FINAL EXAM PREP Flashcards
(95 cards)
1
Q
This is characterized by progressive partially reversible airway obstruction with lung hyperinflation.
A
Chronic Obstructive Pulmonary Disease (COPD)
2
Q
Differentiate between Chronic Bronchitis and Emphysema.
A
Chronic Bronchitis - Chronic inflammation of LOWER respiratory tract with excessive secretions, cough and dyspnea
Emphysema - Destruction of Alveoli with the enlargement of the distal airways and the breakdown of alveolar walls (Alveoli get wrecked).
3
Q
Franz has late COPD. Which of the following clinical manifestations would you expect to see? A/ Death due to infection B/ Fatigue, SOB C/ Sputum production D/ Progressive dyspnea and infections
A
A/ Death is the most common CM of COPD in the late stages. typically the result of an infection.
4
Q
Willem has Middle-stage COPD. Which of the following clinical manifestations would you expect to see? A/ Cough/sputum production B/ Progressive dyspnea with infections C/ Chronic respiratory failure D/ Dyspnea, chronic fatigue
A
B/
5
Q
Yuri has been diagnosed with ____, because his use of accessory muscles to breathe, pursed lip-breathing, Ø cyanosis, and a distinct Barrel chest.
A
Emphysema
“Pink Puffer” = Ø cyanosis
6
Q
How does spirometry test for COPD?
A
By measuring the amount of air the person can forcefully expire.
*If their Forced exp. volume capacity to forced vital capacity ratio is less than 0.7… they have COPD. (This means they are retaining air.)
7
Q
How could a nurse improve ventilation in a patient with COPD? list all interventions with brief explanations of each (4)
A
Diaphragmatic breathing (Abdominal breathing): Focus on using the diaphragm to breathe instead of accessory muscles to achieve max inhalation - use with pursed-lip breathing
Pursed-lip breathing:
Helps prolong exhalation, prevents bronchial collapse and air trapping.
Coughing:
to help remove sputum
Postural drainage:
Helps loosen thick secretions
8
Q
What are some preventative measures that can be used to delay the progression of COPD? (6)
A
- Smoking cessation
- PRN short acting-bronchodilators (Salbutamol/ventolin)
- Long-acting bronchodilators (Spiriva)
- Inhaled Corticosteroids (Flovent, Asmanex).
- Oxygen
- Surgery (Last resort)
9
Q
For a patient with COPD, what arterial pressure of O2 do you want to attain? A/ 50-55 mmhg B/ 45-50 mmhg C/ 55-65 mmhg D/ 50-60 mmhg
A
C/ 55-65 mmhg is ideal for maintaining a SaO2 of 90%
10
Q
What can you do to decrease dyspnea and pulmonary hypertension, increase activity tolerance and improve neuropsychological functioning in patients with COPD?
A
Supply Oxygen therapy
11
Q
What is the fear of using Oxygen therapy to patients with COPD?
A
Decreasing their hypoxic drive.
If patient is given O2 to increase PaO2 to greater than 60 mmhg, they actually can decrease their drive to breathe because their body has a tolerance of chronically high CO2 levels -> decreasing the body’s response to breathe deep to release the CO2
12
Q
Henrik is at the end stage of COPD and requires constant O2. What should we monitor?
A
Monitor for O2 toxicity: Nausea/emesis Substernal pain Sore throat Malaise
Ensure the Pt.’s PaO2 is above 60 mmhg
13
Q
Which of the following is a result of hypoxemia? A/ Bradycardia B/ Peripheral Vasoconstriction C/ Hypotension D/ Emesis
A
B/ Peripheral Vasoconstriction
14
Q
Wilfred has come into the ER with the Following vitals.
HR: 118 Respirations: 12 Temp: 36.8 SaO2: 76% B/P: 143/98
He is restless and agitated and demonstrating signs of delirium. He is profusely sweating. What should you do?
A
Apply Oxygen!!!!
obtain ABG and VBG and correct the cause of hypoxemia.
15
Q
What is Cor pulmonae? How is is associated with COPD? Signs and symptoms?
A
Hypertrophy of the right side of the heart. Caused by pulmonary hypertension due to exacerbated COPD.
S/S: Dilation of RV, JVD, enlarged liver, Ascites, peripheral edema
16
Q
How is Cor Pulmonae Treated?
A
Low flow O2 and Diuretices
17
Q
Dimitri comes into the Er with the following:
HR: 114 B/P: 137/96 Temp: 39.4 Resp: 23 SaO2: 89
He woke in the night with a sudden onset of Fever and chills and a productive cough with purulent sputum. Upon inspection you notice increased fremitus and crackles. What is his problem and what do you do?
A
Pneumonia (unspecified).
Chest X-ray to confirm, gram stain of sputum, check CBCs, Blood chem/cultures, etc.
Testing is important to determine what has caused it and how to treat. (I.E. antibiotics).
18
Q
What are benzodiazepines and barbiturates used for?
A
Sedative and amnestic agents used in surgery.
19
Q
Why are anticholinergics used during surgery?
A
To reduce bodily secretions.
20
Q
What are common causes of Post-op airway compromise?
A
Obstruction: Due to tongue or secretions and drowsiness.
Hypoxemia: Decreased amount of O2 in the blood
Hypoventilation: Decreased respirations due to decreased drive (Narcotics, loss of muscle tone, etc).
21
Q
What is crucial nursing care in the Post-Op period?
A
Assess head-to-toe!
Vitals, Oximetry, respiratory patterns, and breath sounds are essential!
Airway patency, chest symmetry, depth and rate.
22
Q
Why are deep breathing and coughing techniques crucial in the post-op period?
A
Help move resp. secretions for removal and prevents alveolar collapse!
*Remind patient to splint abdominal incision to prevent injury while coughing and reduce potential pain
23
Q
Explain how the following can occur in the PACU:
Hypotension
Hypertension
Dysrhythmias
Syncope
A
Hypotension:
Unreplaced fluid and blood loss. (IF EVIDENCE OF BLEEDING POST-OP… TAKE VITALS)
Hypertension: Results from sympathetic stimulation from pain, anxiety, bladder distention or respiratory compromise.
Dysrhythmias: Often from identifiable cause such as: acid-base imbalances, circulatory instability or pre-existing heart disease
Syncope: Decreased cardiac output, fluid deficit, or poor cerebral perfusion
24
Q
Which of the following stats should you notify the anaesthesiologist about?
A/ Pulse 120 bpm
B/ Systolic 160
C/ Irregular cardiac rhythm develops
D/ Significant variance from preoperative readings
A
ALL OF THEM. THEY ALL SUCK
25
How can Hypothermia occur in a PACU? What are risk factors and complications? How do you treat it?
Occurs when there is a significant loss of heat comparative to production of heat.
*Possibly due to exposure of organs to cold air.
Risk factors include:
* Age
* Debility (Weakness)
* Intoxication
* Prolonged anaesthetic administration
Complications:
* Compromised Immune function
* Post-op pain
* Increased Bleeding
* Myocardial ischemia
* Delayed lung metabolism
TX:
* Apply warm devices
* O2 therapy for increasing demands
26
What can Cause Mild/Moderate and prolonged Hyperthermia during Post-op periods? How can you treat it?
Mild elevation (38 degrees) is caused by stress response
Moderate (>38) caused by respiratory congestion
48 hours post-op signifies possible infection
Tx:
Encourage airway clearance.
Provide antipyretics if fever passes above 39.4 degrees
27
How do you know your patient may be experiencing septicemia post-op?
Intermittent fever with shaking chills and severe sweating.
28
What are possible post-op gastrointestinal issues that patient may experience?
1. Nausea and Emesis
* can lead to electrolyte imbalance, or decreased fluid volume
2. Paralytic Ileus
* Peristalsis stops causing severe nausea and vomiting
3. Hiccups
* Spasm of the diaphragm causes by nervous stimulation of phrenic nerve
29
What nursing care would you provide to a patient with Nausea and Vomiting post-op?
1. Document characteristics of emesis
2. Antiemetics
3. Keep suction at bedside
4. Turn patient to their side if emesis occurs to prevent aspiration (Keep upright if possible)
5. NPO until bowel sounds return for abdominal surgery
6. Regular mouth care when NPO
7. Encourage ambulation to stimulate GI tract
30
Why do patients often have significantly decreased Urine output post-op for the first 24 hours?
Increased Aldosterone and Anti-diuretic hormone as a result from the stress of surgery, along with fluid restriction and loss, drainage or diaphoresis.
Anaesthesia may depress the nervous system, allowing the bladder to fill more than normal before urge to void is felt
31
What is the counter-regulatory hormone in the body to insulin?
Glucagon
32
What is insulin? What does it do?
Hormone secreted by the pancreas that uses glucose for cellular metabolism as well as the metabolism of fat and protein.
*Also increases the permeability of K+/Mg+/P+ ions in cells.
33
What does Insulin do to the Na+/K+ pump within cells?
Increases the concentration of K+ inside of cells (NOT GOOD).
But if a patient is Hyperkalemic, Insulin can be given to decrease the ECF concentration of K+ and equilibrilize the patient.
34
____ Increases Blood glucose, while _____ decreases Blood glucose.
Glucagon, Insulin
35
What is the normal desired range of Insulin within the body?
4-6 mmol/L
36
Differentiate between the causes of Type 1 and 2 Diabetes. Include the three P's and which type of predominantly affected.
Type 1:
* *Little to Ø endogenous insulin
* *Polydipsia, Polyuria, Polyphagia (Increased thirst, urine and appetite).
Type 2:
* *Impaired secretory response of insulin
* Hereditary, Obesity or sedimentary lifestyle
37
What is Hypoglycemia defined as? What are some symptoms at the Mild, Moderate and Severe levels?
Low blood sugar levels (Below 4mmol/L)
Mild:
Pale, sweaty, tachycardic
Moderate:
Impaired concentration, slurred speech, Blurred vision, awkward gait
Severe:
May be incapacitated, uncooperative, seizures
38
What can cause Hypoglycemia? How do you treat it?
Can occur in a sudden drop of Blood-sucrose (13mmol/L -> 7mmol/L)
Mismatch of food timing and peak action of insulin.
Starvation/decreased caloric intake
Exercise
Menstration
Tx:
Mild-moderate:
Simple carbohydrates (fruit juices, soft drinks)
Severe (unable to swallow):
1mg Glucagon (or D5W)
Once awake , treat orally
39
What is Diabetic Ketoacidosis (DKA)? What can cause DKA?
Severe Hyperglycemia, Ketonuria, acidsosi, and dehydration. ****NOT ENOUGH INSULIN
Causes:
* Underlying infection (40%)
* Missed Insulin (25%)
* Undiagnosed Diabetic (15%)
* M.I. or Cardiovascular Athlerosclerosis or Complicated preganacy, trauma, stress, surgery, etc.
40
What occurs in the body during DKA?
The body has no insulin and begins to burn fats which leads to the build up of ketones (acids) -> metabolic acidosis -> alterations in respiration and the release of glucose in urine. Diuresis (Increased amount of urine), dehydration and severe volume depletion.
41
What causes tachycardia and hypotension during DKA?
Dehydration
42
What can metabolic acidosis cause in a patient experiencing DKA?
Kussmaul respirations (Rapid shallow)
Abdominal tenderness with Nausea and vomiting
Altered Level of Awareness
43
What are the treatment options for a patient with DKA?
Tx:
1. ENSURE PATENT AIRWAY (Intubate prn)
2. Administer O2
3. IV NaCl until Blood pressure stabalizes and urine output increases (30-60mL/hr
4. NPO
5. Insulin Infusion to treat acidosis (ONLY MEANS OF CORRECTING DKA)
44
What should the aim of IV insulin therapy be for a patient with DKA?
AIM to decrease blood glucose levels be NO MORE THAN 5mmol/L/hour!!
45
When a patient in DKA on IV insulin therapy, what should be done when their Blood glucose levels approach 12-14mmol/L?
Start a D5W drip to avoid hypoglycemia and ensure patient equilibrium.
46
Floyd is a diabetic who called in sick for work. He felt nauseated and began throwing up. Over the past 12 hours he vomited 3 times. What should Floyd do?
A/ Take an antiemetic and continue clear fluids
B/ Drink a fruity drink as tolerated to replenish sugars lost
C/ Go to emergency department
D/ Withhold insulin because the loss of electrolytes do to emesis.
C/ He should go to the ER or contact his doctor.
47
What are some symptoms of Irritable bowel Diseases (Crohn's and Colitis)?
```
Diarrhea
Fatigue
Abdominal Pain
Weight loss
Fever
Bloody diarrhea
Rectal bleeding
```
48
Differentiate between Crohn's and Colitis.
Crohn's:
* *Inflammation of the layers of the bowel wall an is segmented (Skip lesions).
* *Symptoms depends on site of involvement and extent of disease. Typically diarrhea and abdominal pain
Colitis:
* *inflammation in the rectum that spread's to the colon in a continuous pattern. Abscesses form in the intestinal glands and increase bleeding.
* *Symptoms include, Relapsing periods of diarrhea, blood mucousy stool, abdominal pain, Nocturnal Diarrhea, anorexia, weigh loss, fatigue, fever.
49
What are the common treatment options for Crohn's and Colitis?
Corticosteroids, immunosuppressants, aminosalicylates, antidiarrheals, anti-TNF agents... last resort is surgery (colectomy with ileostomy)
50
What is Hypovolemic Shock? Differentiate between relative and absolute hypovolemia. How do you treat it?
"Empty Tank"
Excessive fluid loss from a multitude of sources.
Relative = Pooling of blood/fluid in extremities
Absolute = Loss of fluid from the body
Tx:
* *O2 therapy to increase supply and reduce demand
* *Fluid replacement if loss, or drug therapy if pooled.
* *Locate and correct underlying cause
* *Warm fluids (they could become hypothermic)
* *Optomize cardiac output through medications (Vassopressors, adrenaline, noradrenaline, dopamine).
51
What is Cardiogenic shock? Differentiate between Systolic dysfunction and diastolic dysfunction. How do you treat it?
Failure of the cardiac muscle caused by a multitude of issues.
Systolic = Inability of the heart to pump blood forward.
Diastolic = inability of the heart to fill with blood.
Tx:
* *O2 therapy
* *Drug therapy for cardiac symptoms
* *Control of pain (Morphine)
* *Tx of arrhythmias and assistance in circulation
52
What is Multiple organ dysfunction syndrome (MODS) in relation to shock?
The failure of multiple organs in an acutely ill person which homeostasis cannot be achieved without intervention.
53
Explain the 4 stages of Shock.
1. Initial
2. Compensatory
3. Progressive
4. Decompensated
1. Initial
- Ø outward signs
- Imbalance of O2 supply and cellular demand
- Metabolism - aerobic to anaerobic causing lactic acid to build up
- Increased lactic acid requires more O2
- increased lactic acid increases body acidity and ceases cell function.
2. Compensatory
- Compensatory mechanisms are summoned to protect the body from consequences of anaerobic metabolism and maintain BP and BV. Goal is to maintain homeostasis!!
- Specific to each type of shock
3. Progressive
- Compensatory mechanisms begin to fail
- Organ perfusion is grossly inadequate and begins to affect each system negatively
- This can develop to MODS
4. Decompensated
- You gonna die
- Profound hypotension and hypoxia. Organs begin to fail leading to a cascade of other organ failures
- Respiratory arrest and cardiac failure are imminent
54
These are the following signs and symptoms of compensatory shock. Explain why each occurs.
1. Tachycardia
2. Rising diastolic BP
3. Cool extremities and poor capillary refill
4. Weak pulse
5. Decreased urine output and concentration
6. Increased Respiration
7. Diaphoresis
8. Nausea
9. Increased Blood sugar
10. Confusion/anxiety
1. Tachycardia (catecholamines: epinephrine, etc)
2. and 3. Rising diastolic BP and cool extremities (Vasoconstriction)
4. Weak pulse (Decreased stroke volume)
5. Decreased Urine and urinary concentration (Failure of Sodium and H20 pump)
6. Increased Respiration (due to increase in HR causing increased O2 demand)
7. Diaphoresis (Release of catecholamines)
8. Nausea (Caused by diversion of blood)
9. Increased blood sugars (Caused by stress response)
10. Confusion/anxiety (Stress and catecholamines)
55
What is once significant difference between all types of shock and Neurogenic shock?
The Heart rate does not go up because the brain does not communicate with the heart.
56
What is neurogenic shock? What are some major symptoms and how do you treat it?
Trauma to the spinal cord (above T5), that results in MASSIVE vasodilation without compensation due to loss of sympathetic NS response which would typically vasoconstrict. This leads to pooling of blood in the vasculature, and bradycardia.
```
Symptoms:
Bradycardia
HYPOTENSION
Hypothermia
Flaccid paralysis below injury
Increased ICP
Vomiting
Headache
Changes in behaviour
Progressive/decreased consciousness
Seizures
```
Tx:
* Treat underlying cause
* Careful neurologic observations (GCS)
* Monitor Temp
* Watch for DVT from pooling blood
* Watch for increased ICP
57
What is anaphylactic shock? What are some major symptoms and how do you treat it?
Systemic allergic reaction to an antigen. (IgE antibodies)
```
Symptoms:
*Peripheral edema
*Pooling of fluids
*Respiratory and cardiovascular collapse in minutes
*Bronchoconstriction
*Chest pain
*SOB
*Flushing and itchiness of skin
*Anxiety
Abdominal pain, N/V, Diarrhea
```
Tx:
* Epinephrine SC/IV every 5-20 minutes
* Bronchodilators
* Antihistamines
* Corticosteroids
* Fluid resuscitation with colloids
* Intubate PRN
58
What is septic shock? What are some major symptoms and how do you treat it?
Most common form of distributive shock, Bacteremia (Bacteria in blood) leads to chemical cascade and an inflammatory response
(Typically gram negative bacteria)
Symptoms:
```
Early:
MASSIVE vasodilation
Pink warm flushed skin
Tachycardia and bounding pulse
tachypnea
Increased Cardiac output
```
```
Late signs:
Vasoconstriction
Pale skin and cool
tachycardia
hypotension
changes in LOC
Decreased cardiac output
changes in clotting dysfunction
metabolic/respiratory acidosis
```
Tx:
* I.D. causative organism
* O2 therapy
* Treat with appropriate antibiotic
* IV fluids
* Inotropes (noradrenaline, which alters muscle contractility)
* ABGs to assess imbalance
* Strict universal precautions for nurses and staff
59
What is central venous pressure in relation to shock? what does an increase/decrease mean?
What is the average CVP reading?
Is a measure of the Right side of the heart and its ability to handle venous return.
Increase = there is a problem with the heart (Cardiogenic shock)
Decrease = Hypovolemic shock or vasodilation
6 mmHg
60
What are the rates of impulse formation for the following?
1. SA node
2. AV node
3. Ventricular system
1. SA = 60-100 (typical pacemaker)
2. AV = 40-60
3. Ventricular = 20-40
61
```
What is the typical length of a QRS interval on a ECG?
A/ 0.12-0.2 seconds
B/ 0.02-0.06 seconds
C/ 0.06-0.12 seconds
D/ 0.2-0.3 seconds
```
C/ 0.06-0.12 seconds
62
What does a "Peaked" T wave indicate on an ECG?
HYPERKALEMIA
K+ accentuates electrical activity
63
What is the Tx for Sinus bradycardia?
Ø if no symptoms!!!
```
Otherwise:
Pulse Oximetry
Given O2 prn
IV access
Obtain 12-lead ECG
Atropine
```
64
What does Atropine do?
Blocks chemical signs at the vagus nerve that stops the heart from being slowed. Increases sympathetic activity (Increase HR)
65
What Tx should be involved with Sinus Tachycardia?
* Treat underlying cause
* Fluid replacement
* Relief of pain
* Removal of offending substances or medications
* Reduction of fear/anxiety
66
What is supra-ventricular tachycardia?
A faster than normal HR in the ventricles that originates ANYWHERE above the ventricles (Atria, S node, AV junction)
67
What are common indications of decreased cardiac output and perfusion?
* SOB
* Altered LOC
* Syncope
* Weakness
* Chest pain
* Hypotension
68
```
What is the drug of choice for controlling atrial tachycardia?
A/ Atropine
B/ Adenosine
C/ Atorvastatin
D/ Amiodarone
```
B/ Adenosine
Rapid-onset
Short half-life
Slows HR fast
69
What is Atrial Flutter? How do you treat it?
Rapid and unreadable atrial contraction that typically lasts a short time and is RARELY chronic.
Tx:
If Ventricles are tachy control their response.
70
What is Atrial Fibrillation? What can it lead to and how do you treat it?
Minimal to no real atrial contractions (No p wave identifiable on ECG). Ventricles contract but typically are initiated from elsewhere
Can lead to a stroke. Because blood pools in the atria, there is an increased risk of clot formation... which can move to the brain.
Tx:
* O2
* Falls precaution
* Control ventricular response prn
* Anticoagulant therapy!!!!!!
71
```
What assessment should be done for A-Fib?
A
T
R
I
A
```
```
A - Asymptomatic?
T - Trend in HR?
R - Report syncope
I - Incidents of chest pain?
A - Altered LOC?
```
72
What is a PVC?
Preventricular contraction.
Originates from somewhere in the ventricle and is a premature ventricular beat that looks like a widened QRS complex
73
```
What two drugs can be used to treat PVCs?
A/ Amiodarone
B/ Lidocaine
C/ Atropine
D/ Digoxin
```
A and B
Amiodarone is the drug of choice.
Typically used when there is an increased risk of V-tach or V-fib
74
Klaus is emitted to the ER with Ventricular Tachycardia and is Stable. You check for a pulse and find one... what do you do?
O2 if needed
IV access
Ventricular anti-arrhythmics (AMIODARONE)
If unstable, synchronized cardioversion
75
Jasper is emitted to the ER with Ventricular Tachycardia and has No pulse... what do you do?
Defibrillate immediately!
76
When might you want to notify a physician about your patient's CVAD/PICC line?
1. Increase in bleeding
2. New/Different Cardiac Rhythms
3. Sudden/Unexplained Respiratory distress
4. Chest pain
5. Pain/numbness/tingling in cannulated arm
77
An M.A.P. of ___ mmHg is needed to adequately perfuse coronary arteries... while ____ mmHg is ideal.
60 mmHg to perfuse
70-90 mmHg is ideal
78
What are complications that can be associated with PICC/CVAD's?
Infection
Hemorrhage
Thrombus
Neurovascular compromise
79
Which of the following readings are a cause for concern?
pH: 7.37
PaCO2: 31 mmol/L
HCO3: 26 mmol/L
PaCO2 should be between 35-45 mmol/L
80
What does an acidotic state do to the cardiac system?
Decreases the force of myocardial contraction
81
What are the signs and symptoms of Respiratory Acidosis?
```
Dyspnea
Respiratory distress
Shallow respirations
Headache
Restlessness
Confusion
Tachycardia
Dysrhythmias
```
82
What is angina Decubitus?
Chest pain when supine. Usually relieved by sitting up or standing
83
What is Prinzmetal's (Variant) Angina?
Spasm of the coronary artery that may be relieved by moderate exercise.
84
What is the nursing/collaborative care for Chronic Stable Angina?
1. O2
2. Short and Long-acting nitrates (spray/patch)
3. Beta-blockers (Decrease contractility, HR, BP, and O2 requirements of the heart)
3. Calcium Channel Blockers (Systemic vasodilation, decreased contractility, coronary vasodilation)
4. Ace inhibitors (They do stuff... to lazy to type it)
85
What is a transmural M.I.?
M.I. that encompasses the full thickness of the Ventricle (Typically the Left ventricle)
86
Joachim is suffering from a large wound that is bleeding heavily... for the sake of education, all the medical staff are observing him to see what happens next without intervention. He begins to become tachycardic, Nauseated, tachypneic, and his BP is 87/84
What stage of Shock if he in?
Compensatory stage.
The mechanisms are in place to try and relieve the issues.
87
What care would you provide Joachim who is bleeding profusely and in the compensatory stages of hypovolemic shock?
What happens if the treatment works, but his BP is still low?
O2
ADRESS CAUSATIVE INJURY/STOP BLEEDING
Blood transfusion
Drugs to increase Cardiac Output
Crystalloids for volume loss (NaCL, Dextrose, Ringers)
If BP is still low....
Provide vasoconstrictors
88
What does the SNS do during cardiogenic shock that is actually counter-productive and makes the situation worse?
Increases HR and contractility which increases the Heart's demand of oxygen... worsening the ischemia.
89
Milosevic was in a 4 car crash and was thrown from his vehicle because he was an arrogant ass who didn't wear his seat belt. These are his vitals:
```
Temp 35.8
HR 39
BP 69/53
Resp. 9
SaO2 87
```
Which type of shock is he likely in? What care should be provided.
Neurogenic shock (Extremely low BP, bradycardia)
Tx:
Provide O2
Treat underlying injury
Neurological investigation (GCS)
Monitor temp
Watch for DVT from pooling blood and increased ICP
90
Rick was eating an odd ethnic dish he go at a orthodox Ukranian Church bake sale. After a few bites, he realized there were nuts in the dish. Rick is now in Anaphylactic shock... What do you do for Rick?
REMOVE NUTS (Not Rick's nuts. The cookie)
Optimize ventilation and intubate if needed
Epinephrine (1:10,000 SC/IV 5-20minutes)
Bronchodilators, Antihistamines, Corticosteroids
Fluid resuscitation
91
Edwin Isn't doing so good. He's been really sick for a few days now and is presenting the following vitals and C.M.'s
```
HR: 121
Resp. 8
BP 91/68
SaO2: 84%
Temp: 39.2
```
What is wrong with Edwin? How do you treat him?
Septic Shock (Late progression)
Tx:
Identify causative organism and treat with antibiotics
O2
I.V. fluids
Correct acidosis
Universal precautions
Vasoconstrictors (Noradrenaline).
92
What should be done for patient prior to an Endotracheal intubation?
Oxygenate with BVM at 100% O2 (3-5 minutes)
93
What should be done immediately after intubation of a patient with an endotracheal tube?
Inflate cuff and confirm placement of ET tube while manually venting patient with 100% O2
Auscultate lungs and apices for bilateral breath sounds
94
What does a low pressure alarm mean in association with a patient on a ventilator? What do you do?
The tidal volume is not being met due to a leak or break in the system.
Check all connections and the tubing/cuff for a leak
95
What does a High pressure alarm mean in association with a patient on a ventilator? What do you do?
Tidal volume can't be delivered at a set limit due to:
Secretions/ Client biting tubing/ coughing/anxiety
Suction/ Place oral airway/ sedatives
