NS 540 Complex Care Exam 1 | Verified with 100% Correct Answers

NS 540 Complex Care Exam 1 | Verified with 100% Correct Answers What are central lines most commonly used for? vasopressors, critical illness, monitoring central venous pressure, TPN What types of temporary CLs are there? internal jugular, subclavian, femoral vein, PICC What types of long-term lines are there? tunneled, port-a-cath How is a CL placed? sterile (with a timeout) and confirmed with x-ray What are possible immediate complications of a CL to look out for? bleeding, arterial puncture, arrhythmia, air embolism, pneumo or hemothorax What are possible delayed complications of a CL to look out for? infection, venous thrombosis, catheter migration How is a CL removed? Check coag tests (PT, PTT) Clean, not sterile Remove sutures, then remove catheter Position insertion site below heart level, hold gauze over insertion site, have patient hold breath and hum, apply direct pressure for 5 min after When would a medication be given via a continuous infusion? meds that need to stay at consistent level in blood, have short half life, and might need to be titrated What types of medications are given as a continuous infusion? vasopresors, afterload reducers, antidysrhythmias, positive inotropes, sedation, analgesics, paralytics, anticoagulation How do vasopressors work? they cause vasoconstriction to increase BP How do afterload reducers work? they vasodilate to lower BP How do positive inotropes work? Stimulate the heart Increase strength of contractions Increase heart rate What are some examples of vasopressors? norepi, epi, phenylephrine, vasopressin, dopamine What are some examples of afterload reducers? clevidipine, nitro, esmolol What are some examples of antidysrhythmics? amidarone, lidocaine What are some examples of positive inotropes? dobutamine, milrinone What are some examples of sedatives? Propofol, midazolam, dexamedetomidine, ketamine What are some examples of analgesics? morphine, fentanyl, hydromorphone, Percocet (oxytocin and aceteminophen) What are some examples of paralytics? cisatracurium, vecuronium What are some examples of anticoagulants? heparin, warfarin What do alpha receptors do? vasoconstriction (increase afterload) What do beta 1 receptors do? increase HR and inotropy What do V1 receptors do? Vasoconstriction What do V2 receptors do? act on the kidneys like ADH to reabsorb more water Which receptors does Levophed (Norepinephrine) stimulate? mostly alpha and little bit of beta 1 Which receptors does Vasopressin stimulate? V1 and V2 Which receptors does Neosynephrine (Phenylephrine) stimulate? only alpha Which receptors does Epinephrine stimulate? little bit of alpha, a lot of beta 1 What happens if a patient is undersedated? impaired recovery, immunosuppression, hypercoag, increased agitation, disturbed sleep, increased stress, increased HR and O2 demand, delirium, self extubation, PTSD, noncompliant with ventilator, family distress What happens if a patient is oversedated? risk for withdrawal (benzos), delirium, prolonged hospital stay, ventilator associated pneumonia, hypotension, respiratory depression What does sedation limit the assessment of? Neuro- mental status, orientation, muscle strength How do we assess level of sedation? RASS score: -5 (no response to stimulation) to +4 (violent) How do we assess pain under sedation? Critical Care Pain Observation Tool (CPOT) and vital signs What medications are commonly used for sedation? Propofol (Diprivan), Dexamdetomidine (Precedex), and Benzos Which sedation medication has the fastest onset and shortest duration, making it ideal for situations where you might need to wake the patient up quickly? Propofol Which sedation medication is also an analgesic and does not cause respiratory depression? Dexamdetomidine (Precedex) What are the possible negative side effects of Dexamdetomidine (Precedex)? hypertension, bradycardia, fever Which sedative is used as a last resort because they have a long duration and can lead to withdrawal and delirium? Benzos Which sedative requires ventd tubing? Propofol When is morphine often used? most often at the end of life Which analgesic is the fastest and strongest with the shortest duration? Fentanyl What are the adverse effects of fentanyl? respiratory depression, bradycardia, hypotension When should Hydromorphone (Dilaudid) be given? only if the patient has tried other opioids before What is the maximum dialy dose of Oxycodone and Acetaminophen (Percocet)? 4 grams Which organ does Percocet affect? Liver How much Dilaudid is equivalent to 10 mg of Morphine? 1.5 mg How much Fentanyl is equivalent to 10 mg of Morphine? 200 mcg or 0.2 mg What are some risk factors of delirium? older age, substance use, depression, dementia, vision or hearing problems, infection, organ dysfunction, electrolyte imbalances, anemia What can be done to prevent delirium? frequent orientation and communication, sleep routine, limit environmental stimulation, give glasses and hearing aids, limit use of restraints, early mobilization, limit use of benzos, treat pain What scale is used to assess delirium? Confusion Assessment Method - CAM-ICU What is used to manage delirium? eliminate cause, reduce meds, antipsychotics (Haldol), Dexmedetomidine (Precedex) What are potential complications of immobility? loss of muscle strength, bone resorption, increased cardio workload, reduced SV, orthostatic intolerance, atelectasis, diaphragm dysfunction, reduced ability to perform ADLs, DVT, skin breakdown How can you prevent DVT? mobility, compression devices, blood thinners How can you prevent skin breakdown? change positions, nutrition, foam dressings, specilized beds, mobility What are some contrindications to enteral feedings? bowel ischemia, GI bleed, bowel obstruction, paralytic ileus malabsorption, diverticular disease, fistula, short bowel disease, severe diarrhea or vomiting What is given if a patient cannot receive enteral nutrition? Total Parenteral Nutrition (TPN) What type of access is needed for TPN? central access How often are TPN bags changed? every 24 hours What labs are monitored when giving TPN? blood sugar, electrolytes, creatinine and BUN, protein, LFTs What else can be given through a TPN line? Nothing How do ectopic cells cause dysrhythmias? they fire (depolarize) by themselves and cause an irregular rhythm instead of generating a rhythm from the SA node What happens during a 1st degree block? the electrical impulse comes from the SA node, but it is delayed at the AV node What do you see on a strip when there is a 1st degree block? longer PR interval (>0.2 seconds, 5 little squares) What can cause 1st degree heart block? CAD, MI, hypokalemia, BBs, Digoxin How are 1st degree heart blocks treated? no tx necessary, usually asymptomatic What happens during a 2nd degree block MOBITZ I? with every beat, the AV node gets lazier until the impulse does not pass through to the ventricles What do you see on a strip with 2nd degree block MOBITZ I? PR interval gets progressively longer until p wave isn't conducted and there is no QRS complex, rhythm is irregular What can cause 2nd degree block MOBITZ I? drugs, CAD, inferior MI, myocarditis How is 2nd degree block MOBITZ I treated? not treated if asymptomatic, can use temporary pacemaker, continue to monitor What happens during 2nd degree block MOBITZ 2? some sinus impulses are not conducted, usually every other beat or every 3rd beat What do you see on the strip for 2nd degree block MOBITZ 2? 2 or more p waves in front of each QRS complex What causes 2nd degree block MOBITZ 2? rheumatic heart disease, CAD, anterior MI, cardiac surgery, hyperkalemia, drugs How is 2nd degree block MOBITZ 2 treated? temporary or permanent pacemaker, usually symptomatic What happens during 3rd degree block? complete heart block - no conduction of impulses from atria to ventricles, so they beat independently of each other What do you see on a strip for 3rd degree block? bradycardia, p waves with no relationship to QRS, or hiding, inconsistent PR interval length, atrial rate is higher than ventricular but both rhythms are regular How do you treat 3rd degree block? Pacing What is torsades de pointes? Polymorphic V tach in which the QRS complex twists around the baseline, associated with QT prolongation What do you see on a strip with torsades? V tach with irregular shapes changing in waves