Critical Care- HESI QUESTIONS AND CORRECT ANSWERS

Critical Care- HESI How to calculate HR on EKG - ANSWERS big boxes: take 300 and divide by the number of boxes between RR Atrial Fibrillation - ANSWERS Rapid, random, ineffective *contractions of the atrium* No P Waves, *Normal QRS w/ irreg intervals* Risk for thrombi Tx: anti coagulants (Heparin), TEE, Synchronized Cardioversion Atrial Flutter - ANSWERS No P Waves, QRS at reg intervals Sawtooth or FLUTTER WAVES Tx: Anti coagulants, TEE, synchronized cardioversion Adenosine, beta blockers, calcium channel blockers, digitalis (digoxin) (Fluttering in a circle singing "ABCDs") Supraventricular Tachycardia (SVT) - ANSWERS Episodes of abnormally fast/racing heartbeat (between 150-250) Normal QRS w/ reg intervals Tx: first - valsalva's maneuver, carotid massage, ice to face *Adenosine*, beta blockers, calcium channel blockers, dig Premature Atrial Complexes (PAC) - ANSWERS stimulus can be caffeine, nicotine, alcohol stress common but if pt has cardiac probs it can cause ischemia usually asymptomatic tx: take away trigger Ventricular Tachycardia (V-tach) - ANSWERS Can deteriorate to V Fib Tx: check pulse and LOC... if they have a pulse: synchronized cardioversion Vasopressin, Lidocaine, Amiodarone, Magnesium, Epi (V TACH = V LAME) if pulseless = CPR and defibrillation 3 or more PVCs in a row - ANSWERS V-tach Ventricular Fibrillation (V-fib) - ANSWERS abnormal heart rhythm which results in quivering of ventricles *FATAL RHYTHM* Tx: *Defibrillation*, CPR Asystole - ANSWERS no electrical impulses unconscious and pulseless *DO NOT START CPR UNTIL YOU CHECK TWO LEADS* TX: CPR, epi or vasopressin Cardioversion - ANSWERS - Elective procedure (informed consent is needed) - Synchronized with QRS - *50-100* Joules Defribrillation - ANSWERS - Emergency (call code) - V-fib / V-Tach - Begin with 200 joules (can go up to 300) - No CO - Synch off - Make sure O2 is shut off before starting to avoid fire! - No one can touch bed First Degree AV Block - ANSWERS - Prolonged PR interval - Pt usually asymptomatic - tx: nothing, not fatal Second Degree AV Block Type 1 (Wenckebach) - ANSWERS PR lengthens progressively then drops a QRS complex (longer... longer... longer, drop = Wenckebach usually benign tx: monitor if symptomatic or HR 60 Second Degree AV Block Type 2 (Mobitz) - ANSWERS PR interval is constant then drops QRS can progress to third degree AV block and asystole tx: temp pacemaker and then permanent pacemaker Atropine, Epi, Dopamine Third degree AV Block (complete heart block) - ANSWERS - atria and ventricles contract independently (Atria 60-100 bpm; ventricles 24-40) - can progress to V. Fib (bad) tx: pacemaker, atropine, epi, dopamine Hold Digoxin - ANSWERS HR 60 Low K+ = risk for ______ toxicity - ANSWERS Digoxin Pad Placement for Defib or Cardioversion - ANSWERS one pad is placed at the third intercostal space to the right of the sternum the other is placed a the fifth intercostal space on the left midaxillary line CPR (cardiopulmonary resuscitation) - ANSWERS CAB: compressions - airway - breathing check pulses for 10 secs depth: 2 in rate: 100-120 compressions per min 30 compressions: 2 breaths Glasgow Coma Scale (GCS) - ANSWERS LOC Assessment eye opening (4), verbal response (5), motor response (6) 8 = intubate!! Early signs of increased ICP - ANSWERS Decreased LOC Late signs of increased ICP - ANSWERS - Cushing's triad (1- widened pulse pressure, 2- bradycardia w/ bounding pulse, 3- slow, irregular respiration) - pupil changes - elevated temp - resp changes - abnormal posturing Treatment of ICP - ANSWERS goal to keep ICP 20 mannitol diuretics controlled hyperventilation avoid narcotics keep head in neutral position Basilar Skull Fracture - ANSWERS Raccoon eyes (periorbital ecchymosis) and Battle's sign (mastoid ecchymosis). + halo nasal/ ear drainage Brown Recluse Bite Care - ANSWERS apply ice immediately and intermittently for up to 4 days (decreases enzyme activity of venom and risk of necrosis) Black Widow Spider Bite Care - ANSWERS (bite will cause small, red papule; venom is neurotoxic) ice applied immediately! Tarantula Bite Care - ANSWERS (spider launches its hair into skin and causes inflammatory action) - remove hair ASAP with sticky tape, throughly irrigate the skin, saline irrigation for eye exposure - elevate involved extremity and immobilize - antihistamines and corticosteroids are necessary - tetanus shot Snake Bite Care - ANSWERS - immediately move victim away from area and try to calm them down - extremity is immobilized and kept BELOW level of the heart - constricting clothing and jewelry should be removed - victim should be kept warm and avoid alcoholic or caffeinated beverages - if unable to seek emergency med attn promptly a constricting band should be placed proximal to the wound (loosen band if edema occurs) - the wound should NOT be incised or sucked to remove venom and ice should NOT be placed - anti-venom may be administered along w