NURS 2208>Med Surg 2 Hesi Outline Bri

• Critical Care/ Basic Nursing Skills/ Safety/ ICU Confusion 480, 618 • People on ventilation are more prone to ICU confusion b/c of sleep deprivation, secluded rooms. • Drug calc mL/hr to mcg/min Nitroglycerin • Car ...

• Critical Care/ Basic Nursing Skills/ Safety/ ICU Confusion 480, 618 • People on ventilation are more prone to ICU confusion b/c of sleep deprivation, secluded rooms. • Drug calc mL/hr to mcg/min Nitroglycerin • Cardiovascular/ sinus bradycardia/ recognize • Rate are less than 60 • P and QRS width are within normal limits • Low heart rate is normal for some people but with people with decreased cardiac output, treatment is needed. • Assess patient for syncope, dizziness, confusion, hypotension, diaphoresis, SOB, chest pain • TX: Find out the cause of the bradycardia (maybe their meds), Admin O2 if needed, admin atropine sulfate to increase heart rate, monitor for hypotension and admin fluids IV. • The client might need a pacemaker • Cardiovascular/ V-fib/ Interpret • Ventricles fire in a totally disorganized manner. • Client lacks a pulse, BP, respirations, and heart sounds • Cardiac emergency • Irregular undulations of varying amplitudes • No cardiac output • TX: CPR, defib, anti-dysrhythmic drugs • Neuro and Resp/ Subdural Hematoma/ ET Suction • No more than 3 times; 10- 15 Seconds; May need hyperventilation for up to 3 minutes before suction to prevent hypoxia.• In patients with severe head trauma, ET suctioning may cause adverse reactions including cough, systemic HTN, increased ICP and reduced cerebral perfusion pressure (Found on the internet) • ET Suction is used to clear airway of secretions when the cough reflex is suppressed by the ET tube. • Resp/ Chest tube/ deep breathing • You want to encourage coughing and deep breathing • Assist pt. to deep breathe, cough, perform maximal sustained inhalations and use incentive spirometry. • Asses breathing effectiveness by pulse ox • Professional issues/ Document/ Leadership/ STEMI Post thrombolysis/ Lidocaine • Before administering lidocaine, always check the vial label to prevent administering a form that contains epinephrine or preservatives because these solutions are used for local anesthesia only. • May need double verification • Monitor ECG strip, VS • Drug Calc/ units/kg/ heparin bolus • Basic Nursing Skills/ HIV/ Candidiasis • Standard precautions include washing hands even if gloves have been worn to give care. • Wear exam gloves for touching blood or body fluids or any non-intact body surface • Mouth care can improve appetite; rinse pt. mouth with sodium bicarb w/ sterile H2O or NS several times a day. Use soft toothbrush and drink plenty of fluids. Avoid using alcohol-based mouthwashes.• Wear gowns during procedure that might generate splashes (changing clients w/ diarrhea) • Use mask when droplets may be dispersed (suctioning) • Basic Nursing Skills/ Esophageal Varices/ diet • Soft diet, if bleeding they are NPO, no hard candy • Med Administration/ teaching/ Addison’s/ Discharge plan • Needs lifelong hormone replacement • Need for close medical supervision • Needs medical alert bracelet • S/S of overdosage and underdoasge of medication • Diet: High sodium, low potassium, and high carb (complex carb) • Fluid: At least 3 L of fluid per day • GI/ Hepatic/ Oncology/ Colon Cancer/ Intestinal polyps • Risk factors for colon cancer include previous colorectal polyps, history of colorectal cancer. • Cardiovascular/ Acute Coronary syndrome/ Cardiac Enzymes • Elevations in troponins and myoglobin indicate myocardial injury or infarction. • Troponin: <0.10 ng/mL Onset(as early as 1 hr post injury) Peak(10- 24hrs) Return to normal(5-14 days) • Myoglobin: <90 mcg/L Onset (1-4 hr) Peak(12hr) Return to normal(24hr) • CK-MB: Onset(4-8hrs) Peak (12-24) Return to normal(48-72) • Ordered every 6 hours.