Critical Care Hesi Review SG.docx

Inflammation for 5 10 days to decrease inflammation

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inflammation, glucocorticosteroids for 5-10 days to decrease inflammation labs : inc. Hgb, hypoxemia w/o hypercapnia, ABG’s to determine O2 status Heart Failure Right-Sided Evident in the systemic circulation, Pitting dependent edema of the feet, legs, sacrum, back, and buttocks, Ascites (caused by portal hypertension), Tenderness of the right upper quadrant, organomegaly, Distended neck veins, Pulsus alternans (regular alteration of weak and strong beats in the pulse), Abdominal pain, bloating, Anorexia, nausea, Fatigue, Weight gain, Nocturnal diuresis Left-Sided Evident in the pulmonary system, Cough, which may produce frothy sputum, Presence of crackles on auscultation, Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea, Tachycardia, Cyanosis, Confusion and disorientation, Signs of cerebral anoxia Hemodynamic monitoring - (lesson 46)
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Increased Intracranial pressure - normal level 5-15 , if above 20 assess & contact provider; caused by head trauma, pressure on brain either from inflammation of brain tissue, CSF leakage, or blood loss from hemorrhage, **change in LOC is one of the first signs of increased intracranial pressure s/s: hyperglycemia (cushing’s triad) widening pulse pressure (inc. BP), bradycardia, irregular RR, inc. temp Nurs. Interventions : arterial CO2 should be kept at 40mm/Hg, pt should not cough, or strain, provide quiet environment, low lights, HOB 30 degrees or higher, keep BP 150/85 (not within normal limits, but above baseline), space out care, monitor CO2 levels so there’s not a drop in CO2 which would cause vasoconstriction, avoid morphine tx: craniotomy, mannitol (for tx of cerebral edema), ventricular peritoneal shunt, intracranial pressure monitor, BP meds, antiseizure meds (lorazepam/Ativan) given prophylactically Calculations -Map (sys + dys (2)/3 Liver -liver takes substances in our blood and metabolizes and detoxifies them along with storing and producing substances to help with digestion, clotting, & immune health, secretes bowel Q wave on EKG -(w/ ST elevation) means pt had an MI or currently has an MI, or right coronary artery occlusion Hypokalemia causes a flattening of the T wave on an electrocardiogram, as observed on the monitor, because of its effect on muscle function. causes a depression of the ST segment , causes a widening of the QRS complex . MODS - interventions to decrease MODS: (1) prevention and treatment of infection, (2) maintenance of tissue oxygenation, (3) nutritional and metabolic support, and (4) appropriate support of individual failing organs. Can result from sepsis or trauma. VS change (tachypnea, high HR, low BP) if MAP is consistently low, it is indicative of MODS Percutaneous transluminal coronary angioplasty (PTCA) -procedure to increase blood flow to coronary arteries, by inserting a cath with a balloon tip Nurs interventions : watch groin for bleeding and check distal pulses, pt must agree to stop smoking, lose weight, get more exercise, and stop other behaviors resulting in the progression of artery occlusion, administer anticoagulants and antiplatelet agents as prescribed to prevent thrombus formation, IV nitroglycerin, which may be prescribed to prevent coronary artery spasm Pacemakers
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