Summary 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
 Anterior MI: Cardiogenic shock (V leads)
o LAD