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NURS 2501 > Critical Care Environment > Flashcards

Critical Care Environment Flashcards

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1
Q

first line drug for all emergency situations Giving a drug to treat a disorder brought on by hypoxemia without effectively correcting the cause of hypoxemia is ineffective - O2 sat >96%

A

Oxygen

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2
Q

Nitrate Dilates peripheral vessels decreasing preload and afterload, reduces blood pressure ; Also dilates coronary arteries- used for chest pain  Continuous blood pressure and heart monitoring  SE: Hypotension, headache

A

Nitroglycerin

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3
Q

narcotic analgesic to treat chest pain associated with MI and acute PE  Relieves pain and reduces anxiety, dilates venous vessels and reduces cardiac workload  SE: Respiratory depression, hypotension  Narcotic antagonist naloxone (Narcan)

A

Morphine sulfate

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4
Q

anticholinergic to treat bradycardia, heart block and asystole  Inhibits vagus nerve  Cardiac and blood pressure monitoring needed  SE: dysrhythmias, increased HR, ischemia, restlessness, anxiety, mydriasis, thirst, urinary retention

A

Atropine sulfate

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5
Q

Beta-adrenergic  To increase heart rate - temporary measure while waiting for transcutaneous pacemaker  Increases myocardial oxygen consumption, therefore, myocardial ischemia is a concern  Tachycardia, ventricular fibrillation may occur

A

Isoproterenol (Isuprel)

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6
Q

antidysrhythmic to treat paroxysmal supraventricular tachycardia (PSVT)  Slows conduction through AV node, interrupts dysrhythmia producing re-entry pathways and can restore NSR  Cardiac monitoring and vital signs  SE: hypotension, dysrhythmias, short period of asystole following injection

A

Adenosine (Adenocard)

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7
Q
  • antidysrhythmic to treat supraventricular tachydysrhythmias (SVT)  Calcium channel blocker - (negative chronotropic & inotropic) - also used to treat angina  Monitor HR and BP  SE: headache, bradycardia, hypotension
A

Verapamil (Calan, Isoptin)

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8
Q

antidysrhythmic to treat PSVT, A-fib/flutter (with increased rate)  Calcium channel blocker - (negative chronotropic & inotropic) - also used to treat angina  Monitor BP and HR  SE: myocardial depression, bradycardia, can increase digoxin levels

A

Diltiazem (Cardizem, Dilacor XR)

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9
Q

antidysrhythmic to treat ventricular dysrhythmias  A fast sodium channel blocker, class 1B  Local anesthetic effect on heart; ↓myocardial irritability  Monitor cardiac and assess for S/S toxicity (confusion, drowsiness, hearing impairment, conduction defects, myocardial depression, muscle twitching, seizures)  Metabolized in liver

A

Lidocaine

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10
Q

antidysrhythmic to treat atrial, ventricular and supraventricular dysrhythmias  A fast sodium channel blocker, class 1A  SE – severe ↓BP, heart block, rhythm disturbance & cardiac arrest  Excreted via kidneys

A

Procainamide (Procan; Pronestyl)

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11
Q

to correct body depletions and dysrhythmias  Works with Na+-K+ ATPase pump  Physiologic effects similar to Ca++ channel blockers with neuromuscular blocking effects  If Mg++ ↓ - atrial & ventricular dysrhythmias  Uses - ↓Mg levels; refractory VT & VF & life threatening dysrhythmias associated with digoxin toxicity and tricyclic antidepressants, torsades de pointe  SE - ↓BP, mild ↓HR, flushing, sweating

A

Magnesium sulfate

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12
Q

sympathomimetic to treat profound ↓HR, asystole, pulseless ventricular tachycardia and ventricular fibrillation (VF & VT)  Catecholamine with alpha & beta adrenergic effects  Improves perfusion of heart and brain in cardiac arrest  Requires cardiac & hemodynamic monitoring  Do not give at same site as sodium bicarbonate

A

Epinephrine

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13
Q

to treat metabolic acidosis  Monitor ABGs  Do not administer epinephrine, norepinephrine, or dopamine in same site

A

Sodium bicarbonate

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14
Q

osmotic diuretic to treat edema of CNS and other conditions  Highly irritating to veins, use filter needle  Assess neurological status, labs, serum osmolality, I/O

A

Mannitol (Osmitrol)

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15
Q
  • glucocorticoid to treat edema of CNS and other conditions  Stabilizes Na+/K+ pump – thus no excess H20 crosses cellular membrane  SE – transient ↑BP, ↑BS
A

Methylprednisolone (Solu-Medrol)

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16
Q

opiate antagonist  Competitively binds to opiate receptor sites  Shorter duration than many opiates, may need to repeat dosing  Can precipitate withdrawal symptoms  SE – Potential for pulmonary edema and cardiovascular collapse in some OD patients

A

Naloxone (Narcan)

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17
Q

Reversal agent for the respiratory depressant and sedative effects of benzodiazepine medications (Valium, Versed, Librium)

A

Flumazenil (Mazicon, Romazicon)

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18
Q

to treat poisoning  absorbs ingested toxins in GI tract & prevents absorption body

A

Activated charcoal

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19
Q

drugs should not be used to correct the hypotension associated with this condition → administer fluids or blood products

A

hypovolemic shock

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20
Q

to treat hypotension; low dose ↑urine output  Sympathomimetic  SE - ↑HR, dysrhythmias, myocardial ischemia, N/V  Assess IV site hourly for S/S of drug infiltration, extravasations causes tissue necrosis, treat extravasations with phenotolamine (Regitine) 5-10mg diluted in 10-15cc NS

A

Dopamine

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21
Q

to treat shock states with ↓CO (↑BP D/T ↑CO – no vasoconstriction)  Sympathomimetic with beta-1 adrenergic activities; beta-1 effects (↑force of contraction, ↑HR)  Requires cardiac & BP monitoring, assess for ischemia  Adverse effects are dose related – myocardial ischemia, ↑HR, dysrhythmias, headache, nausea, tremors

A

Dobutamine

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22
Q

to treat hypotension  Catecholamine with potent vasoconstrictor (alpha adrenergic) effects  Requires cardiac and BP monitoring, assess for ischemia, nursing care is similar to dopamine  Additional effects – myocardial ischemia, dysrhythmias, impaired organ function; extravasation causes tissue necrosis

A

Norepinephrine (Levophed)

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23
Q

to treat anaphylactic shock  Bronchodilator and maintains blood pressure due to vasoconstrictive effect, also ↑cardiac performance  SE - ↑HR, dysrhythmias, ↑BP, angina

A

Epinephrine

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24
Q

antihypertensive to treat hypertensive crisis  Rapid acting vasodilator, acts on the smooth muscle of the vessels  Protect from light- keep wrapped with aluminum foil, medication has a faint brown color, increases cyanide levels (measure cyanide and thiocyanate levels every 24 hours)

A

Sodium nitroprusside (Nipride)

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25
loop diuretic  Diuretic effect  Depletes Na+ and K+ - assess electrolyte levels
Furosemide (Lasix)
26
Indications for Arterial line
1. Monitor blood pressure ( 5-15 mm Hg higher than manual ) 2. Obtain blood specimen and arterial blood gases 3. Administration of vasoactive medications
27
A-line : insertion points
Radial, brachial
28
A-line : measurements - waveforms
1. Systolic (top waveform) , diastolic( bottom ) and mean arterial pressure ( min 60 - to perfuse vital organs) \* Dicrotic notch - closure of aortic valve Small, wavy , dampened - obstruction or inducer imbalance
29
A-line : complications
1. Bleeding 2. Infection 3. Thrombosis 4. Neurovascular impairment
30
Phlebostatic axis ( R atrium level ) - Level and calibrate transducer Q8hrs , when pt bed or position is changed
4th intercostal space on the R sternum - to the side of the pt chest midway between ant and post chest
31
PA catheter : indications
for patients with complicated fluid balance conditions
32
PA catheter : measurements
1. CVP - right atrial pressure 2. PAP - pulmonary artery pressure 3. PCWP - pulmonary capillary wedge pressure 4. CO
33
CVP
1-8 mmHg
34
PAP
15/5- 25/15 mmHg
35
PAWP
indirect measurement of left atrial pressure + left ventricular and diastolic pressure 4-12 mmHg; High - left ventricular failure , hypervolemia
36
PA catheter insertion
jugular or subclavian veins
37
PA catheter complications
1. Infection 2. Air embolism 3. Pulmonary infarction or rupture 4. Ventricular arrhythmias
38
Cardioversion
deliver a synchronized shock during QRS wave
39
Cardioversion: indications
for unstable atrial and ventricular dysrhythmias ( pulse is present - fast rhythm) - A-fib, A-flutter, V-tach
40
Cardioversion: sedate
IV Valium, Versed if awake ; consent
41
Cardioversion : pad placement
1. Upper right chest, just under the clavicle, next to the sternum 2. Left lower chest, just lateral to the precordium
42
Cardioversion : monitor
1. Maintain airway 2. Monitor VS & LOC
43
Defibrilation
asynchronous electric shock
44
Defibrilation : indications
Pulseless ventricular rhythms - Vtach & Vfib
45
Defibrilation : procedure
1. Biphasic -start at 200 joules ( mono - 360) 2. Perform within 15-20 sec of the onset or arrhythmia 3. CPR - Shock 4. Two minutes of CPR between shocks
46
IABP - intra-aortic balloon pump - purpose
increased coronary perfusion - increases CO by as much as 40 % - decreases LV work and myocardial oxygen requirements
47
IABP - insertion
through the femoral artery , threaded into the descending aorta
48
IABP - diastole
Ventricles are filling - balloon inflates ( blocking the aorta ) - blood forced into coronary artery
49
IABP - systole
balloon deflates when ventricles contract - creates a vacuum affect ( reduces afterload) - improves LV ejection + CO
50
IABP - indications
1. Failure to wean from cardiopulmonary bypass 2. Cardiogenic shock 3. HF 4. MI
51
IABP - complications
1. Vascular injuries 2. Displacement of balloon 4. Peripheral nerve damage + thrombus formation 5. IABP destroys platelets - thrombocytopenia 6. Infection 7. Improper timing - can increase afterload ( decrease CO ) 8. Pt is relatively immobile - HOB less than 45 ; cant flex leg
52
VAD - ventricular assist device
TX of end stage heart failure - improve CO
53
VAD used ...
short term - bridge while waiting for a heart transplant long term - when unresponsive to medication or surgery
54
VAD for L ventricular heart failure
more common - Tube pulls blood from left ventricle into a pump - sends blood to the aorta
55
CO
4-7 L/min
56
Amount of blood pumped from the LV each minute
CO
57
Preload = CVP = Right atrial pressure
how much the myocardial fibers are stretched at the end of diastole just before the next contraction
58
Amount of blood ejected with each contraction
SV
59
Pressure or resistance the heart must overcome to eject blood through the semilunar valves during systole
Afterload
60
Locus of control
degree of control : \* inner ( decisions ) & external ( fate, luck ) or combination
61
Respiratory failure
PaO2 \< 60 mm Hg & PaCO2 \> 50 mmHg
62
Endotracheal tube - verify placement
1. check end-tidal CO2 levels - use CO2 detector 2. listen for bilateral breath sounds 3. X-ray
63
Hemodynamic monitoring consists of
1. Catheter 2. Infusion system 3. Transducer 4. Monitor 5. Pressure bag
64
Pressure bag - A-line & PA catheter
1. NS or D5W 3-10 ml/hr - prevent back up of the blood and oclusion 2. 300 mmHg - maintains pressure
65
Allen's test
prior to insertion of A-line - 1. patency of the ulnar & radial artery 2. adequacy of collateral circulation
66
Central venous pressure cather ( CVP line ) - measures and provide
1. RA pressure - preload - monitor pt fluid status 2. Venous access for fluids and blood sampling
67
CVP line inserted
subclavian, jugular, femoral veins ; catheter tip - superior vena cava
68
CVP readings - high & low
High - fluid overload - decrease IV rate, IV diuretics Low - hypovolemia - increase IV rate
69
PA catheter : balloon
1. wedged briefly 8-15 sec - get reading - remove - risk for pulmonary infarction
70
CVAD
1. PICC lines ( long term IV TX - vesicant ; 1 year) 2. Non-tunneled CVAD ( few weeks ) 3. Tunneled CVAD ( years ) 4. Subcutaneous ports ( non - coring needle ; years )
71
CVAD complications
1. Infection 2. Bleeding 3. Pneumothorax and hemothorax 4. PE 5. Cardiac tamponade
72
AED
Automatic external defibrilator ; \* " All clear "
73
ICP catheters - Infection !!! - strict aseptic technique
1. Epidural ( easy, low risk ) 2. Intraventricular ( most invasive, drainage + sampling of CSF ) 3. Subarachnoid ( easy )
74
Quinton catheter
double lumen dialysis catheter ; jugular or subclavian veins; for ARF or CRF ( while waiting for fistula to mature)
75
Sengstaken-Blakemore tube
TX bleeding esophageal varices ( last resort ); two ballons ( one -stomach; second - esophagus) ; pt is intubated on mechanical ventilator
76
Parenteral nutrition - PPN & TPN
1. PPN ( peripheral parenteral nutrition) - peripheral IV - lower osmolarity 2. TPN ( total parenteral nutrition ) - central IV - higher osmolarity
77
Paternalism
restriction of one's freedom ( autonomy ) to protect the pt from harm (making decision for pt )
78
Beneficence
prevent harm
79
Nonmaleficence
do no harm
80
Fidelity
keep promises
81
Veracity
tell the truth
82

NURS 2501 (11 decks)

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