2017 RN HESI Critical Care Cardiac Exam.docx

Helps shunt all the blood back to heart given q3

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: potent vasoconstrictor. Helps shunt all the blood back to heart. Given q3 minutes during a code. Vasopressin : does same thing as epinephrine. Can’t give any more vasopressin or epinephrine for 20 minutes once medication is given. Torsades de Pointes : form of V-tach. Pt needs magnesium. PEA : pulseless electrical activity. Electrical activity in heart has woken up but it is not enough to get mechanics of heart moving. On the monitor, it looks like the pt is in sinus rhythm. Pt will be treated just like asystole. CPR, Epinephrine, Vasopressin– look for underlying cause How can it be assessed: H’s 1. Hypoxia: oxygen 2. Hypovolemia: fluids 3. Hypothermia: warming 4. H + ions (acidosis): bicarb 5. Hypokalemia or hyperkalemia: potassium. Insulin/glucose. What are the causes and treatments: T’s 1. Tablets (overdose): whatever the antidote is. 2. Tamponade (cardiac): pericardial centises. 3. Tension pneumothorax: chest tube. 4. Thrombosis (coronary): thrombolytics (TPA) 5. Thrombosis (pulmonary): thrombolytics (TPA) Code Procedure 1. Assess ABCD’s (quickly, no more than 10 seconds) 2. Call a Code Blue and have someone bring the crash cart
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HESI EXAM RN Critical Care Exam 1 (6) 3. Begin CPR (need a backboard): Push hard and fast 4. Code procedure is determined by patient’s underlying pathology Remain present even after the code team arrives! Medications for Dysrhythmias: Rate control medications 1. Beta blockers 2. Calcium Channel Blockers 3. Amiodarone Medications for bradycardia 1. Atropine 2. Epinephrine 3. Dopamine Anticoagulants 1. Heparin 2. Coumadin Emergency Medications 1. Epinephrine 2. Vasopressin 3. Lidocaine: old school drug. Antiarrhythmic like amiodarone; we use amiodarone a lot more. Used in case pt is allergic to amiodarone or has been on amiodarone. 4. Adenosine 5. Amiodarone 6. Atropine Pacemaker: Delivers electricity to the heart to stimulate depolarization (contraction) Stimulates atria, ventricles or both (dual) Indications: slow rhythm, HF, pts post-cabbage. Temporary 1. Cutaneous 2. Intravenous 3. Epicardial Permanent: Implanted Temporary Pacemaker: Transcutaneous Pacemaker: pace pts through skin.
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HESI EXAM RN Critical Care Exam 1 (7) Epicardial Pacemaker: seen in pts post cabg. Leads are sewn into heart during surgery. Not all pts need to be paced after surgery but are there if needed. Transvenous Pacemaker: insert pacemaker into one of veins. (intrajugular, subclavian, femoral). Put lead into heart & pt will be hooked up to pacemaker generator. -Generator has different knobs for different settings. Pacemaker Terminology: Mode: 1. Demand (only fires/works if the pts heart does not. Preferred mode. If your heart is able to do it, just let your heart do it.) 2. Fixed (fires no matter what you’re heart is doing) Rate: depends on pt. Electrical Output: measure in mA (milli-amps). How much energy is needed to depolarize the heart. How hard does the pacemaker have to work to stimulate the heart.
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