NURSE 200Wcritical care HESI final.study guide

Critical Care HESI Final Critical care HESI – 55 questions • Cardiac o SVT: supraventricular tachycardia ▪ No p waves seen ▪ Treatment: • Adenosine – give 6mg, then 12mg, then another 12mg • Cardioversion if pt not tolerating rhythm • Don’t defibrillate!!! ▪ Have someone bring crash cart to room o Atrial fibrillation: ▪ Chaotic atrial activity ▪ Irregularly irregular ▪ Controlled: vent rate 100 • On digoxin at home and has controlled a fib  look at digoxin level ▪ Uncontrolled: vent rate 100 ▪ P waves are fibrillatory ▪ High risk for clots  give anticoagulant ▪ Common in elderly ▪ Holiday heart syndrome: alcohol and emotional stress o Atrial flutter: ▪ Ventricular rhythm stays regular ▪ Sawtooth waves ▪ Cardiovert! o Asystole: flat line ▪ Patient is essentially dead ▪ Give CPR and epi ▪ Pulse is gone ▪ Patient in asystole for 20 minutes  talk to family, patient is dead o 3rd degree heart block ▪ Look at patient’s blood pressure, bradycardia ▪ Give atropine, epinephrine, pacemaker o Alcoholic EKG ▪ Wide QRS and flat T = life threatening ▪ Flat T means hypokalemia o Peaked t waves are usually from hyperkalemia o STEMI: ST elevation myocardial infarction ▪ Give thrombolytics within 4 hours of onset o MI vs. Indigestion ▪ Classic symptoms of MI: dull chest pain radiating down left arm ▪ Women, elderly, pt’s with hx of DM may not have classic symptoms, instead: • N/V • Belching • Indigestion • Diaphoresis • Dizziness • Fatigue o New nurse on cardiac unit: ▪ Assign pt with sinus arrhythmia going for a stress test ▪ Don’t assign: • Torsades • V tach • V fib o Pulmonary artery catheter insertion, swan insertion ▪ Priority is monitoring the pressures ▪ When it gets into right ventricle watch for arrhythmias ▪ Sterile field o Hand is cold and decreased capillary refill – call physician because clot may be forming, don’t do an Allen test o Radial artery line and pt has decreased cap refill  call the physician o Hemorrhagic stroke ▪ Do not give tPa!!! o Ischemic stroke ▪ Look at BP before giving alteplase o Cardiac tamponade ▪ Muffled heart sounds ▪ Jugular venous distention ▪ Hypertension ▪ Tx: pericardial centesis o Vasodilation medications ▪ Morphine ▪ Lidocaine o Dopamine ▪ Vasopressor and will increase BP ▪ Increases renal flow at low doses ▪ So if low dose  renal dose • Increases vasodilation of artery no higher than 5 mcg/kg/min o DIC: first sign is often gums bleeding ▪ PT/INR o Heart failure ▪ BNP should be less than 100, if it’s over 100 it’s indicative of heart failure, lung dysfunction o Pacemaker is firing and nothing is