Critical Care Hesi Review SG.docx

Adenosine svt sodium bicarb last ditch effort if

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ADENOSINE: SVT Sodium bicarb: last ditch effort if everything fails calcium choride: hyperkalemia, hypocalcemia Magnesium: Torsades ***drugs down ETT: LEAN (Lidocaine, Epinepherine, Atropine, Narcan) Atrial flutter-saw tooth pattern V-tach-upside down “u’s” tx for pulseless vtach: amiodarone PVC-pulm art cath should be advanced so the PVC’s can stop showing on ECG 3 rd degree AV block 1 st : atropine, 2 nd : tx with pacemaker V-fib-CPR IMMEDIATELY!! SVT-adenosine Torsades-Administer Mg+ Cardiac Tamponade - accumulation of fluid in the pericardial sac restricting ventricular filling, causing dec. CO s/s: pulsus paradoxus, JVD, clear lung sounds, muffled heart sounds, tachycardia, dec. CO, & narrowed pulse pressure [ Beck’s triad (diminished heart sounds, JVD, &
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hypotension (a drop of more than 10mm Hg sys)], pericardial friction rub, ST seg elevation & t wave inversion meds: admin. IV fluids tx: pericadiocentesis, chest x-ray, echo, pulm artery cath, VTE prophylaxis, CPR Nurs. Interventions : position client in lateral position/high fowlers or upright & leaning forward, auscultate for pericardial friction rub Cardioversion -indicated for fast rhythms w/ a pulse (SVT, V-tach, a-fib, or flutter), shocks the heart, Nurs. Interventions : start anticoagulation therapy several weeks prior to procedure b/c of risk of thromboembolism, pt should remain NPO prior to procedure Chest Tubes - It is never ever safe to milk or strip the chest tube, because it increases negative intrapleural pressure and does not significantly affect the tube patency. SO NEVER EVER Milk or Strip the CHEST TUBE [1 st chamber-collects drainage, 2 nd chamber-water seal (ensures air does not enter plueral space), 3 rd -suction] After chest tube is inserted l isten to the lung sounds and confirm placement with a Chest X-ray Fluctuations of the fluid in the water-seal chamber indicate chest tube patency; excessive bubbling indicates an air leak in the chest tube sys If the drainage system cracks or breaks, insert the tube into a bottle of sterile water, remove the cracked or broken system, and replace it with a new system. If chest tube dislodges you should immediately apply the occlusive dressing, tented to one side to prevent a tension pneumothorax (never clamp chest tube, it will result in a tension pneumothorax), encourage pt to cough & deep breath, keep drainage sys below level of chest An output of more than 100 mL/hr of fluid at one time can cause hypotension & rebound pleural effusion; chest tube drainage that exceeds this amt should be reported to the physician DIC -blood oozing from 2 or more unexpected sites, PT & aPTT prolonged , platelets decreased, s/s -petechiae, purpura, hematomas, GI or GU bleeding, hemoptysis, mental status changes, hypotension, & tachycardia Nurs. Interventions -provide gentle oral care w/ mouth swabs, minimize needle sticks (use smallest gauge possible), turn client frequently, minimize # of BP cuff readings, use gentle suction to prevent trauma to mucosa, apply pressure to any oozing site, Administer heparin IV during 1 st phase to inhibit coagulation if bleeding isn’t controlled by platelets or plasma , administer fresh frozen plasma to restore clotting factors labs : d-dimer DKA
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