NR 340 CRITICAL CARE FINAL STUDY GUIDE

NR 340 CRITICAL CARE FINAL STUDY GUIDE• Ethics o Informed consent  Competence  Voluntariness  Disclosure of information o Proxy- makes decisions for patient, designated by state • Comfort and Sedation o Rapid sequence intubation  Succinocholine and etomidate o Conscious sedations  Versed and fentanyl o Reversal for fentanyl narcan o Reversal for versed flumazenil o Medications  Benzos • Versed • Ativan • Valium • Precedex- similar to versed, not as addicting  Opioids • Morphine sulfate • Dilaudid • Fentanyl • Druamorph- spinal  Local anesthetics “-caines” o Pain scale for sedated patients behavioral pain scale o Medication for alcohol withdrawl Haldol  CIWA score relates to treatment given • The Heart o Hemodynamics (BP)  Purpose of hemodynamic monitoring assessment of tissue perfusion  Swan ganz catheter • Measures pulmonary capillary wedge pressure (8-12) determines functioning of the left side of the heart (arterial)  CVP measures pressure on right side of heart (venous) • Normal: 2-6 • Indicates patients fluid volume status • If CVP is low give fluids to correct  Cardiac Index (CI): 2.5-4.2 • Less than 2 is BAD cardiogenic shock o Cardiogenic shock is usually caused by and MI (anterior) • Low CI caused by trauma, hypovolemic shock • Interventions: fluids  Hgb: 12-16  Hct: 35-45  WBC: 4-11  Stroke volume • Components- preload, afterload, and contractility o Preload-ventricular filling (volume)  Diastole (dub) o Afterload (pressure)  Contraction  Systole (lub) • Low SVI CHF, beta blockers, late septic shock • High SVI early septic shock, positive inotropes, fever, hypervolemia  Allen’s testmeasures collateral circulation  Arterial line/invasive monitoring CHECK CONNECTIONS  Central line complications: (get x-ray for placement) • Cardiac dysrhythmias • Carotid puncture • Pneumothorax/Hemothorax • Perforation or r. atrium/ventricle o Acute coronary Syndrome/EKG (Ch. 12)  1st intervention for chest pain: • 12 lead EKG  Angina- caused by ischemia but doesn’t cause cell death • Stable- occurs with exercise, relieved with rest • Unstable- may occur at rest o May show ST depression o Requires more nitrates • Prinzmetal- coronary spasms at rest or active o Treatment- nitrates and calcium channel blockers (-pine)  MI • s/s- radiating chest pain, diaphoresis, n/v, SOB o Women’s- fatigue, diaphoresis, indigestion, • Laboratory o Elevated troponin o Elevated CK-MB (>4.9) • Treatments o MONA- morphine, oxygen, nitrogen, aspirin  Check BP before giving nitro, ask about ED drugs (-fil) o TPA within 6 hours of onset  Contraindicated- o #1 intervention cardiac cath  Post sent Clopidogril (Plavix) • STEMI- Plaque rupture or complete occlusion (ST elevation- ALWAYS MI) • NSTEMI- partially occluded coronary vessel