NRNP 6566 final prep 6-12

19 y.o male in ER with drug overdose, 100 ativan, oxycodone and valium lethargy and mental status changes, what treatment will you implement first? - answer-Narcan-or Naxolalone treat the opioid first then the benzodiazepines. 5 causes of hypoxemia - answer-VQ mismatch shunt PNA, interstitial lung dz hypoventilation high altitude A-a gradiant varies with age, calculation - answer-2.5 + 0.21 x age in years A-a gradiatian calculation is a calculation of what? - answer-level of hypoxia PA02-Pa02 AC control vent settings how do you determine tidal volume? - answer-is based on ideal body weight. careful with obese patients. acute otitis media treatment - answer-Amoxicillin or Augmentin antiboitics that require serum monitoring - answer-vancomycin, amikacin, gentamicin antibotic for strep - answer-amoxicillin ARDS pt who have high peak pressures with rising levels of static pressures have this complication... - answer-compliance decreases BiPAP use - answer-patients who require positive pressure with inspiration AND expiration. carbapenem serious side effect - answer-seizures cardiac surgery patients do not use this for sedation during surgery - answer-benzodiazepines cellutlitis treatmen - answer-cephalexin clinical symptoms and treatment of patient with hyperkalemia - answer->6 mEq/L. tall T waves on EKG, prolonged P waves, PR interval, P waves are flattened. wide QRS. slowed AV conduction, arrhythmias. bradycardia, idioventricular rhythms, v-tach, v-fib, asystole. clinical symptoms of hyponatremia - answer-Na+ <115 seizures, coma treatment is to restrict all fluid intake, 1000 ml/24 hours. bolus with 3% hypertonic saline. 100 ml/ over 10 minutes. clinical symptoms that require intubation - answer-neuromuscular depression or failure. spinal cord injuries guillain barre syndrome trauma-spinal cord injuries, phrenic nerve injury myasthenia gravis shock status asthmaticus sustained apnea of any kind clinical syptoms of hypermagnesium - answer-Na+ 135-145 complete heart block and arrest with mag >15 >5 prolonged PR & QT interval and wide QRS ALWAYS check K+ with Mag Combination Inhalers for Asthma - answer-Fluticasone + Salmeterol (Advair®) Budesonide + Formoterol (Symbicort®) Mometasone + Formoterol (Dulera®) Fluticasone + Vilanterol (Breo®) complications r/t 3% NS - answer-rise in Na+ is seizures, renal failure and pulmonary edema, along with heart failure. confusion assessment for ICU - answer-CAM-ICU, confusion assessment method for the ICU COPD treatment - answer-COPD TREATMENT ● Immunizations ● Antibiotics ● Bronchodialators ● Corticosteroids - Oral and Inhaled ● Beta-Adrenergic Agonists ● Oxygen Therapy - Low flow rate: Normally, CO2 stimulates breathing b/c it initiates Hypoxic Drive. Chronic COPD patients have chronic elevated carbon dioxide levels. They "retrain" their bodies to breath when they are low in oxygen. High rate flow may actually stop breathing. This will increase PaC02 leading to somulence and respiratory failure. CPAP - answer-patients who require inspiratory postive pressure like OSA patients. Critical Care Pain Observation Tool (CPOT) - answer-for the non communicative patient -facial expression -body movements -muscle tension (eval by passive flexion extension and of upper extremities) -compliance with ventilator OR vocalization 0-8 scale - 0 being no movement 8 being most movement Deep sedation - answer-client cannot be easily aroused, but can respond after repeated stimulation. respiration may need to be supported dialysis - answer-PD-at home, nightly through PD cath HD- three times weekly through center. Fistula or vas cath for access. must have a MAP >60 CCRT/CVVH-in ICU settings, can use with hypotensive patients dissociation - answer-type of moderate sedation that occurs when using meds such as ketamine. dissociation of the limbic system. DKA s/s - answer-D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea DKA treatment - answer-High IV flow rate (150-200hr) with insulin R in prescribed mixture (Rehydrate and push K back into cell, Oxygenate) do not give this drug for patients who are hypotensive - answer-fentanyl do not give this paralytic for CVA patients - answer-succinylcholine do not give this sedating drug in hypertensive patients - answer-ketamine do not give this sedating drug to patients with seizures - answer-etomidate do not give to patient with head injuries - answer-rocuronium dusky bluish tent - answer-cyanosis emergency placement of chest tube is placed between which two ribs? - answer-4th-5th intercostal space, over the ribs to avoid the nerve system midaxillary line general anesthesia - answer-the blockage of all body sensations, causing un-consciousness and loss of reflexes. cardiac and respiratory monitoring is essential gram negative antibotics - answer-ampicillin +sulbactam cefazolin ceftrazidime/clavulanic acid cefdinir cefuroxime ciprofloxacin cotrimoxazole gatitloxacin levofloxacin linezzolid meropenem ofloxacin Gram positive antibiotics - answer-ciprofloxacinroxithromycin tetracycle vancomycin tobramycin gentamacin chloramphenicol cefazolin clindamycin erythromycin levoflaxacin oxacillin penicillin rifampicin Gram-negative bacteria - answer-ecoli, psuedomonas aeruginosa, klebsiella pneumoniae, haemophilus influenzae, nesseria gonorrhea, chylamidia trachomatis, serratia marcens, enterobacter cloacae, acinetobacter baumanii, proteus mirabillis, kiebsiella oxytoca, hellobactor pylori. Gram-positive bacteria - answer-Staphylococcus aureus, staphyloccus epidermis, streptococcus pneumoniae, enterococci, bacillus anthracis, corynebacterium diphtheriae, and listeria monocytogenes HAP treatment - answer-tripple therapy. cefepime, meropenem, vancomycin until C&S is back. then specify which abx are sensative.