hemorrhagic strokes.
  • Risk of bleeding precludes using tPA in hemorrhagic strokes.
• Monitoring Post-Administration:
  • Conduct NIH Stroke Scale assessments and ensure PT/OT speech evaluations are conducted.
• Post-Stroke Medications: Aspirin is given, but not during the first $24$ hours post-tPA.

Chronic Kidney Disease (CKD) and Dialysis

• Guidelines:
  • For all CKD patients, dietary restrictions apply (low potassium, low sodium, low phosphorus).
• Dialysis Types:
  • Hemodialysis: Requires a matured fistula; involves a risk of disequilibrium syndrome.
  • Peritoneal Dialysis: Performed at home, can lead to risk of infection (peritonitis).

Medications of Note

• Lisinopril Use:
  • Effective for hypertension, especially in specific ethnic groups.
  • Potential for angioedema; monitor for allergic reactions (swelling of lips/throat).
  • Watch for dry cough as a common side effect.
• Patient Education: Advise on what to expect and when to seek help.

Emergency Response Techniques

• Chest Pain Assessment and Intervention
  • First Step: Identify nature of chest pain, assess radiation of pain.
  • First $10$ Minutes: Critical for diagnosis (EKG must be obtained).
  • Medications: Follow the MONA protocol (Morphine, Oxygen, Nitro, Aspirin).
  • Cautions: Avoid nitroglycerin if the patient took Viagra or has low blood pressure.

COPD Management

• Recognition of Symptoms:
  • COPD patients may present shortness of breath and utilize tripod positioning for easier breathing.
• ABG Results Interpretation: Typically indicates respiratory acidosis due to $CO_2$ retention.
• Oxygen Therapy: Careful titration to avoid further $CO_2$ retention.

Important Patient Education and Protocols

• Reinforce patient understanding of medication and diet guidelines, especially concerning potassium and anticoagulant therapy (warfarin).
• Instruct patients to monitor signs of toxicity, side effects, or adverse reactions, while emphasizing the