Cen Exam 2 Concepts

Front 1

wide complex non-perfusing tachycardia

Back 1

V tach

Front 2

Narrow QRS Tachy

Back 2

SVT

Front 3

No p-waves, fibrillatory f-waves, variable R-R intervals

Back 3

A fib

Front 4

Wide QRS typically less than 40bpm

Back 4

Idioventricular rate

Front 5

L vent HF produces what s/s

Back 5

Pulm. edema. Blood in L vent has difficulty with forward flow-- engorges L Atria and engorged pulmonary return causing the pulm edema

Front 6

Administer to pt's with R Ventricular MI (RVMI) to maintain CO

Back 6

IV crystalloids. W/ RVMI the R vent pump function is damaged and blood doesn't pump efficiently leading to decreased L vent filling and decreased CO. Increasing prefload (volume of blood entering R vent will result in increased blood volume ejected, leading to incresed SV and CO.) If still hypotensive p 2L, consider inotrope swuch ad dobutamine. Nitro/MS contraindicated decreases CO and causes hypotension. IV colloids ok w/ low H&H

Front 7

MI pt >85 yo most common abnormal presentation

Back 7

SOB.

Front 8

QRS represents what mechanical event

Back 8

Vent. contraction

Front 9

P wave mechanical event

Back 9

atrial contraction

Front 10

T wave mechanical event

Back 10

Vent. relaxation

Front 11

Atrial relaxation

Back 11

not displayed on ECG as a specific waveform because it cooccurs with vent. depolarization and is electrically insignificant

Front 12

Successfully defib pt. HR regular, rate 86, no pulses palpable

Back 12

PEA-- electrical disturbance in the electrical/mechanical activity of heart

Front 13

Cardiac tamponade

Back 13

Occurs w/ rapid accumulation of blood in pericardial sac-- decreased ventricular filling.

Cardnial signs... Becks triad:

hypotension, muffled heart tones, distended neck veins

Front 14

What indicates fibrinolytic therapy has been effective Txment of a STEMI?

Back 14

Typically a relief from pain, resoluation of the ST-segments, and reperfusion dysrhthymias such as accelerated idioventricular rhythms.

Fibrinolytic therapy isn't coronary-specific... so you can expect bleeding to occur at the puncture and ejection sites.

Front 15

Can't get peripheral access ... cardiac arrest, what next?

Back 15

IO intraosseous provides access to non-collapsible marrow venous plexus. Rapid, reliable & safe for crystalloids/colloids, blood, meds

Front 16

What is the rationale for heprin or LMWH for a pt with ACS?

Back 16

It inhibits further thrombin (clot) time. Heparin/LMWH does NOT lyse current present clots.

Heparin/LMWH can cause thrombocytopenia or fewer platelets therefore a lower PLT count.

Front 17

New onset A fib w/ RVR in asthmatic patient.. Pt A&O, bp 119/62, HR 158, RR 22. First line med?

Back 17

diltiazem (Cardizem)

Front 18

Pt with implated cardioverter/debrillator (ICD) report syncope. Monitor shows NSR suddently yells that the device went off & shocked him. What is next?

Back 18

Place a magnet on the device to temporarilty deactivate it and prevent inappropriate firing of the defib. until the device can be interrogated and corrected as necessary

The device should fire when the pt has a shockable rhythym --not NSR. If combined with pacemaker, it may also perform demand-pacing functions.

Front 19

Pt dx w/ IWMI (inferior wall MI) What is the most common dysrhtymmia to occur?

Back 19

bradycardias are often seen in the presence of IWMIs due to ischemia to the R coronary artery.

Front 20

What is angina?

Back 20

Ischemic CP occurring when myocardial O2 demand exceeds O2 supply.

Front 21

Elderly pt w 2-hr Hx of dizziness/fatigue. ECG is irreg, no p-waves. Suspects the pt's s/s are due to?

Back 21

A fib w/ RVR.

Front 22

Most common dysrhythmmia in older adults? What occurs pysiologically? Why can't older adults tolerate it?

Back 22

A fib

Loss of atrial kick or coordinated filling/pumping of blood into the vents which typically makes up 30% of CO. When the vent rate increaswes, they don't fill completely which decreases CO even more.

Older adults have a decreased ability to compensate (and don't tolerate) the drop in CO as well as young pt's. More likely to report fatigue, weakness, dizziness

Front 23

ST elevation in V4, V5, and Leads I and AVL

Back 23

lateral wall MI

Front 24

ST changes leads II, III, and AVF

Back 24

Inferior wall MI

Front 25

ST Elevation in leads V1-V4

Back 25

anterior septal MI

Front 26

Cardioversion synchs w/

Back 26

ventricular depolarization (QRS complex)

Front 27

Purpose of B-blockers with STEMI

Back 27

AHA reccomends within 24h... it reduces morbidity and mortality w/ no contraindications.

Front 28

adenosine (Adenocard) What happens?

Back 28

interrupts conduction at the AV node causing apparent aystole that can last 10secs... allows the SA node to take over and regular impulses to conduct.

Complex gets more narrow and rate decreases. Narrows the QRS complex.

Front 29

Assessing a pt in high speed, head on MVC... bp 100/50 HR 110, RR 22, LUQ abraisons. Focused organ assessment?

Back 29

Pancreas is in the LUQ behind the stomach in the retroperitoneal area. Direct blunt force to the epigastric area may result in pancreatic injury with a mortality rate as high as 50%. Also, the spleen, duodenum, jejunum, ileum, transverse/descending colons, and stomach.

Front 30

Newly Dx pt with liver failure... s/s: cognitive changes, irratibility, some muscle rigidity and hyperreflexia, what is another expected sx?

Back 30

Asterixis-- a flapping tremor usually of the hand... an early indication of hepatic encephalopathy. Have pt "stop traffic" with hand-- involuntary flapping is a positive sign. Bruising/bleeding tendancies may develop as a result of impaired clotting factors and squestration of PLTs in the spleen.

Front 31

late sx of bowel obstruction

Back 31

Absent bowel sounds: indicative of paralytic ileus or diminshed perfusion indicating a closed bowel lumen (complete bowel obstruction)

Front 32

Mid epigastric and RUQ discomfort ... what increases suspicion that the pt is having s/s of cholecystitis? What are the s/s? What is it?

Back 32

fatty foods "two bowels of chili and french fries" resulting in RUQ discomfort or epigastric pain.

other sx indigestion, NV, anorexia

It is an inflammation of the gallbladder.

Front 33

bethanechol (Urecholine) and use for GERD. ADRs include?

Back 33

Cholenergic drug. Increases sphincter pressure and facilitates gastric emptying. ADR of cholenergic drugs: urinary urgency, diarrhea, abd. cramping, hypoTN, increased salivation.

Front 34

Esophagitis, what is it? dietary instructions?

Back 34

It is inflammatory response to the mucosa, avoide causitive factors such as spicy foods. Avoid alcohol, eat small frequent meals.

Front 35

Assessment of suspected hepatic injury may reveal?

Back 35

RUQ tenderness extends transversely across the midline. Live is extremely vascular and a injury could result in a major hemorrhage.

Front 36

Post MVC. Lap belt injury most likely to occcur

Back 36

Colon rupture due to compression powerful enough to rupture the small bowel or colon.

Front 37

Young adult present N/V, abd. bloating & cramping IBS dx... dietary instructions

Back 37

don't drink w/ meals as it may cause distention.

Front 38

Pt DC from ER dx with acute prostatitis .. include these instructions

Back 38

increase daily fluids to aid in eliminating the bacteria. Take meds as directed typically for several weeks. PCP followup within next week, no sexual activity restrictions.

Front 39

29wk gestation awaiting xfer to high-risk OB Dx preeclampsia. Rec'ving Mg Sulfate 1g/hr via IV. Priority assessment?

Back 39

RR. ADR if Mg is muscle weakness. Monitor for hyporeflexia. Normal for preesclamtic pt to have proteinurea.

Front 40

Painless dark red urine caused by these foods

Back 40

Beets, rhubarb, blackberries, several medications (not blackberries though)

Front 41

38 week gestation triaging with onset of spontaneous bright red painless vag bleed. Most likely cause is?

Back 41

Placenta previa. Placenta is abnormally implanted in the lower uterine segment. May partially or completely cover the cervical os... as trhe cervis dilates, the placenta may be torn and bleeding will be bright red vs dark blood assoc. w/ abruption. Early dilation may not be felt by pt, which is why it is painless.

Front 42

Placental abruption

Back 42

premature separation of the normally implanted placenta from the uterine wall. Painful. Classic s/s: vag bleeed dark red, uterine tenderness, abd. pain, back pain, uterine hyperactivity w/ poor relaxtion between contractions. May be vague or severe presentation.

Front 43

uterine rupture

Back 43

can also be severe and acute. injury involving sudden deceleration, severe abd. compression, or direct force to the abd can result in uterine rupture.

Front 44

When should the RN prepare for a d&c?

Back 44

oNGOING BRIGHT RED BLEEDING WITH TISSUE PRESENT & CRAMPING The pt needs D&C if bleeding does not decreased.. She is at high risk for hypovolemia and coagulopathy is bleeding continues. Darkening of blood indicates that it isn't fresh bleeding FYI...even w/ occasional clots.

Front 45

interventions for renal calculi

Back 45

analgesics for pain

antiemetics may be necessary

fluids to flush it out

Front 46

Pt w hx of PID pelvic inflamm. disease... RLQ pain, scant vag bleeding, dizziness, pain radiating to L shoulder. 88/50, 127bpm, 22RR, 36.4C, +Hcg. What is most likely?

Back 46

Ectopic pregnancy. PID may lead to scarring of the fallopian tubes, which can make it difficult for a fertilized ovum to move into the uterus. Tube can rupture and cause severe bleeding in the peritoneum. Blood irritating the diaphragm causes pain radiating to L shoulder (Kehr's sign)

Front 47

Thick white cheese-like vag DC.... RN to expect Dx of

Back 47

candidiasis.

Front 48

Gray-greenish vag DC...

Back 48

trichomoniasis

Front 49

Yellow vag DC

Back 49

gonorrhea

Front 50

Endometriosis, what is it, who is F/U with?

Back 50

Endometriosis when endometrial tissue grows outside of the uterus. During menstruation tissue sloughs and causes pain. Tissue often found in peritoneal area, endometriosis has been found in the lungs, brain and many non-peritoneal sites.

Analgesia therapy is appropriate. Refer for hormonal therapy w/ OBGYN. Surgery may be neccassry but is not urgent.

Front 51

Best indication of a viable fetus?

1) 10 kicks/hour in a term fetus

2) FHR >160

3) 26cm fundal height above symphysis pubis.

4) minimal contraction q3min

Back 51

1) 10 kicks/hr is indiciative of fetal well being. No fetal movement in an hr may indicate detal demise. US to eval fetal status.

2) normal for term is 100-160 bpm. >=160 may indicate a young nonviable or distressed fetus

3) 26cm = 26 weeks old. Considered viable.

4) Contractions may indicate labor but do not indicate viablity.

Front 52

Corneal abrasion

Back 52

damage to epithelial layer of cornea w/ uptake of fluorescein dye. The denundation/scraping away of the superficial layer alters the surface and causes the dye to adhere to the tissue

Front 53

hyphema

Back 53

bleeding into anterior chamber of which is detected by presence of RBCs visible on slit lamp exam

Front 54

traumatic iritis

Back 54

ititis involves the iris and/or choroid body, which are deeper structures in the eye. The superficial layer of the cornea remains intact-- no uptake of dye.

Front 55

Glucagon hcl action useful in managing esophageal food impaction

Back 55

Relaxes smooth muscles.

Front 56

chemical burn to orbit greatest concern

Back 56

altered visual sensory-perception... chemical burn will cause some degree of impaired vision-- therefore they're emergent. Any disruption of the visual senses will alter the sensory perception. Immediate eye irrigation is needed to minimize exposure of tissue to caustic chemicals. May not require opthalmic FU, infx is uncommon complication, damage to eye from increased intraocular pressure and necrosis is more of a concern.

Front 57

priority assessment of larynx fx

Back 57

airway patency... larnyx is vital part of upper airway. can lead to immediate or progressive airway obstruction. ongoing monitoring. be prepared for immediate intervention. Observe for hoarseness, stridor, hemoptysis, dyspnea, cough & painful/difficult speech.

Front 58

concerning finding indicating a globe disruption

Back 58

Peaked, teardrop shaped pupil in pt w/ unilateral eye pain.

Front 59

globe rupture

Back 59

major ocular emergency that may require immediate surgical intervention. It may be an occult injury,

other assesment findings: enophthalmos an afferent papillary defect and possible extrusion of aqueous or vitreous humor may also be noted. Shallow anterior chamber may be the only abnormal finding and is associateed with a poor prognosis

Front 60

hyphema`

Back 60

blood in ant. chamber. associatied w/ disruption of the ciliary body. possible conncurent injury with globe disruption pt.

Front 61

steamy hazy cornea w/ cleral injection

Back 61

common finding w/ acute narrow-angle glaucoma. in globe rupture scleral redness is more likely due to severe conjunctival hemorrhage rather than injection.

Front 62

Bells palse teaching is effective when pt states

Back 62

" will wear sunglasses anytime I go outside" Helps keep debris out of eye due to loss of the normal blink response. Cold exposure can be a precipitating factor and should be avoided, pt will need to instill eye drops frequently, steroid therapy is short term

Front 63

Untreated lyme disease may cause

Back 63

AV blocks! Also, expanding bulls eye circle on skin, flu-like sx, AV blocks, meningitis, hepatitis, arthralgia. Tx w antibx and supportive therapy

Front 64

Tick paralysis

Back 64

Caused by wood/dog ticks. Ascending motor paralysis occuring over 1-2 days. Sx: ataxia, lower extremity weakness progressing to UE, parathesia, hypo/absent reflexes, eventual respiratory failure. Remove the tick. Supportive care. Sx usually resolve in 72hr.

Front 65

Rocky Mntn Spotted Fever

Back 65

Rickettsia rickettsii from wood and dog ticks. Untreated... the classic sx are petechial rash on the palms, wrists, soles of the feet or ankles. Mortality 8-25% in unTx. Antibiotics and supportive care.

Front 66

what is myxedema coma? mgmt of?

Back 66

Loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood

o2 therapy. Tongue can swell and impede airway. Hypovent. is not uncommon, resp drive is decreased leading to alveolar hypovent. No B-blockers-- these pts have a decreased SV and CO, often bradycardic,

peripherally vasocontricted lower core body temp. No aggressive cooling. Passively rewarm slowly. Monitor UOP

Front 67

Adrenal crisis expect

Back 67

hypoTN. Insuffiecient glucocorticoid and mineralocorticoid hormone production. HypoTN and electrolyte disturbances hyperK & hypoNA, death occurs due to circ. collapse and hyperK-induced dysrhthmias

Front 68

10 mo old, bluish gray specks on buccal mucosa, rash on face....

Back 68

Measles. Immunized @12-15mos.

Koplic spots are classic. (bluish gray).

Front 69

Mumps

Back 69

swelling and tender to salivary and parotid glands.

Front 70

Lab value indicating viral vs bacterial meningitis?

Back 70

Leukocytes are less than 1000cells/mL in viral meningitis and >1000 in bacterial. Normal range is 0 to 5 WBCs.

Glucose elevated in viral, low in bacterial.

Protein less than 200 in viral, >200 in bacterial. Normal 15-45

Front 71

Elderly pt-- febrile, restless, confused, weak and recent hx of iodine tx. Dx w thyroid storm. What is tx option?

Back 71

Propranolol./esmolol to control tachycardias <100bpm.

No ASSA duie to it displacing thyroid hormone from binding sites.. tylenol is better for fever

Sodium bicarb if acidotic

Front 72

Flagyl DC instructions

Back 72

NO ETOH! It'll cause a disulfiram (antabuse) reaction-- violent vomiting. Not even mouthwash for up to 48 hr after taking it.; Not safe for pregnancy

Front 73

Elderly pt given IV synthroid (T4) for tx of myxedema coma. Which lab would indicate improvement?

Back 73

Inc in Thyroid hormone level. Myxedema coma occurs in pt's w long-standing or undx hypothyroidism. Administration of T4 saturates empty sites and replensishes peripher circulating levels. Increased thyroid hormone levels indicate tx successful.

Front 74

Elederly pt, extremity lac. On 5mg coumadin qD. Complications?

Back 74

Prolonged wound healing r/t decrease in skin tensile strength, subq fat, and the ability to tamponade underlying bleeds--all of which lead to prolonged wound healing.

Front 75

Pt presents w/ generalized ecchymosis and CC of nose bleed, which subsided PTA. Hx of chronic idiopathic thrombocytopenia purpura (ITP) Dx workup revelas need to provide replaceement therapy. What is most appropriate?`

Back 75

PLT-- ITP has dec. in PLT production. PLT less than 150. Tx of chornic ITP is PLT replacement. Minimize IM. Consider topical to clot wounds.

Front 76

progressive confusion x3 weeks. Which focal head injury is most likely cause?

Back 76

SDH. W/ chronid SDH blood collects in the subdural space over a period of 2 weeks tto months. The geriatric brain loses mass over time, this bleeding process produces subtle s/s over time.

Front 77

Pt on backboards...

Back 77

get them off ASAP...particularly with any sensory losses.

Front 78

GCS consists of

Back 78

best: eye opening, motor and verbal responses.

Front 79

Elderly pt c/o severe HA, red nodules over temporal region. Other c/o associate with temporal arteritis

Back 79

Wt loss, night sweats, aching joints, fever, classic systemic s/s associated w/ temporal arteritis which is inflammation of the branches of the temporal artery

Front 80

S/S early IICP & most reliable indicator of neuro fx

Back 80

change in LOC

Front 81

Cincinatti prehospital stroke scale

Back 81

facial droop, arm drift, abnormal speech.

Front 82

IV phenytoin (Dilantin)

Back 82

ADR hypoTN and bradycardia especially with rapid IVP. Elderly especially, decrease loading IVP to 25mg/min. Max adult is 50mg/min.

HypoCA reported in prolongd high dose anticonvulsant therapy. Some dr's give adty'l 4,000U/week of vitD esp to pt with poor diet and no sun exposure.

NS or LR diluents are okay. INCOMPATIBLE w/ D5NS, D5W, and fat emulsion 1%. Dilutions of 1-10 mL reccommended. Give ASAP after dilution. Discard within 4hr if not used. Do not refrigerate.

Front 83

Fall, struck head, LOC briefly, c/o Severe HA, followed by another LOC...

Back 83

epidural hematoma. Period of unconciousness followed by brief period of wakefulness, with return to unconsciousness is the hallmark pattern.

Front 84

Clear fluid draining from R nares s/p MVC. This may indicate

Back 84

basilar skull fx. These bones are thin and fragile-- may tear the dura when fx'd causing CSF rhinorrhea or otorrhea.

Front 85

High dose Solu-Medrol methylprednisolone protocol w/ SCI pt at C7-T1 level.

Back 85

30mg/kg over 15min, then wait 45 min, then 5.4mg/kg/hr x23 hrs. Start within 8 hrs for max effect.

Front 86

Epi drip rate

Back 86

1mg mixed in 250mL of D5W or NS to infuse at 2-10 mcg/minute

Front 87

Inotropin (dopamine) gtt rate

Back 87

400mg in 250mL D5W or NS to infuse at 2-20 mcg/kg/min. Can be double concentrated.

Front 88

Norepi (Levophed) gtt rate

Back 88

8mg in 250mL of D5W at 0.5-12mcg/min.

Front 89

Central cord syndrome

Back 89

Caused by hyperextension and is seen most often in elderly pt's s/p fall. Results in loss of fx in UE while LE functional. B/B fx also maintained. "pt can dance but they can't play piano"

Front 90

Anterior cord syndrome

Back 90

characterized by hyperesthesia, hypoalgesia, and incomplete or complete paralysis of the LEs

Front 91

Brown Sequard syndrome

Back 91

results from hemisection of the cord usually following penetrating trauma

Front 92

tPA IV alteplase

Back 92

uncontrolled HTN 180/110 despite repeated measurements excluses from Tx

IV within 180min window. Intraarterial tPA has shown to be effective though

ICH is a definite exclusion. Managed usually with surgical intervention

Front 93

removal of UE/LE sutures not involving joint surface

Back 93

7-10 day

Front 94

Removal of facial sutures

Back 94

3-5 days

Front 95

Removal of scalp sutures

Back 95

5-8 days

Front 96

Removal of joint/knee sutures

Back 96

12-14 days

Front 97

foul smell, febrile, sloughing, pain

Back 97

C. gangrene infx

Front 98

Cast syndrome

Back 98

obstruction of the 3rd part of the duodenum by an artery following use of plaster body cast

Front 99

Lac from rock in freshwater/streams

Back 99

Tx aggressively. Bacteria are associated w fresh water. Meticulous irrigation. Antimicrobials. Become infected withint 12-48 hrs.

Front 100

Compartment syndrome

Back 100

unrelieved pain is a cardinal sign

Front 101

Fat emboli suspected. Where is petechiae typically observed?

Back 101

Anterior chest and neck.

Front 102

radial gutter spline

Back 102

fx or soft tissue injury to 1st or 2nd metacarpal

Front 103

ulnar gutter splint

Back 103

fx, injury to 4th/5th metacarpal

Front 104

thumb spica splint

Back 104

soft tissue injury or metcarpal fx of the navicular or scaphoid bone

Front 105

volar FA splint

Back 105

carpal bones of wrist injured

Front 106

where to give IM human diploid cell (HDCV) vacc

Back 106

Deltoid only, never glut for sure.

Front 107

cane instruction/fitting

Back 107

Use on uninjured side to support during ambulation. When held next to heel elbow should be at 30degree angle of flexion

Front 108

Osteoporosis risk factors

Back 108

post menopauseal women, chronic ETOH abuse, long term steroid use

Front 109

how to check for radial nerve function in kids

Back 109

thumbs up

Front 110

dislocation imaging

Back 110

seen on xray

Front 111

C. tetani is found

Back 111

in soil and human/animal intestines

Front 112

Nitro gtt... decrease it when pt is

Back 112

hypoTN <90. it could decrease perfusion to heart. Consider fluid bolus. Titrate to relief of pain and while maintaining SBP >90. Common SE is a HA.. tx with morphine or tylenol. Target resting HR 50-60 with b-blocker therapy.

Front 113

differentiation of a traumatic LP vs SAH

Back 113

Compare cell count in 1st tube to last tube. If there is a decrease in RBCs it's probably a traumatic LP rather than SAH

Front 114

Echinacea

Back 114

contraindicated in pt's w cancer/autoimmune disorders. This herbal remedy stimulates the immune system. Check with your doctor.

Front 115

Who to explain procedure in detail for

Back 115

preschool age

Front 116

Allow parents to remain in room during a procedure

Back 116

toddler fear parental separation

Front 117

required documentation w/ organ donors

Back 117

notification of procurement team, family notification (consent it not necessary), determination and declaration of death.

Family education documentation is NOT required

Front 118

tPA dosage/appropriate interventions

Back 118

0.9mg/kg up to 90mg. IVF NS is appropriate, as is passsive or active cooling for 24 hrs and starting within 3 hrs of onset.

Front 119

Corticosteroids (such as in advair) are known to contribute to ______ especially in geriatrics

Back 119

depresive symptoms ie emotional lability, trouble sleeping, loss of appetite,

Front 120

Mental health triage scale non urgent, semi urgent, urgent, emergent,

Back 120

non urgent- med refill and NAD

semi urgent SI accompanied by friend

urgent pt presents paranoid w moderate behaviorla disurbances

emergent extreme agitation

Front 121

s/s anorexia nervosa

Back 121

amenorrhea, low body weight, hypoTN, tachy w/ possible dysrhythmias, dehydration, intolerance to cold due to poor fat storage

Front 122

resp. difficulties in elderly caused by

Back 122

decreased muscle strength i.e. diaphragmatic muscle results in trouble maintaining normal resp.

Front 123

crackles in lungs are caused by

Back 123

fluid/secretions in small airways or alveoli. popping sounds produced by passage of air through fluid or secretions

Front 124

near strangulation pt presents in distress, swelling of neck, subq emphysema-- which is likely have caused subq emphysema

hypoxia,

tension pneumo,

tracheal transection,

laryngeal spasm

Back 124

tracheal transection due to meechanism of injury. Esophageal, pleural, tracheal, or bronchial injuries can present with subq emphysema

Front 125

elderly pt presents SOB xseveral years, getting worse x1 month, especially exertional dyspnea, unable to walk to mailbox without resting. Hx of HTN and 40 yrs smoking.. what does RN suspect

Back 125

ephysema-- structural changes of emphysema (breakdown of alveoli, loss of elasticity and increased diameter of chest wall) contribute to a decrease in the vital capacity of the resp. system. Due to the decrease the pt will experience exertional dyspnea

Front 126

Flail chest priority

Back 126

Pain management to promote effective ventilation. FFlail chest is result of significant blunt force trauma, 2+ adjacent ribs fx in 2_ locations or a free-floating sternum. Extreme pain and may contribute to hypoventilation, risking pt for pneumonia, atelectasis, and ARDS in addition to systemic narcotic analgesic , nerve blocks, epidural analgesia and RSI, sedation and paralysis may be used to maximize ventilation

Front 127

s/p blunt force chest trauma from rollover, pt has sudden onset of anxiety, diminished breath sounds on one side, tracheal deviation and hypoTN .... this is s/s associated with a rapid

Back 127

increase in intrathoracic pressure. most likely a tension penumo. shifts lung/cardiac tissue to uninjured side & decreaseed vent filling and CO. Impedes venous return, shifts mediastinum and depresses diaphragm causing distortion of the great vessels and ressults in decreased CO

Front 128

Sellick maneuver indication (cricoid pressure)

Back 128

VOMITING AND ASPIRATION

Front 129

Following ET placement, first step to confirm placement is to

Back 129

ausc. absent epigastric sounds with chest rise. If sounds are heard over epigastrium in the absence of chest rise, suggestive of esophageal placement. Remove, reoxyugenat, attempts again.

Front 130

albuterol sulfate beta 2 agonist ADR

Back 130

inadvertent beta 1 stim leading to cardio effects such as tachy, PVC and palpitations.

Front 131

what is peak flow used to evaluate

Back 131

peak expiratory flow rate, with pts who have obstructive diseases such as asthma ... evals response to bronchoilator therapy

Front 132

ABGs of pregnant women

Back 132

RR increased r/t progesterone levels. PaCO2 decreased to 30-34mmHg. Kidneys increased excretion of bicarb in an effot to compensate for the drop in CO2. AEB hyperventilation in pregnant pt who will also have a decreased bicarb.

PaO2 normal, PaCO2 decreased, bicarb decreased as compensation, pH increased

Front 133

Early s/s pneumonia in elderly pt

Back 133

leading infection cause of death in this age group-- more susceptible to infx--

acute onset of confusion, lethargy, deteriorating general healh

Front 134

neurogenic shock findings

Back 134

brady, poikilothermia, hypoTN

involved loss of sympathetic vasomotor regulation. Bragy from loss of sympathetic innervation. Poikilothermia due to inability to vasoconstrict and produce piloerection to generate heat. HypoTN from massive vasodilation and inability to vasocontrict.

Front 135

how to prevent injury w TQ palcement

Back 135

use padding, keep it visible, tighten high enough to compleetely occlude arteries and arterioles, a wide TQ and padding, remove ASAP p bleeding controlled.

Front 136

early s/s hypovolemic shock in adults

Back 136

gradual increase in rate/depth of resp. Tachpynea to decrease Co2 and compensate for cellular acidosis since inadequate circulating volume causes cellular hypoxia and anaerobic cellular metabolism.

Front 137

When do coagulapathies develop after autotransfusion

Back 137

When the amt of blood auto transfused is 25-50% of total blood volume-- there is a dilution of clotting factors which can result in coagulopathies.

Front 138

What do you add to the collection bag of auto transfusions in order to prevent clotting during collection and plugging the filter?

Back 138

Citrate phosphate dextrose.

Front 139

Auto transfused blood shouldn't be held for more than _____ because of the increased risk of infx

Back 139

4-6 hours.

Front 140

Absolute contraindication to administration of recombinant human activated protein C (Tigris) in pt's with multiple organ failure

Back 140

presence of bleeding risk

Front 141

when is antivenin most therapeutic p a bite?

Back 141

within 4 hours. There is limited value p 12 hours.

Front 142

Grade the following s/p rattlesnake bite:

Severe pain over bite area, edema 25cm spreading toward the trunk, petechiae and ecchymosis in the edematous area, N/V, hypoTN...

Back 142

Grade 2- moderate s/s envenomation

Front 143

Pt presents hyperthermic, confused, hallucinating, tachypenic, pulmonary edema, dehydrated with evicence of renal failure... using OTC arthritis meds and Pepto-Bismol for her upset stomach. This is probably due to toxic levels of what substance?

Back 143

ASA toxicity. Chronic use of salicylate in the elderly is frequently undx or confused with other disease states. Neurotoxicity is common with ASA toxicity-- but not common with tylenol/ibuprofen

Front 144

Pupils of suspected opiate ingestion and pt w AMS?

Back 144

pinpoint fixed pupils are expected of pt's with opioid ingestion.

Front 145

pupils of pt who ingested CNS stimulants or hallucinogens

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dilated but reactive to light.

Front 146

Pupils of THC ingestion pt

Back 146

equal with constriction to light

Front 147

Rate TBSA:

Superficial partial thickness burn to entire R leg, full thickness to anterior portion of L leg superficial burn to chest

Back 147

27%. Leg is 18% and anterior leg is 9%=27% Superficial are not calculated into the TBSA of a burn injury

Front 148

Antidote for hydrofluouric acid-- what happens with copious use of H2O?

Back 148

calcium gluconate.

Unlike alkali and acid burns, HF penetrates the skin and affects calcium in bone and tissue.

H20 can actually exacerbate the burn

Front 149

When does American Burn Assoc recommend Tx at a burn center

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>10% TBSA

Chemical/inhalation burns

Burns involving face, hands, feet, genitalia, perineum, or major joints

Pt w electrical burns including lightning injuries

Front 150

What substance is suspected in this pt:

Suffenly disoriented, drowsy, w/ decreased RR minutes p ingesting a cocktail. Following Resp arrest, the pt was quickly resuscitated but remained difficult to arouse. Within 4 hrs pt A&O but with ℅ amnesia.

Back 150

Gamma-hydroxybutyric acid (GHB) s/s include confusion and rest. depression occur rapidly and are usually short in duration

Front 151

Pt presents w/ lacrimation, salivation, N/V, bradycardia p ingesting blackberries... what should the RN administer?

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Atropine. The pt is experiencing s/s of nerve agent poisoning from organophosphates on the blackberries. Nerve agents fx by inhibiting the enzyme acetylcholinestrase (AChE) allowing excess accumulation of acetylcholine at neuromuscular junctions causing overstim of the organs.

Front 152

String ray bite and hot water immersion DC'd when

Back 152

Pt has relief of pain. Stingray vensum is heat labile and will dissipate with soaking in warm to hot water.

Front 153

Tx of cocaine OD that manifests as ACS is

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Nitroglycerin (Tridil) has been shown to reverse the effects of vasoconstriction caused by cocaine overdose.

Propranolol has been shown to worsen effects of ACS.