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Interview Flashcards

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1
Q

Q. What are your RSI drugs (rapid sequence intubation), what order do you give them, can you give them, or does a doctor?

A

(Optional) Lidocaine or Fentanyl, (Sedative) Ketamine or Propofol, (Paralytic) Succinylcholine or Rocuronium, (post-intubation) Propofol, midazolam or fentanyl.
Nurses can administer RSI drugs but only under a physician’s order.

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2
Q

Q. Who needs to be present during intubation? What drips will be running?

A

Physician or Advanced practice provider, Critical care nurse, RT, support staff/other nurses.
Drips that will be running will be: post-intubation sedation drips (propofol, versed, precedex), Pain control drips (fetanyl/morphine),and vasopressors if pt is unstable (Levophed, epi, vasopressin)

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3
Q

Q. What resuscitation equipment will be needed?

A

Intubation kit, suction, bag mask

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4
Q

What are your sedation drugs? (3)

A

Propofol (Diprivan)
Midazolam (Versed)
Precedex

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5
Q

What is primary action for propofol?
Notes?

A
  • Fast-acting sedation
  • Reduces brain O2 demand
  • Can cause hypotension
  • Requires secure airway
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6
Q

What is primary action for Midazolam (Versed)?
notes?

A
  • Benzo used for sedation and amnesia
  • May cause hypotension
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7
Q

What is primary action for Precedex?
notes?

A
  • Sedation w/o deep respiratory depression
  • Good for weaning off vent
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8
Q

What are your vasopressors? (3)

A

Epinephrine
Norepinephrine (Levophed)
Vasopressin

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9
Q

Primary action for Epinephrine
notes?

A
  • Increases BP & HR
    *used in Cardiac arrest/severe anaphylaxis
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10
Q

Primary action for Norepinephrine (Levophed)

notes?

A
  • Increases BP
  • 1st line hypo/shock
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11
Q

Primary action for Vasopressin

notes?

A
  • Increases BP w/o increasing HR
  • Often added to NE
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12
Q

What are your paralytic drugs? (2)

A

Cisatracurium (Nimbex)

Rocuronium (Zemuron)

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13
Q

When to use Cisatracurium (Nimbex)

A

Common in ARDS, severe resp failure, or high vent demands

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14
Q

When to use Rocuronium (Zemuron)

A

Bolus for RSI
Long-acting paralytic

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15
Q

When to use Cardizem (diltiazem)?
Monitor?
Push?

A
  • Treats rapid HR or high BP
    (Afib, Atrial flutter, SVT)
  • Monitor BP closely (hypotension), ECG monitoring (heart block, bradycardia)
  • Push over 2min/never rapid push
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16
Q

NS - what kind of fluid?
Used for?

A

NS 0.9% NaCl - ISOTONIC
General use - Fluid resuscitation, hydration
(Hypovolemic shock, trauma, sever dehydration, sepsis, hypotension, burn)
If the patient is hypotensive, a fluid bolus of 500-1000ml may be given before vasopressors

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17
Q

LR - what kind of fluid?
Used for?
Better than NS because?

A

ISOTONIC
* Trauma, burns, metabolic acidosis, electrolyte replacement
* due to rapidly expanding intravascular volume, provides electrolytes, and helps correct acidosis.
Contains lactate and helps correct lactic acidosis from blood loss or ischemia

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18
Q

D5W 0 what type of fluid?
Used for?
Never use in?

A

HYPOTONIC
* Hypoglycemia or to maintain BG, hypernatremia, severe dehydration, heat stroke
* Never use in ICP, brain injury (swelling), Stroke, hypovolemia, hyperglycemia,

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19
Q

What do isotonic fluids do?
What are the 2 isotonic fluids?

A

Expand blood volume, increase BP, maintain fluid balance
NS, LR,

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20
Q

What do hypertonic fluids do?
What are the 4 hypertonic fluids?

A
  • Fluid to shift OUT of cells into blood stream
  • Reduce swelling, cerebral edema, and severe hyponatremia
  • 3%NaCl, 5%NaCl, D51/2NS, D10W
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22
Q

What do hypotonic fluids do?
What are the 4 hypotonic fluids?

Study These Flashcards
A

Fluid to shift OUT of bloodstream into CELLS
dehydration, hypernatremia, DKA,
1/2NS or 0.45%NaCl, D5W, 0.33% NS,

23
Q

How many pressors can you run at a time?

24
Q

What is max titration for levophed?

Study These Flashcards
A

Levophed is titrated to effect based on bp goals (MAP 65-70 mmhg) / max dose usually up to 30 mcg/min

25
What is max titration for vasopressin
Vasopressin is titrated to effect based on bp goals (MAP 65-70 mmhg) / max dose usually up to 0.04 units/min
26
What is max titration for epinephrine
Epinephrine is titrated to effect based on bp goals (MAP >or = MAP 65 mmhg) / max dose, usually up to 0.2mcg/kg/min
27
What is cool therapy mgmt ROSC? Target tempt? How to cool? Rewarming? Complications?
* Cool therapy mgmt aims to reduce the risk of neurological injury by cooling the brain and body * ROSC - Return of Spontaneous Circulation after cardiac arrest * 32-36C target cooling maintained for at least 24 hours * Cooling blankets, ice packs, internal cooling (IV chilled fluids) * Rewarming should be slow (0.25C/hr) to avoid hemodynamic instability and seizures * Infection, coagulation issues, rewarming shock (hypotenison, cardiac arrhythmias)
28
What are nitro drips used for and what are contraindications?
Nitro drips and contradictions Used to treat ACS, HTN, HF Contraindications are hypotension (SBP <90, MAP <65mmhg), Severe anemia, ICP, PDE-5 inhibitors (viagra, cialis w/in last 48hours)
29
What is DKA and what are symptoms?
Life-threatening complications of diabetes result from severe insulin deficiency, leading to hyperglycemia, ketosis, and metabolic acidosis. * Hypeglycemia >250mg/dl, ketouria, dehydration, fruity breath, kussmaul respirations, electrolyte imbalances, particularly potassium
30
What is your insulin drip rate for DKA and how often do you check BGL?
Insulin drip rate 0.1units/kg/hr Check BGL q hourly until stable then q2-4hr
31
What other fluids do you run for DKA? What labs do you draw? how often?
Run normal saline first 1st 1-2 hours ,switch to 0.45% NS once BG falls to 250mg/dl to avoid fluid overload, and add 5% dextrose once BG reaches around 200mg/dl to prevent hypoglycemia **Labs**: BG, aretial pH and bicarb, electrolytes K+(insulin therapy will shift potassium INTO cells, which can cause hypokalemia), ketones and renal function. check potassium q 2-4hours
32
Q. Which critical meds must only run through a central line
Vesicants - chemo drugs, vasopressors, TPN, Milrinone
33
What is the protocol for blood transfusions?
Blood transfusions can only be paired with **NS** and must be given **within 4 hours**; must be started within 3**0 min of retrieval from blood bank, double verified, run at 75ml/hr** for the f**irst 15 min and watch for transfusion reactio**n, some facilities will have you start it at 90ml/hr. After 15 min, increase rate based off doctor order or patient history.
34
Normal range for SODIUM ?
Sodium 135-145
35
Normal range for POTASSIUM
Potassium 3.5-5.0
36
Normal range for Chloride
Chloride 98-106
37
Normal range for HCO3
HCO3- 22-28
38
Normal range for Calcium
Calcium 8.5-10.2
39
Normal range for mag
Mag 1.7-2.2
40
Normal range for Phosphate
2.4-4.5
41
42
As the pH goes ----
So does my patient except POTASSIUM
43
**HypErnatermia** - Causes? S/S **HypOnatermia** - causes? S/S
**HypErnatermia ** (DKA, DI, HHNK) S/S- dehydration - Dry skin, Thready pulse, Rapid HR **HypOnatermia** (SIADH) S/S - Overlaod
44
**Calcium Channel blockers** Like what? Negative ___ Treats? S/S Drug? ending in plus __ + __ Monitor?
Like valium for your heart * Negative inotropic, dromotropic, chronotropic Treat - A, AA, AAA * Antihypertensive, AA - Anti-angina, AAA - Anti atrial arrhythmias S/S Headache & hypotension Drugs - anything ending in DIPINE + verapamil & Cardizem Monitor BP and hold if SYS is under 100
45
**Kalemias** - Does --? Hypo? Hyper? Never push? Decrease fast? slow?
***Same as prefix, except HR and Urine output*** **Hypo** - Lethargy, Bradypnea, U wave, Ilius / constipation, Flaccidicy, Tachycardia, Increased urine / polyuria **Hyper** - Agitated, Seizures, Tachypnea, Diarrhea, Spasticity/clonus , Bradycardia ,Oliguria * NEVER PUSH IV / No more than 40mEq of K+/liter of IV fluid * Give D5W & Insulin to decrease K+ **FAST** - hides K in cells * Kayexalate - K+ exists-late **SLOW** - gets K out via poop
46
47
**Calemias** (Calcium) Does? Hypo? Hyper?
**Opposite as prefix** **Hypo** - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria Chvosteks, Trousseau **HYPER** - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation.Flaccidicy / hypoactive reflexes, Oliguria
48
**HypErnatermia** - Causes? S/S **HypOnatermia** - causes? S/S
**HypErnatermia ** (DKA, DI, HHNK) S/S- dehydration - Dry skin, Thready pulse, Rapid HR **HypOnatermia** (SIADH) S/S - Overlaod
49
S/S HYPERGLYCEMIA
Hyperglycemia - Polydipsia, Polyuria, Fatigue, blurred vision, headache, dry mouth, Kussmaul resp, nausea, vomit Fruity breath,
50
S/S HYPOGLYCEMIA
Hypoglycemia - below 70, Shakiness/tremors, sweating, hunger, anxiety, tachycardia, dizzy, headacheconfusion, seizures
51
S/S SHOCK
Shock - Hypovolemic - low bp, tachycardia, weak pulse, cold skin, decreased urine Cardiogenic - SOB, rapid or weak pulse, low bp, chest pain Septic - fever, chills, warm, flushed skin, rapid hr, low bp, confusion Anaphylactic - swelling, diff breathing, hypotension Neurogenic - hypotension, bradycardia, warm dry skin
52
What is a shockable heart rhythm?
Ventricular Fibrillation (VF or V-fib) Ventricular Tachycardia (VT or V-tach)

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