Er Nurse At A Glance

Front 1

Respiratory Acidosis (Causes)

Back 1

Upper Airway Obstruction. Pulmonary Edema, Hypoventilation, Head Trauma, Chest Trauma, Pneumonia, COPD, Narcotic Overdose

Front 2

Respiratory Acidosis
(S/S)

Back 2

Tachycardia, Headache, Confusion, Weakness, Coma, Cyanosis, Bradypnea, Paralysis, Respiratory Arrest

Front 3

Respiratory Acidosis
RN Interventions

Back 3

O2, Breathing Treatments, Treat Underlying Condition, Prepare for Mechanical Ventilation, Pulse Ox, Monitor Cardiac Rhythm, Obtain IV Access

Front 4

Respiratory Alkalosis (Causes)

Back 4

Hyperventilation, Pain, Anxiety, Pulmonary Embolus, Hypoxia, ASA Overdose, 3rd Trimester Pregnancy, Fever

Front 5

Respiratory Alkalosis
(S/S)

Back 5

Tetany, Seizures (from Hypocalcemia), Tingling of the extremities, Dizziness, Altered Mental Status, Anxiety, Parasthesias, Palpitations, Tachycardia, Hyperventilation

Front 6

Respiratory Alkalosis
RN Interventions

Back 6

Hyperventilate, 02, Nonrebreather mask (leave 02 turned off it works like a paperbag

Front 7

Metabolic Acidosis
(Causes)

Back 7

DKA, Renal Disease, Starvation, Shock, Sepsis, Severe Diarrhea

Front 8

Metabolic Acidosis
(S/S)

Back 8

Altered Mental Status, Hypotension, Abdominal Pain, N/V/D, Kussmaul Respirations, Hyperventilation, Hyperkalemia, Flushed Warm Skin, Bradycardia, Muscle Weakness

Front 9

Metabolic Acidosis
RN Interventions

Back 9

IV Fluids (LR), Sodium Bicarb, IV Dextrose, IV Regular Insulin (puts K back into the cell), Assist Ventilation, Monitor Cardiac Rhythm, BMP

Front 10

Cause of DKA

Back 10

Uncontrolled Blood Sugar

Front 11

DKA
(S/S)

Back 11

Dry flushed skin, Serum glucose >300, N/V, Increased Thirst, Urinary Frequency, Weakness, Kussmaul breathing, Keytones in urine, Change in LOC, Coma

Front 12

DKA
RN Interventions

Back 12

Obtain and Monitor BS every hour, Monitor Acetone level, Check ABG's, BMP and Urinalysis, Monitor Cardiac Rhythm, 2L 02 Nasal Cannula, NS Bolus, Medicate for N/V, IV Insulin (1st 5-10 units IV push) then 0.1 units/kg per hour (infusion pump). Once BS is <250 change to SQ per providers order. Change IV sol from NS to D5 1/2 NS at a rate of 150- 200 ml/hr

Front 13

Metabolic Alkalosis
(Causes)

Back 13

Vomiting, Ingesting to much Antacids, MOM or Baking Soda, Diuretics, Hypokalemia, Cushing's Syndrome

Front 14

Metabolic Alkalosis (S/S)

Back 14

Hypocalcemia (Tetney, Twitching, Shaking, Seizures) Confusion, N/V/D, Coma, Decreased ST segment, Bradypnea, Hypokalemia (Muscle weakness), Polyuria

Front 15

Metabolic Alkalosis
RN Interventions

Back 15

Antiemetics, IV NS, BMP, Potassium supplements, Monitor Cardiac Rhythm and Respirations (AVOID GASTRIC SUCTIONING)

Front 16

Aspirin
(A/E)

Back 16

Side Effects - EENT: tinnitus. GI: GI BLEEDING, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting. Hemat: anemia, hemolysis. Derm: rash, urticaria.
Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND LARYNGEAL EDEMA

Front 17

Morphine
(A/E)

Back 17

Side Effects - CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. Resp: RESPIRATORY DEPRESSION. CV: hypotension, bradycardia. GI: constipation, nausea, vomiting. GU: urinary retention. Derm: flushing, itching, sweating.
Misc: physical dependence, psychological dependence, tolerance.

Front 18

Nitroglycerin
Indications

Back 18

Acute ( translingual and SL ) and long-term prophylatic ( oral, transdermal ) management of angina pectoris • PO: Adjunct treatment of CHF • IV: Adjunct treatment of acute MI • Production of controlled hypotension during surgical procedures • Treatment of CHF associated with acute MI

Front 19

Atropine
Indications

Back 19

IM: Given preoperatively to decrease oral and respiratory secretions • IV: Treatment of sinus bradycardia and heart block • PO: Adjunctive therapy in the management of peptic ulcer and irritable bowel syndrome • IV: Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine) • IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning • Inhaln: Treatment of exercise-induced bronchospasm

Front 20

Adenosine
Indications

Back 20

Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm when vagal maneuvers are unsuccessful • As a diagnostic agent (with noninvasive techniques) to assess myocardial perfusion defects occurring as a consequence of coronary artery disease

Front 21

Digoxin
Indications

Back 21

Heart failure • Atrial fibrillation and atrial flutter (slows ventricular rate) • Paroxysmal atrial tachycardia

Front 22

Furosemide
Indications

Back 22

Edema due to heart failure, hepatic impairment or renal disease • Hypertension

Front 23

Calcium Channel Blockers
Indications

Back 23

Used in the treatment of hypertension (amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine, verapamil) or in the treatment and prophylaxis of angina pectoris or coronary artery spasm (amlodipine, diltiazem, felodipine, nicardipine, verapamil). Verapamil and diltiazem are also used as antiarrhythmics. Nimodipine is used to prevent neurologic damage due to certain types of cerebral vasospasm

Front 24

Beta Blockers
Indications

Back 24

Management of hypertension, angina pectoris, tachyarrhythmias, hypertrophic subaortic stenosis, migraine headache (prophylaxis), MI (prevention), glaucoma (ophthalmic use), congestive heart failure (CHF) (carvedilol and sustained-release metoprolol only) and hyperthyroidism (management of symptoms only).

Front 25

Amiodarone
Indications

Back 25

PO: Management of supraventricular tachyarrhythmias • IV: As part of the Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines for the management of ventricular fibrillation/pulseless ventricular tachycardia after cardiopulmonary resuscitation and defibrillation have failed; also for other life-threatening tachyarrhythmias

Front 26

Lidocaine
Indications

Back 26

IV: Ventricular arrhythmias
IM: Self-injected or when IV unavailable (during transport to hospital facilities)
Local: Infiltration/mucosal/topical anestheticm Patch: Pain due to post-herpetic neuralgia

Front 27

Epinephrine
Indications

Back 27

SC, IV, Inhaln: Management of reversible airway disease due to asthma or COPD
SC, IM, IV: Management of severe allergic reactions
IV, Intracardiac, Intratracheal, Intraosseous (part of advanced cardiac life support [ACLS] and pediatric advanced life support [PALS] guidelines): Management of cardiac arrest (unlabeled)
Inhaln: Management of upper airway obstruction and croup (racemic epinephrine)
Local/Spinal: Adjunct in the
localization/prolongation of anesthesia

Front 28

Heparin
Indications

Back 28

Prophylaxis and treatment of various thromboembolic disorders including » Venous thromboembolism» Pulmonary emboli » Atrial fibrillation with embolization» Acute and chronic consumptive coagulopathies » Peripheral arterial thromboembolism
Used in very low doses (10–100 units) to maintain patency of IV catheters (heparin flush)

Front 29

Coumadin (Warfarin)
Indications

Back 29

Prophylaxis and treatment of » Venous thrombosis » Pulmonary embolism » Atrial fibrillation with embolization
Management of myocardial infarction » Decreases risk of death » Decreases risk of subsequent MI » Decreases risk of future thromboembolic events
Prevention of thrombus formation and embolization after prosthetic valve placement

Front 30

Dopamine
Indications

Back 30

Adjunct to standard measures to improve » Blood pressure » Cardiac output » Urine output in treatment of shock unresponsive to fluid replacement
Increase renal perfusion (low doses)

Front 31

Norepinephrine
Indications

Back 31

Produces vasoconstriction and myocardial stimulation, which may be required after adequate fluid replacement in the treatment of severe hypotension and shock

Front 32

ASA
Interactions

Back 32

May ↑ the risk of bleeding with warfarin, heparin, heparin-like agents, thrombolytic agents, dipyridamole,ticlopidine, clopidogrel, tirofiban, or eptifibatide, although these agents are frequently used safely in combination and in sequence. Ibuprofen: may negate the cardioprotective antiplatelet effects of low-dose aspirin. May ↑ risk of bleeding with cefoperazone, cefotetan, and valproic acid. May ↑ activity of penicillins, phenytoin, methotrexate, valproic acid, oral hypoglycemic agents, and sulfonamides. May ↓ beneficial effects of sulfinpyrazone. Urinary acidification ↑ reabsorption and may ↑ serum salicylate levels. Alkalinization of the urine or the ingestion of large amounts of antacids ↑ excretion and ↓ serum salicylate levels. May blunt the therapeutic response to diuretics and ACE inhibitors. ↑ risk of GI irritation with NSAIDs.

Front 33

Morphine
Interactions

Back 33

Use with extreme caution in patients receiving MAO inhibitors within 14 days prior (may result in unpredictable, severe reactions—↓ initial dose of morphine to 25% of usual dose). ↑ CNS depression with alcohol, sedative/hypnotics, clomipramine, barbiturates, tricyclic antidepressants, and antihistamines. Administration of partial-antagonist opioid analgesics may precipitate opioid withdrawal in physically dependent patients. Buprenorphine, nalbuphine, butorphanol, or pentazocine may ↓ analgesia. May ↑ the anticoagulant effect of warfarin. Cimetidine ↓ metabolism and may ↑ effects.

Front 34

Nitroglycerin
(A/E)

Back 34

CNS: dizziness, headache, apprehension, restlessness, weakness. EENT: blurred vision. CV: hypotension, tachycardia, syncope. GI: abdominal pain, nausea, vomiting. Derm: contact dermatitis (transdermal or ointment). Misc: alcohol intoxication (large IV doses only), cross-tolerance, flushing, tolerance.

Front 35

Atropine
(A/E)

Back 35

CNS: drowsiness, confusion, hyperpyrexia. EENT: blurred vision, cycloplegia, photophobia, dry eyes, mydriasis. CV: tachycardia, palpitations, arrhythmias. GI: dry mouth, constipation, impaired GI motility. GU: urinary hesitancy, retention, impotency. Resp: tachypnea, pulmonary edema.
Misc: flushing, decreased sweating.

Front 36

Adenosine
(A/E)

Back 36

CNS: apprehension, dizziness, headache, head pressure, light-headedness. EENT: blurred vision, throat tightness. Resp: shortness of breath, chest pressure, hyperventilation. CV: facial flushing, transient arrhythmias, chest pain, hypotension, palpitations. GI: metallic taste, nausea. Derm: burning sensation, facial flushing, sweating. MS: neck and back pain. Neuro: numbness, tingling.
Misc: heaviness in arms, pressure sensation in groin.

Front 37

Digoxin
(A/E)

Back 37

CNS: fatigue, headache, weakness. EENT: blurred vision, yellow or green vision. CV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block. GI: anorexia, nausea, vomiting, diarrhea. Hemat: thrombocytopenia. Metabolic: electrolyte imbalances with acute digoxin toxicity.

Front 38

Furosemide
(A/E)

Back 38

CNS: blurred vision, dizziness, headache, vertigo. EENT: hearing loss, tinnitus. CV: hypotension. GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, pancreatitis, vomiting. GU: excessive urination. Derm: photosensitivity, pruritis, rash. Endo: hyperglycemia, hyperuricemia. F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis. Hemat: APLASTIC ANEMIA, AGRANULOCYTOSIS, hemolytic anemia, leukopenia, thrombocytopenia. MS: muscle cramps. Neuro: paresthesia.
Misc: fever, increased BUN, nephrocalcinosis.

Front 39

Calcium Channel Blockers (A/E)

Back 39

Additive myocardial depression with beta blockers and disopyramide (diltiazem and verapamil). Effectiveness may be decreased by phenobarbital or phenytoin and increased by propranolol or cimetidine. Verapamil and diltiazem may increase serum digoxin levels and cause toxicity.
Contraindications Hypersensitivity. Contraindicated in bradycardia, 2nd- or 3rd-degree heart block, or uncompensated CHF (verapamil).

Front 40

Beta Blockers
(A/E)

Back 40

May cause additive myocardial depression and bradycardia when used with other agents having these effects (digoxin and some antiarrhythmics). May antagonize the therapeutic effects of bronchodilators. May alter the requirements for insulin or hypoglyemic agents in diabetics. Cimetidine may decrease the metabolism and increase the effects of some beta blockers.
Contraindications - Uncompensated CHF (most beta blockers), acute bronchospasm, some forms of valvular heart disease, bradyarrhythmias, and heart block.

Front 41

Amiodarone
(A/E)

Back 41

CNS: confusional states, disorientation, hallucinations, dizziness, fatigue, malaise, headache, insomnia. EENT: corneal microdeposits, abnormal sense of smell, dry eyes, optic neuritis, optic neuropathy, photophobia. Resp: ADULT RESPIRATORY DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, PULMONARY TOXICITY. CV: CHF, WORSENING OF ARRHYTHMIAS, bradycardia, hypotension. GI: anorexia, constipation, nausea, vomiting, abdominal pain, abnormal sense of taste, ↑ liver enzymes. GU: ↓ libido, epididymitis. Derm: TOXIC EPIDERMAL NECROLYSIS (RARE) , photosensitivity, blue discoloration. Endo: hypothyroidism, hyperthyroidism. Neuro: ataxia, involuntary movement, paresthesia, peripheral neuropathy, poor coordination, tremor.

Front 42

Lidocaine
(A/E)

Back 42

CNS: SEIZURES, confusion, drowsiness, blurred vision, dizziness, nervousness, slurred speech, tremor. EENT: mucosal use—↓ or absent gag reflex. CV: CARDIAC ARREST, arrhythmias, bradycardia, heart block, hypotension. GI: nausea, vomiting. Resp: bronchospasm. Local: stinging, burning, contact dermatitis, erythema.
Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

Front 43

Epinephrine
(A/E)

Back 43

CNS: nervousness, restlessness, tremor, headache, insomnia. Resp: paradoxical bronchospasm (excessive use of inhalers). CV: angina, arrhythmias, hypertension, tachycardia. GI: nausea, vomiting. Endo: hyperglycemia.

Front 44

Heparin
(A/E)

Back 44

GI: drug-induced hepatitis. Derm: alopecia (long-term use), rashes, urticaria. Hemat: BLEEDING, anemia, thrombocytopenia (can occur up to several weeks after discontinuation of therapy). Local: pain at injection site. MS: osteoporosis (long-term use).
Misc: fever, hypersensitivity.

Front 45

Coumadin (Warfarin)
(A/E)

Back 45

GI: cramps, nausea. Derm: dermal necrosis. Hemat: BLEEDING.
Misc: fever.

Front 46

Dopamine
(A/E)

Back 46

CNS: headache. EENT: mydriasis (high dose). Resp: dyspnea. CV: arrhythmias, hypotension, angina, ECG change, palpitations, vasoconstriction. GI: nausea, vomiting. Derm: piloerection. Local: irritation at IV site.

Front 47

Norepinephrine
(A/E)

Back 47

CNS: anxiety, dizziness, headache, insomnia, restlessness, tremor, weakness. Resp: dyspnea. CV: arrhythmias, bradycardia, chest pain, hypertension. GU: decreased urine output, renal failure. Endo: hyperglycemia. F and E: metabolic acidosis. Local: phlebitis at IV site. Misc: fever.