Critical Care HESI Final

Critical care HESI – 55 questions  Cardiac o SVT: supraventricular tachycardia  No p waves seen  Treatment:  Adenosine – give 6mg, then 12mg, then another 12mg  Cardioversion if pt not tolerating rhythm  Don ...

Critical care HESI – 55 questions  Cardiac o SVT: supraventricular tachycardia  No p waves seen  Treatment:  Adenosine – give 6mg, then 12mg, then another 12mg  Cardioversion if pt not tolerating rhythm  Don’t defibrillate!!!  Have someone bring crash cart to room o Atrial fibrillation:  Chaotic atrial activity  Irregularly irregular  Controlled: vent rate < 100  On digoxin at home and has controlled a fib  look at digoxin level  Uncontrolled: vent rate > 100  P waves are fibrillatory  High risk for clots  give anticoagulant  Common in elderly  Holiday heart syndrome: alcohol and emotional stress o Atrial flutter:  Ventricular rhythm stays regular  Sawtooth waves  Cardiovert! o Asystole: flat line  Patient is essentially dead  Give CPR and epi  Pulse is gone  Patient in asystole for 20 minutes  talk to family, patient is dead o 3 rd degree heart block  Look at patient’s blood pressure, bradycardia  Give atropine, epinephrine, pacemaker o Alcoholic EKG  Wide QRS and flat T = life threatening  Flat T means hypokalemia o Peaked t waves are usually from hyperkalemia o STEMI: ST elevation myocardial infarction  Give thrombolytics within 4 hours of onset o MI vs. Indigestion  Classic symptoms of MI: dull chest pain radiating down left arm  Women, elderly, pt’s with hx of DM may not have classic symptoms, instead:  N/V  Belching  Indigestion  Diaphoresis This study source was downloaded by 100000831988016 from CourseHero.com on 05-06-2022 11:49:09 GMT -05:00 https://www.coursehero.com/file/52376523/critical-care-HESI-finaldocx/  Dizziness  Fatigue o New nurse on cardiac unit:  Assign pt with sinus arrhythmia going for a stress test  Don’t assign:  Torsades  V tach  V fib o Pulmonary artery catheter insertion, swan insertion  Priority is monitoring the pressures  When it gets into right ventricle watch for arrhythmias  Sterile field o Hand is cold and decreased capillary refill – call physician because clot may be forming, don’t do an Allen test o Radial artery line and pt has decreased cap refill  call the physician o Hemorrhagic stroke  Do not give tPa!!! o Ischemic stroke  Look at BP before giving alteplase o Cardiac tamponade  Muffled heart sounds  Jugular venous distention  Hypertension  Tx: pericardial centesis o Vasodilation medications  Morphine  Lidocaine o Dopamine  Vasopressor and will increase BP  Increases renal flow at low doses  So if low dose  renal dose  Increases vasodilation of artery no higher than 5 mcg/kg/min o DIC: first sign is often gums bleeding  PT/INR o Heart failure  BNP should be less than 100, if it’s over 100 it’s indicative of heart failure, lung dysfunction o Pacemaker is firing and nothing is happening  Look at sensitivity/sync mode of pacemaker, possibly increase rate o IABP: intraaortic balloon pump  Pt condition is improving with IABP when you see a decreased wedge pressure, and an increased cardiac output o CVP: for monitoring  Need transducer hooked up and at phlebostatic axis This study source was downloaded by 100000831988016 from CourseHero.com on 05-06-2022 11:49:09 GMT -05:00 https://www.coursehero.com/file/52376523/critical-care-HESI-finaldocx/ o Phlebostatic axis – 4th intercostal space @ midaxillary line – also points to right atrium  You’ve already calibrated transducer to right atrium – that’s correct  Endocrine o HHNS  Extreme hyperglycemia  No ketones  Extracellular fluid deficit  Osmotic diuresis  Some insulin still produced so blood glucose rises slowly  Associated with type 2  Neuro manifestations:  Blurry vision  Lethargy  Obtundation  Coma o DKA  Hyperglycemia  Ketones present  Acidosis  Caused by intense decreased level of insulin  Electrolytes are depleted  Kussmaul respirations  Priority: rehydration  Body tries to compensate with respiratory alkalosis  Type 1  Pt experiences dehydration bc of osmotic diuresis  When DKA resolves  hypokalemia frequently occurs o Addison’s disease – adrenocortical insufficiency  May be hypotensive initially  Increase dose of steroids during times of stress: surgery, sick  First thing is to hang IV fluids  Second thing is give corticosteroids  Decreased immune response  Hyperglycemia  Cataracts  Don’t stop abruptly  Cortisol levels: High in morning, after 8PM you’ll see a decrease o SIADH  Causes hyponatremia  Give hypertonic solution  Fluid restriction  Monitor neuro status  Vasopressor antagonist  Put on seizure precautions  Neuro This study source was downloaded by 100000831988016 from CourseHero.com on 05-06-2022 11:49:09 GMT -05:00 https://www.coursehero.com/file/52376523/critical-care-HESI-finaldocx/ o Cushing’s triad  Widening pulse pressure/hypotension  Bradycardia  Irregular respirations (bradypnea/Cheyne-Stokes) o Pt with increased ICP  Spread out interventions – give rest periods o GCS  GCS of 9 – want to compare it to what it was last time it was checked  A decline of even 1 in 1 hour is significant  Maximum score is 15, minimum is 3  Eye opening (alertness) o 4: spontaneously o 3: to speech o 2: to pain o 1: none  Verbal response (o