Cardiac and chest tube

Question 1

What do Calcium Channel Blockers (CCB) do? What do they end in?

Answer 1

Slow and relax the heart (negative inotrope, chronotrope, and dromotrope)

-DIPINE (plus diltiazem)

Question 2

What do CCB treat?

Answer 2

Antihypertensives
AntiAnginal drugs
AntiAtrialArrythmia

A, AA, AAA

Question 3

What are the SE of CCB? What should you measure prior to giving it?

Answer 3

Headache and Hypotension

Check BP and hold if SBP is less than 100

Question 4

QRS depolarization means….

P wave means….

Answer 4

QRS depolarization means ventricular

P wave means atrial

Question 5

P wave in the form of saw tooth

Answer 5

Atrial flutter

Question 6

Chaotic P Wave pattern

Answer 6

atrial fibrilation

Question 7

Chaotic QRS complexes

Answer 7

ventricular fibrillation

Question 8

Bizzare QRS complexes

Answer 8

Ventricular tachycardia

Question 9

Periodic wide bizarre QRS complexes? When are these a low priority? When are they a moderate priority? When are they a high priority?

Answer 9

PVC

PVCs after an MI is common and is a low priority
Only a few

6 or more PVCs in a minute
More than 6 PVCs in a row
R on T phenomenon (a PVC falls on a T wave)

Never a high priority

Question 10

What are the 2 lethal rhythms? Why?

Answer 10

Asystole and V-fib

Both are not giving very low or no CO –> confusion and death

Question 11

What is a potentially lethal cardiac arrhythmia?

Answer 11

V-tach but only potentially b/c it has CO

Question 12

When the pulse is present there is…. when the pulse is not present there is….

Answer 12

When the pulse is present there is CO, when the pulse is not present there is not CO

Question 13

What is the treatment for PVCs and V-tach?

Answer 13

Amiodarone

Question 14

What is the treatment for supra ventricular/atrial arryrthmias?

Answer 14

ABCDs
Adenosine - push in less than 8 seconds followed by 20 mL NS
Beta-blockers
CCBs
Digoxin/Lanoxin

Question 15

What are the 2 treatments for A, AA, AAA?

Answer 15

CCB

BB

Both do the same thing with the same side effects

Question 16

What is the treatment for V-fib?

Answer 16

Defib for V-fib

Question 17

What is the treatment for Asystole?

Answer 17

Epinephrine FIRST then Atropine

Question 18

The purpose if a chest tube is to..

Answer 18

Reestablish negative pressure in the pleural space so that the lung expands when the chest wall expands

Question 19

A chest tube will remove what in a pneumothorax? Hemothorax? Hemopneumonthorax?

Answer 19

Removes air in a pneumothorax

Removes blood in a hemothorax

Removes air and blood in a hemopneumonthorax

Question 20

An apical chest tube removes… and a basilar chest tube removes…

Answer 20

Apical (top) - removes air therefore should bubble

Basilar (base) - removes blood or fluid therefore should not bubble

Question 21

If the question does not specifically state that it is unilateral or bilateral what do you assume?

Answer 21

ALWAYS assume it is unilateral

Question 22

If a closed drainage device (JP, hemovac, pneumovac, ect..) gets knocked over what do you do?

Answer 22

Ask the patient to take a few deep breaths
NOT a medical emergency so DONT call the Dr

Question 23

If the water seal of the chest tube breaks you should? How fast does this need to get done?

Answer 23

Clamp with rubber tooth double clamps, cut the tube, submerge tube in sterile water, unclamp

Needs to be done within 15 seconds b/c tube cannot be clamped for longer than that

Question 24

If the chest tube gets pulled out what is the first thing you should do? What is the priority if a chest tube gets pulled out?

Answer 24

Take a gloved hand and cover the opening (first step)

Take a sterile Vaseline gauze and tape 3 sides (best step)

Question 25

When should the water seal chamber bubble in a chest tube?

Answer 25

Should bubble intermittent If there is a continuous bubble then there is a leak. Find it and tape it

Question 26

When should the suction control chamber bubble in a chest tube?

Answer 26

Should bubble continuously If intermittent then suction is too low so increase it on the wall

Question 27

If a congenital heart defect is TRouBLe then that means you tell the parents..

Answer 27

Needs surgery now/soon to live Has slowed/delayed growth and development (failure to thrive) Has a shortened life expectancy Parents will experience a lot of grief, financial and emotional stress Pt is likely to be discharge home on a cardiac monitor After, birth, pt will be in the hospital for weeks Pediatrician or pediatric nurse will likely refer pt to a pediatric cardiologist

Question 28

A TRouBLe congenital heart defect will shunt blood _____ to _____ leading to ______

Answer 28

A TRouBLe congenital heart defect will shunt blood right to left leading to blue/cyanosis

Question 29

All TRouBLe heart defects start with the letter...

Answer 29

T Tetralogy of Fallot Truncus arteriosus Transposition of the great vessels Tricuspid atresia Totally anomalous of pulmonary vasculature (TAPV)

Question 30

If a congenital heart defect does not start with a T, then what does that mean?

Answer 30

It is not trouble and it is a left to right shunt

Question 31

Whether or not a child has a TRouBLe congenital heart defect or a no TRouBLe congenital heart defect they will ALWAYS have what 2 things?

Answer 31

A Murmur d/t shunting of blood An echocardiogram need to be done to find out the cause of the murmur

Question 32

What are the 4 defects of Tetralogy of Fallot?

Answer 32

Pulmonary artery stenosis RVH (right ventricular hypertrophy) Overriding aorta VSD (ventricular septal defect) Ways to remember: PROVe, VarieD, PictureS Of A RancH

Question 33

What diseases are on contact precautions?

Answer 33

Anything Enteric (GI/fecal/oral) - C.Diff, Hep A, E.Coli, cholera, dysentery Staph RSV (transmitted via droplet but pt touches object then mouth) Herpes including herpes zoster (shingles)

Question 34

What is the PPE for contact precautions?

Answer 34

Private room preferred but can be in same room based on culture result NOT based on s/s Disposable supplies like paper plates Dedicated equipment (BP cuff, stethoscope) Gown, gloves, hand wash

Question 35

What diseases are droplet precautions?

Answer 35

Anything traveling on large particles from coughing or sneezing less than 3 feet Meningitis H. influenza B (lead to epiglottis where nothing should be put down the throat)

Question 36

What is the PPE for droplet?

Answer 36

Private room preferred but can be in same room based on culture result NOT based on s/s Handwashing, mask, goggle/face shield, gloves Disposable supply Dedicated equipment Patient wear mask when leave room

Question 37

What diseases are airborne precautions?

Answer 37

MMR TB Varicella (chickenpox) Air MTV

Question 38

What is the PPE for airborne precaution?

Answer 38

Private room preferred but can be in same room based on culture result NOT based on s/s Handwashing, N95 respirator, goggle/face shield, gloves Disposable supply - not essential Dedicated equipment - not essential Patient wear mask when leave room Negative airflow room

Question 39

Order of putting on PPE

Answer 39

Gown Mask Goggle Gloves

Question 40

What is the order of removing PPE?

Answer 40

Gloves Goggle Gown Mask