Orientation Day: MS and Psych

MEDICAL SURGICAL NURSING

CHF or Congestive Heart Failure

Congestive heart failure - a chronic condition where the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs.

• Right to Left is Rare

• Left to Right is Possible

Point of Maximum Impulse (PMI) - Apical Pulse or 4th to 5th ICS LMCL

LEFT SIDED HEART FAILURE (r/t LUNGS)

• 2 pillows/ high fowlers/ tripod

• s/sx. Frothy saliva, Dyspnea, Coughing, Wheezing, Paroxysmal nocturnal dyspnea

RIGHT SIDED HEART FAILURE (r/t REST)

• Backflow to the rest of the body

• s/sx. Jugular vein distention, Ascites, Edema, Hepatomegaly, Loss of appetite

DLADA toxicity level

• Digoxin x 2

• Lithium x 2

• Aminophylline x 20

• Dilantin x 20

• Acetaminophen x 200

COPD

Chronic Obstructive Pulmonary Disease - a common lung condition characterized by restricted airflow, inflammation, and tissue destruction, leading to difficulty breathing, chronic cough, and mucus production.

• 2L - Maximum O2 for COPD driven by hypoxic drive

• Hypoxic Drive - the body's respiratory system being primarily stimulated by low blood oxygen levels (hypoxia) rather than the typical high carbon dioxide (CO2) levels that usually trigger breathing

Arthritis

• Rheumatoid, Osteo, Gouty Arthritis

  • OA - Localized, Bouchard’s and heberden’s

  • RA - Systemic, Swan Neck Deformity

  • GA - Nocturnal, Uric acid

Burns

Rule of Nines (DARNA)

• Head (3), face (3), and neck (3) = (9)

• Left arm (9) and Right Arm (9)

• Chest Anterior (18) and Posterior (18)

• Left leg (18) and Right leg (18)

• Perineum (1)

Paralysis (-plegia)

Key terms

• Theophylline - known as bronchodilator

• Digoxin (Lanoxin) - digitalis glycosides. manages heart rhythm. HR <60 DO NOT ADMINISTER

• Phenytoin - anticonvulsant

• GABSH - Group A beta-hemolytic streptococcus (GABHS), a type of bacterium that causes "strep throat," scarlet fever, and skin infections

• Stenosis - abnormal narrowing of a passageway

PSYCHIATRIC NURSING

Anxiety

Anxiety - vague sense of impending doom (SNS response)

• High HR, BP, RR

+1 Mild - “you seem restless“ - Alert - Wide

+2 Moderate - Pacing - PRN meds - Selective inattention - Narrow

+3 Severe - “Don’t know what to do, what to say” - Directive

+4 Panic - “Don’t touch client“ - Suicide/Safety - Respiratory Alkalosis - Bag

ABG Analysis

Normal Values

• pH - 7.35 to 7.45

• CO2 - 35 to 45

• HCO2 - 22 to 26

Principle #1 (opposite)

• Down - Acidosis

• Up - Alkalosis

• If opposite pH and CO2, decide respiratory

Principle #2 (same)

• If same pH and CO2, decide metabolic

Principle #3

• If same CO2 and HCO2, decide partially compensated

• fully compensated if pH level becomes normal

Nursing Process

Diagnosis - Ineffective individual coping

Planning/Implementation - to lower anxiety, environmental stimuli, and relaxation techniques

Evaluation - Effective individual coping

Antianxiety Agents (Pharma moment)

• Valium - short term - withdrawal causes rebound phenomenon within 1 week (seizures) - so choose gradual taper dose or 10% to 25% every 1 to 2 weeks

• Librium

• Ativan

• Serax

• Tranxene

• Zepam, zolam, zepine

ANTIANXIETY INCREASES GABA

GABA - Gamma Aminobutyric Acid

• Inhibitory

• Remember EVERYTHING lowers down

• NO ALCOHOL AND COFFEE

• Develops orthostatic hypotension

  • Sit

  • Dangle feet

  • Stand

ECG components

Contraction - Depolarization

Relaxation - Repolarization

AD - Atrial Depolarization

VD - Ventricular Depolarization

VR - Ventricular Repolarization

PR interval: 0.12-0.20

QRS complex: 0.6-0.10 (half pr)

Prolonged PR interval: 0.30 (1st degree heart block)

Widened QRS: 0.20

REMEMBER:

• AsystolE - Epinephrine

• VentricLe - Lidocaine

Hypo and Hyperkalemia

Potassium (K+) normal value is 3.5-5

• prolonged, wide, or tall is hyper

• short or narrow is hypo

• U wave is hypo

Hyperkalemia - Kayexalate or Insulin + Glucose

Hypokalemia - Banana, Orange, and Potatoes

REMEMBER:

• NEVER IV PUSH POTASSIUM