Tx/mgmt

Question 1

DI

Answer 1

Fluid deprivation test
Vasopressin

Question 2

SIADH

Answer 2

Neuro assessments
Lasix
3% NS

Question 3

Addison

Answer 3

IV fluids
IV hydrocortisone
Corticosteroids
Vasopressors
Recumbent/legs elevated
Abx if due to infection

(Must have supplemental steroids when undergoing stress)

Question 4

Cushing (procedures and tests)

Answer 4

Dx 2/3 must be positive (serum cortisol, urine cortisol, low dose Dexamethasone suppression test)

Surgery if tumor
Adrenalectomy

Question 5

DKA and HHS

Answer 5

IV fluids
IV insulin
Restore pH and lyte balance
Potassium

Question 6

Components of hemodynamic monitoring system

Answer 6

Disposable flush system
Pressure bag (300 mm Hg, prevents clotting and backflow)
Transducer (to show electrical signal)
Amplifier/monitor

Question 7

Nursing role with hemodynamic monitor

Answer 7

Ensure no air bubbles
Stopcock at phlebostatic axis
Zeroed out

Question 8

What the heck does a CVP monitor do? What’s a normal value?
Where do you stick it?

Answer 8

Measures pressure at vena cava/R atrium and the preload at the right ventricle
Normal 2 to 6 mmHg
At subclavian vein

Question 9

What the heck does a PAP monitor do?
What are some considerations?

Answer 9

Monitors pulmonary arterial pressure at the left ventricle
Don’t fill balloon with fluids - only fill with 1.5 mL air to measure PAWP (L vent preload) for 15 seconds max

Question 10

Sinus bradycardia

Answer 10

Pacemaker
Underlying
Atropine, dopamine, Epi

Question 11

Sinus tachycardia

Answer 11

Synchronized cardioversion
Vagal, cold stimulation
IV BB
CCB
Ablation if all else fails

Question 12

Atrial flutter

Answer 12

Cardioversion
Catheter ablation
Drugs (see other f card)

Question 13

Afib

Answer 13

Cardioversion
Ablation
Maze with cyoablation
LAAO (left arterial appendage occlusion with Watchman for stroke prevention)
Drugs (antiarrhythmics and antithrombics) - see other f card

Question 14

V Tach

Answer 14

Cardioversion
Defibrillation if pulseless/unresponsive
Antiarrhythmics (see other f card)
ICD for long term tx

Question 15

V fib

Answer 15

CPR, ACLS
Defibrillator
Epi, amiodarone

Question 16

Asystole

Answer 16

CPR
IV access
Find cause (Hs and Ts)
Epi, atropine

Question 17

PEA

Answer 17

CPR
Intubation
IV epinephrine
Underlying cause

Question 18

Anemia

Answer 18

Underlying
PRBC
Diet
Iron, folate, B12
Immunosuppressive therapy

Question 19

Education for neutropenia to decrease infection risk

Answer 19

Mask
Avoid crowds
Healthy diet and lifestyle
No fresh fruit or flowers
Handwashing and overall hygiene
Notify provider if infection
IS/deep breathe

Question 20

Bleeding disorders

Answer 20

Platelet transfusion
Aminocaproic acid
Limit injury

Question 21

DIC

Answer 21

Underlying
Correct tissue ischemia
Fluid and lytes
Maintain BP (vasopressor)
Replace coagulation factors
Heparin, LMWH
Do not use aminocaproic acid
Avoid bleeding
Avoid increasing ICP

Question 22

Polycythemia Vera

Answer 22

Phlebotomy
Chemo to suppress bone marrow
Mgmt atherosclerosis
Meds (see other f card)

Question 23

Lupus

Answer 23

Prevent loss of organ function
Avoid sun
Prevent infections
Manage fatigue, impaired skin integrity, osteoporosis
Smoking cessation
Skin integrity

Question 24

Sickle cell

Answer 24

Stem cell
Hydroxyuria
Daily folic acid
Corticosteroids
Transfusions
Vax up to date
Pain mgmt
Fatigue management
Infection prevention
IVF, O2
Hydration, nutrition, rest and activity

Question 25

Hereditary hemochromatosis

Answer 25

Phlebotomy Avoid iron and vitamin C supplements Decrease ETOH

Question 26

AV block

Answer 26

IV atropine Pacemaker

Question 27

Sick day rules for DM

Answer 27

Normal insulin/anti diabetic Test BG and ketones q3-4h Take additional insulin if needed Soft foods 6-8x/day Liquid q30-60m

Question 28

HF

Answer 28

Meds (see other f card) Lifestyle O2 ICD Heart transplant Bed rest when acute 30 minute of activity Avoid extreme temp Good HOB Manage fluid volume, low salt

Question 29

Pulmonary edema

Answer 29

Nonrebreather Furosemide and nitro Dangle feet I/O POND: position/PVV, oxygen, nitro, diuretics

Question 30

Anaphylaxis

Answer 30

O2, intubation, CPR Epi IV Fluids Take to ER Monitor for rebound in 4-8 hours

Question 31

Postexposure prophylaxis for HC worker

Answer 31

ART within 72 hours 2-3 drugs for 28 days HIV testing after 6 weeks, 12 weeks, and 6 months

Question 32

Hematologic assessment includes looking for…

Answer 32

Fatigue Delayed clotting Family history Bruising and bleeding Abdominal pain Joint pain Abnormal blood cell counts Illness Dyspnea Diet low in B12, iron, folate Skin discoloration (ruddy, pallor, bronze, rash, jaundice) Swollen tongue Occult blood

Question 33

Ascites assessment

Answer 33

Girth and weight daily Look for striae, distended veins, umbilical hernia Percuss for dullness Monitor for f and l imbalances

Question 34

Ascites tx

Answer 34

Low sodium diet Diuretics (spironolactone) Bed rest Paracentesis Albumin TIPS

Question 35

Hepatic encephalopathy assessment

Answer 35

EEG LOC Fluid, lyte, ammonia levels Monitor for seizures and fetor hepaticus

Question 36

Hepatic encephalopathy mgmt

Answer 36

Underlying Lactulose IV glucose to decrease protein metabolism Flumazenil 1.2 g protein/kg/day Reduce ammonia via suction, enema, oral abx Dc sedatives Tx comps and infections Rifaximin, neomycin, metronidazole to decrease ammonia forming bacteria in colon

Question 37

Esophageal varices

Answer 37

Shock tx, O2 IVF, lytes, volume expanders, blood products Vasopressin, somatostatin/octreotide to decrease bleeding Nitro with vasopressin Propranolol and nadolol Balloon tamponade Endoscopic sclerotherapy Banding ligation TIPS Surg - bypass, devasc and transaction

Question 38

HAV

Answer 38

Hygiene Safe water Vax IG Bed rest Nutrition

Question 39

HBV

Answer 39

Antivirals ETV and TDF Bed rest Nutrition Vax Screen blood products

Question 40

HCV

Answer 40

Number one cause for liver transplant Stop etoh Antivirals Avoid hepatotoxic meds Needle safety

Question 41

Cirrhosis

Answer 41

IO Small frequent High calorie low sodium 1.2 g protein/kg/day Vitamins Skin Prevent injury

Question 42

Cholelithiasis

Answer 42

ERCP Low fat Ursodeoxycholic acid 6-12 months Chenodeoxycholic acid Laparoscopic cholecystectomy

Question 43

Interventions for gb surg includes

Answer 43

Low Fowler NG/NPO til bowel sounds Progress to soft low fat/high carb Biliary drainage system Pain mgmt Splinting, cough, db Ambulation

Question 44

Pancreatitis

Answer 44

Pain mgmt (PCA) Resp care Biliary drainage NPO, rest, NGT Surg Nutrition (low fat, low protein) Skin F and lytes, combat shock/MODS/pancreatic necrosis