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Block 4 Exam 1 > Tx/mgmt > Flashcards

Tx/mgmt Flashcards

(75 cards)

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1
Q

FVD

A

Oral best
No LR if alkalosis
IO, weight
Prevent vomiting and bleeding and other ways of losing fluid

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2
Q

FVE

A

Diuretics
Salt and fluid restriction
Dialysis
IO, weight
Lung sounds
Promote rest

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3
Q

Hyponatremia

A

Slowly give salt
Water restriction
Look at diet
Are they taking lithium?
Are they on diuretics?
SIADH?

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4
Q

Hypernatremia

A

Slowly give hypotonic or D5W
Diuretics
H2O
Are they taking OTC meds with salt? (Alka Seltzer)

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5
Q

Hypokalemia

A

Diet (banana, spinach, potatoes, orange, nuts, grapefruit)
Oral or
IV (unless oliguria - establish good UPO, don’t slam)
ECG, bowel sounds, ABG, dig tox?

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6
Q

Hyperkalemia

A

ECG, apical pulse
Diet
Kayexelate
Bowel sounds
IV Dectrose 50% Insulin, diuretics, Ca gluconate, bicarbonate, albuterol

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7
Q

Hypocalcemia

A

IV calcium gluconate with D5W (for emergency, watch for extravasation)
Seizure precautions
Oral calcium with vitamin D
Lift weights
Diet

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8
Q

Hypercalcemia

A

Underlying cause (cancer?)
IVF, furosemide, phosphates, calcitonin, Bisphosphonates
Increase mobility
Fluids
Fiber for constipation (not Tums)

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9
Q

Hypomagnesemia

A

Mg sulfate IV (have calcium gluconate on hand in case Hypermagnesemia occurs)
Oral Mg salts (may cause diarrhea)
Seizure precaution
Green leafy, nuts, beans, lentils, PB
Speech therapy and monitor dysphagia

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10
Q

Hypermagnesemia

A

Redraw - might be hemolyzed
IV calcium gluconate
Vent for resp depression
Assess DTR and LOC
Hemodialysis
Loop, NS, LR
OTC meds? (milk of mag)

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11
Q

Hypophosphatemia

A

Oral or IV (watch for extravasation)
Burosumab
Monitor levels of phosph, Ca, and Vitamin D
Milk, beans, liver, nuts, fish, poultry
Gradually increase calories if malnourished

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12
Q

Hyperphosphatemia

A

Phosphate binding agents (watch for hypercalcemia)
Limit vitamin D
Loops
IV NS
Dialysis
Diet
Observe SS of low Ca

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13
Q

Hyperchloremia

A

Hypotonic IV
LR (will increase bicarbonate)
Sodium bicarbonate
Diuretics
Monitor neuro, resp, cardiac

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14
Q

Hypochloremia

A

IV NS or 1/2 NS
Ammonium chloride
LOC
Foods to try: tomato juice, banana, egg, milk, cheese
No tap water
DC diuretics

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15
Q

Metabolic acidosis

A

Bicarbonate
Dialysis

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16
Q

Metabolic alkalosis

A

Fluids
NaCl
K
PPI to decrease HCl in stomachs
Carbonic anhydrase inhibitors to decrease bicarbonate

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17
Q

Respiratory acidosis

A

Improve their ventilation
Fluids

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18
Q

Respiratory alkalosis

A

Breathe into bag
Anxiolytics

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19
Q

D and E in primary survey

A

Disability and Exposure

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20
Q

Emergency tx and assessments for intra-abdominal injuries

A

Assess referred pain
Dx peritoneal lavage
Imaging
ABC, immobilize C collar
Document all wounds
Cover protrusions with moist sterile dressing
NPO, NG aspiration
Prophylactic tetanus and Abx

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21
Q

Heat stroke

A

ABC
Reduce temp ASAP
Cool sheets/towels/sponge
Ice neck, groin, chest, axillae
Cold bath
Monitor temp, VS, ECG, CVP, LOC, I/O
IVF
Labs (look for DIC and rhabdo/CK)
Dialysis if AKI

Meds: anticonvulsants, K, sodium bicarbonate, benzo

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22
Q

Hypothermia

A

ABC
Remove wet clothing
Rewarm with warm fluids, warm humidified oxygen, warm peritoneal lavage, blankets, heaters

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23
Q

Ingested poison

A

Emetics if not corrosive
Gastric lavage
Activated charcoal
Antidote
Diuresis
Dialysis
Hemoperfusion

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24
Q

Carbon monoxide poisoning

A

Fresh air
100% O2
CPR

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25
Goals for treating drug OD
Respiratory and cardiac function Enhance clearance
26
ETOH intoxication
Rule out other causes like hypoglycemia or head injuries ABC, monitor hypotension Sedation if belligerent
27
Essential components of EOP
Activation response Communication plan Coordinated patient care Security plans External resources Traffic flow Data management Demobilization response Corrective plan Practice drills Mass casualty planning Education plan
28
Anthrax
Penicillin, ciprofloxacin, levofloxacin, doxycycline Erythrocin Cremate 6 dose vax
29
Smallpox
Abx Vax Negative pressure room Airborne and contact precautions
30
Radiation decontamination
Isolation precautions Seal air vents Cover floor Double bagged and labeled Water resistant gowns Double glove Caps Goggles Masks Booties Dosimeter Soap and water Collect patient belongings Catharsis and lavage if internal Collect samples of their excretions plus nasal and throat swab
31
Antidote for cyanide
Nitrite
32
Antidotes and drugs for nerve gas
Atropine to decrease secretions Pralidoxime Benzo for seizures
33
Antidote for acetaminophen OD
NAC
34
Antidote for benzo OD
Flumazenil
35
Drugs for meth OD
IV diazepam/haloperidol
36
Drugs for antidepressant OD
Sodium bicarbonate drip IV magnesium for torsades Vasopressors Benzo for seizure
37
Near drowning
CPR Mgmt hypoxia/acidosis/hypothermia ABG, PEEP O2 if breathing spontaneously ET if not breathing spontaneously Assess for cerebral injury Closely observe for vom and aspiration
38
Snake bite
Cover with light sterile dressing Immobilize Poison control Vasopressors Measure circumference Labs Fluids IV Antivenom with Benadryl slowly with 1/2 to 1 L NS
39
Bites
Soap and water Abx Tetanus
40
Brown recluse
Soap and water Debridement
41
Black widow
Ice Elevate Tetanus Benzo Analgesics Antivenom if severe
42
Requirements for zeroing A-line
Supine Transducer at phlebostatic axis (nipple line, 4th intercostal space) Open valve Tap screen Squeeze, close, hit zero Square wave test
43
Priority actions with crush injury
Apply clean dressing to protect wound Elevate to decrease edema Splint to decrease motion
44
Cricothyroidotomy for these patients
Extensive facial trauma Laryngeal edema Obstructed larynx Cervical spine injury Hemorrhage into neck tissue
45
Atelectasis
Turn Cough Deep breath Early mobilization Incentive spirometer Manage secretions Oral care HOB MDI ICOUGH: IS, cough and deep breathe, oral care, understanding, get out of bed 3x/day, HOB CPAP/BiBap Bronchoscopy CPT ET, mech vent PEEP Thoracentesis if pleural effusion
46
COVID Hypoxia
Intubation Mech vent Remdesivir, roids, bamlanivimab Prone Suction ECMO
47
Acute respiratory failure
Underlying cause O2 Bronchodilator Intubation, MV Nutrition (enteral) Reduce anxiety Provide communication Prevent complications: turn, ROM, mouth, skin
48
Indications for noninvasive positive pressure ventilation
Respiratory arrest Dysrhythmia Cognitive impairment Head/facial trauma
49
MV- enhancing gas exchange
Analgesics- but don’t suppress respiratory drive Frequent repositioning Assess edema, IO, weights Meds for primary disease
50
MV- effective airway clearance
Lung sounds q2-4h Suction CPT Position Promote mobility Bronchodilators Mucolytics
51
MV- preventing injury
Infection control Tube care Cuff management (q6-8h) Oral care HOB
52
MV- other interventions
ROM Communication Stress reduction Involve family Nutrition Monitor hemodynamic stability Monitor neuro Monitor for synchrony and distress Monitor for barotrauma/pneumothorax
53
ARDS
Underlying cause Intubation, MV, PEEP to keep alveoli open Tx hypovolemia Prone, frequent reposition Enteral feedings or TPN Sedation, paralysis, analgesics BNP to rule out HF Inotropes and vasopressors to increase BP Circulatory support and adequate fluid volume
54
Nursing for pt undergoing renal testing
Encourage fluids unless contra Sitz, relax Analgesics, antispasmodics Assess voiding and edu
55
Nephrosclerosis
HTN tx
56
Glomerular disease / acute nephritic syndrome
Diet (Na and K restrictions, lots of carbs) For post strep glomerulonephritis you should limit the protein Roids Abx Immune suppressants Lower BP
57
Polycystic kidney disease
Tolvaptan to slow Genetic counseling
58
Nursing for renal patients
Fluid status and restrictions Oral hygiene Nutrition status, restrictions on salt, potassium, phosphate Meds with meals
59
Nursing and assessment for hospitalized patient on dialysis
Don’t use HD arm for BP Bruit and thrill q8-12h Monitor fluid, IO, IV, infection Monitor for uremia, electrolytes Monitor cardiac and respiratory status Hold CV meds before HD Carefully monitor med doses Restrictions on salt, potassium, phosphate, fluids Keep protein at 1.2 g per kg Skin care CAPD catheter care (sterile, mask, gloves)
60
Post intubation assessment and interventions
Bilateral chest movement Breath sounds ETCO2 and O2 CXR Skin color Cuff pressure 20-25 SS aspiration Ensure humidity Set up tube: FiO2, tape and mark, cut if too long, bite block, suction
61
What to do if ET tube dislodged
Immediate bag mask and call for help
62
What can cause the vent alarm for increased peak airway pressure to go off and what do we do about it?
Due to coughing/secretions or biting We can increase sedation, check tubing, bite block, suction, reposition
63
What the heck is an IVC filter for?
For pulmonary embolism- to strain out the clot
64
The 3 principals of HD
Diffusion Osmosis Ultrafiltration
65
What’s a manometer for?
To measure inspiratory force- useful for coma pts to see if MV needed
66
Initial MV settings
Vt 6-10 mL/kg Lowest FiO2 to get 92 sat / PaO2 >60 Keep IP less than 35 Sigh 1.5x Vt 1-3/hr Sensitivity IF 2 mm Hg Adjust based on ABG
67
Stop wean if…
HR spike of 20 Syst BP spike of 20 O2 < 90 RR <8 or >20 Arrhythmias Fatigue, panic, cyanosis, paradoxical chest
68
Prevent VAP by…
Good HOB Daily sedation vacations Daily extubate readiness assessment PUD prophylaxis DVT prophylaxis Daily oral care with chlorahexadine
69
Chest trauma
Airway Fluids Drainage Occlude wounds Correct low CO and volume
70
Chest tube hose and suction for pneumothorax plus other chest tube things
28 Fr at 2nd intercostal 32 Fr at 4/5 if hemothorax 20 mm Hg suction Abx Keep low Gentle bubbling Gentle rising of ball in chamber No tidaling could mean issue resolved (no more pneumothorax etc)
71
Pulmonary embolism
Immediately give enoxaparin - keep giving for 5 days/ til INR >2 Warfarin for 3 months TPA for unstable Increasing fluids will increase fluid volume and reduce risk of DVT DVT prophylaxis (activity, stockings, SCDs)
72
Things to prevent AKI
Early identification and tx sepsis and other infections Tx hypovolemia Hydration Catheter care Caution with NSAIDs IVF and mucomyst before contrast dye
73
Some drugs to consider for PD
Prophylactic abx (prevent pericarditis) KCl to prevent hypokalemia Heparin to prevent clotting Stool softener to promote good bowel habits/prevent hernia
74
Things to assess when determining if ready for extubation
Low RSBI (getting regular nice deep breaths with little help) Secretions Hemodynamic stability (still on lots of pressors?) Mental (able to lift head) Underlying condition
75
These patients need daily dialysis
Increase metabolic rate leading to increased waste due to… Surgery Corticosteroids Bleeding disorders Infection TPN

Block 4 Exam 1 (3 decks)

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