Med Surge III Exam 1
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Med Surge 3 Exam 1 NSG 233 Exam 1 ATI proctored final exam Pa
50 terms 69 terms Teacher 183 terms 75
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Terms in this set (59)
Mix with 120 mL water or juice
Don't crush/chew
Take after meals initially, then before meals if no n/v
Potassium administration Don't suddenly stop taking it
Don't use salt substitutes
Recognize S/S of hypo/hyperkalemia
Never give undiluted by IV or IV push
Slow pulse, fatigue, SOB
S/S hyperkalemia
*both hypo & hyper have palpitations, confusion, and muscle weakness
Dizziness, abdominal distension, frequent voiding
S/S hypokalemia
*both hypo & hyper have palpitations, confusion, and muscle weakness
Activated charcoal
Antidote for ingested poisons Decreases poison absorption
Give within first hour for effectiveness
Priority: airway stabilization
Control of airway, ventilation, and oxygen
Determine what was ingested, time since ingestion, S/S (pain, burning sensation,
Management of ingested poisons redness/burn in mouth, throat, pain on swallowing or inability to swallow,
vomiting, drooling)
Age & weight of patient
Pertinent health history
Headache, dizziness, confusion, palpitations, muscle weakness, intoxication -->
S/S carbon monoxide poisoning
coma, death
Priority - assess carboxyhemoglobin levels
Management of carbon monoxide
Treat with 100% O2
poisoning
May need hyperbaric chamber
, Activated charcoal ("universal" antidote)
Acetylcysteine for acetaminophen
Benzos for alcohol withdrawal/delirium tremens
Atropine for cholinergic drugs (rivastigmine, polocarpine, donepezil, neostigmine,
Meds to treat overdose
etc)
No longer used: Ipecac-induced vomiting or gastric lavage (minimal effectiveness
& potential complications)
Sedate with benzos (reduce agitation, exhaustion, seizures, promotes sleep)
Calm environment
Alcohol withdrawal treatments Physical exam to identify pre-existing illness/injury
Drug history
Baseline BP
Refer to resources
Try to separate them
Treatment of Intimate Partner Violence
Can't report unless child/elderly
Document wounds
Use ESI (emergency severity index) tool
Responsibilities of triage nurse:
Triage patients in the ED
Assess, reassess, initiate treatment, manage and
communicate, educate, sort patients, transport
them
Prophylaxis for gonorrhea
Ceftriaxone + 1% lidocaine
Prophylaxis for syphilis and chlamydia:
Single dose metronidazole
Single dose azithromycin
Meds for managing sexual assault
7-day oral regimen doxycycline
Anti-pregnancy:
Levonorgestrel and ethinyl estradiol
Give within 12-24 hours, no more than 72 hours post-intercourse
Antiemetic for side effects
Immediate needle decompression
Followed by chest tube insertion
Tension pneumothorax care S/S: chest pain, dyspnea, tachycardia, anxiety, air hunger, increased use of
accessory muscles, decreased/absent breath sounds on affected side, deviated
trachea to unaffected side
Leaked air pockets under skin, feels like "rice crispies"
Part of spontaneous pneumothorax
Not usually serious
Subcutaneous emphysema care
Report to provider
Monitor airway
Absorbs once pneumothorax is treated
Risk for hemorrhage - monitor for shock
Liver - right shoulder pain
Spleen - left shoulder pain
Intra-abdominal injury care If stable --> CT
If unstable --> FAST exam (focused assessment with sonography for trauma)
Management: ABCs, C-spine precautions, NPO, antibiotics/tetanus, monitoring,
surgery PRN
, Tracheal alignment - midline (simple pneumothorax)
Chest expansion - decreased
Pneumothorax assessment
Breath sounds - diminished/absent
Chest percussion - normal/hyper-resonant
Goal: to evacuate air/blood from pleural space
A small chest tube (28 Fr) is inserted near second intercostal space
If hemothorax, large tube (32 Fr or greater) is inserted in fourth or fifth intercostal
Pneumothorax care
space
Suction is applied
Pleural cavity is decompressed (drainage of air/blood)
Has programmable settings
Delivers morphine at a preset bolus
Can program a lockout period (control frequency)
Patient-controlled analgesia (PCA) HCP gives loading dose to attain therapeutic blood levels quickly (with
continuous IV infusion)
Assess pain scores after initiation, after any change in pump setting, and
periodically
Pre-procedure cognitive assessment
If opioid-tolerant or opioid-naive
Pain assessment
Sedation assessment (precedes resp depression)
Assessment for appropriateness of PCA
Respiratory assessment
*Tolerant - 60 mg for a week or longer
*Naive - less than tolerant criteria
At risk for rhabdomyolysis (crush syndrome) and compartment syndrome
Observe for:
Hypovolemic shock
Crush injuries
Spinal cord injury
Erythema and skin blistering
Fractures
Acute kidney injury (from acute tubular necrosis)
Destroyed skeletal muscle cells empty contents into circulation, causing kidney
problems
Rhabdomyolysis
S/S: muscle pain & weakness, elevated CK, dark brown urine
Can lead to acute kidney failure (Tx: Fluids)
Increased pressure within muscle compartments
Extreme pain, decreased/absent CMS (circulation, motor, sensory)
Compartment syndrome
Leads to decreased perfusion --> loss of limb
Tx: Fasciotomy
Stop loss of fluid
Replace fluid
Treatment of hypovolemic shock Two large-bore IVs (18 G)
0.9% NS, whole blood, or PRBCs
Warm fluids with massive transfusions to prevent hypothermia
Fix cause (stent placement, thrombolytics for MI)
Decrease preload (diuretics, venous vasodilators)
Decrease SVR* (arterial vasodilators, balloon pump, LVAD - left ventricular assist
device)
Treatment of cardiogenic shock
Decrease HR (digoxin, b-blockers)
Increase contractility (digoxin, dopamine)
*systemic vascular resistance
, Correct obstruction
Pneumothorax: needle decompression/chest tube
Treatment of obstructive shock PE: embolectomy
Abdominal compartment syndrome: laparotomy
Cardiac tamponade: pericardiocentesis (drain fluid from heart sac)
Collect blood cultures
Broad-spectrum IV antibiotics, then narrow after organism ID'ed
0.9% NS for hypotension --> fix preload
Treatment of septic shock Vasopressors if not responsive to fluids --> fix afterload
Anticoagulants to prevent DIC*
*disseminated intravascular coagulation (clotting & bleeding)
Prevent further damage by cervical spine and back stabilization
Maintain patent airway and assist with breathing PRN
Treatment of neurogenic shock Cautious fluid resuscitation (preload)
Vasopressors --> increase BP (afterload)
Atropine --> increase HR
Stage 1 - Compensatory
Stages of Shock Stage 2 - Progressive
Stage 3 - Irreversible
Mild decrease in BP triggers autonomic nervous system and RAAS to compensate
ANS --> increase epi/norepi --> increase BP
also releases cortisol --> increase BG
RAAS --> release renin & aldosterone --> vasconstriction & fluid/Na+ retention -->
increase BP
Shock - Compensatory Stage Laura:
>100 bpm
> 20 breaths/min
PaCO2 <32
Cold, clammy skin
Confused/agitated
Respiratory alkalosis (deep rapid breathing, lightheaded, n/v, muscle twitching)
BP becomes low enough that body can't compensate anymore
MAP decreased
lack of O2 to heart --> ischemia and impaired pumping
Capillary leakage --> hypovolemia
Metabolic acidosis
Laura:
Shock - Progressive stage
Systolic <90
MAP < 65
Fluid resuscitation required for BP
HR >150 bpm
Rapid, shallow respirations, crackles
Lethargy
PaO2 < 80, PaCO2 > 45
Profound hypotension, hypoxemia, acidosis
Requires mechanical ventilation & vasopressors
Shock - Irreversible stage
MODS (multiple organ dysfunction syndrome)
Family care conference to plan for end of life
5.0 (1 review)
Save
Students also studied
Flashcard sets Study guides
Med Surge 3 Exam 1 NSG 233 Exam 1 ATI proctored final exam Pa
50 terms 69 terms Teacher 183 terms 75
tjacobson2014 Preview Preview Msaamberly Preview
Terms in this set (59)
Mix with 120 mL water or juice
Don't crush/chew
Take after meals initially, then before meals if no n/v
Potassium administration Don't suddenly stop taking it
Don't use salt substitutes
Recognize S/S of hypo/hyperkalemia
Never give undiluted by IV or IV push
Slow pulse, fatigue, SOB
S/S hyperkalemia
*both hypo & hyper have palpitations, confusion, and muscle weakness
Dizziness, abdominal distension, frequent voiding
S/S hypokalemia
*both hypo & hyper have palpitations, confusion, and muscle weakness
Activated charcoal
Antidote for ingested poisons Decreases poison absorption
Give within first hour for effectiveness
Priority: airway stabilization
Control of airway, ventilation, and oxygen
Determine what was ingested, time since ingestion, S/S (pain, burning sensation,
Management of ingested poisons redness/burn in mouth, throat, pain on swallowing or inability to swallow,
vomiting, drooling)
Age & weight of patient
Pertinent health history
Headache, dizziness, confusion, palpitations, muscle weakness, intoxication -->
S/S carbon monoxide poisoning
coma, death
Priority - assess carboxyhemoglobin levels
Management of carbon monoxide
Treat with 100% O2
poisoning
May need hyperbaric chamber
, Activated charcoal ("universal" antidote)
Acetylcysteine for acetaminophen
Benzos for alcohol withdrawal/delirium tremens
Atropine for cholinergic drugs (rivastigmine, polocarpine, donepezil, neostigmine,
Meds to treat overdose
etc)
No longer used: Ipecac-induced vomiting or gastric lavage (minimal effectiveness
& potential complications)
Sedate with benzos (reduce agitation, exhaustion, seizures, promotes sleep)
Calm environment
Alcohol withdrawal treatments Physical exam to identify pre-existing illness/injury
Drug history
Baseline BP
Refer to resources
Try to separate them
Treatment of Intimate Partner Violence
Can't report unless child/elderly
Document wounds
Use ESI (emergency severity index) tool
Responsibilities of triage nurse:
Triage patients in the ED
Assess, reassess, initiate treatment, manage and
communicate, educate, sort patients, transport
them
Prophylaxis for gonorrhea
Ceftriaxone + 1% lidocaine
Prophylaxis for syphilis and chlamydia:
Single dose metronidazole
Single dose azithromycin
Meds for managing sexual assault
7-day oral regimen doxycycline
Anti-pregnancy:
Levonorgestrel and ethinyl estradiol
Give within 12-24 hours, no more than 72 hours post-intercourse
Antiemetic for side effects
Immediate needle decompression
Followed by chest tube insertion
Tension pneumothorax care S/S: chest pain, dyspnea, tachycardia, anxiety, air hunger, increased use of
accessory muscles, decreased/absent breath sounds on affected side, deviated
trachea to unaffected side
Leaked air pockets under skin, feels like "rice crispies"
Part of spontaneous pneumothorax
Not usually serious
Subcutaneous emphysema care
Report to provider
Monitor airway
Absorbs once pneumothorax is treated
Risk for hemorrhage - monitor for shock
Liver - right shoulder pain
Spleen - left shoulder pain
Intra-abdominal injury care If stable --> CT
If unstable --> FAST exam (focused assessment with sonography for trauma)
Management: ABCs, C-spine precautions, NPO, antibiotics/tetanus, monitoring,
surgery PRN
, Tracheal alignment - midline (simple pneumothorax)
Chest expansion - decreased
Pneumothorax assessment
Breath sounds - diminished/absent
Chest percussion - normal/hyper-resonant
Goal: to evacuate air/blood from pleural space
A small chest tube (28 Fr) is inserted near second intercostal space
If hemothorax, large tube (32 Fr or greater) is inserted in fourth or fifth intercostal
Pneumothorax care
space
Suction is applied
Pleural cavity is decompressed (drainage of air/blood)
Has programmable settings
Delivers morphine at a preset bolus
Can program a lockout period (control frequency)
Patient-controlled analgesia (PCA) HCP gives loading dose to attain therapeutic blood levels quickly (with
continuous IV infusion)
Assess pain scores after initiation, after any change in pump setting, and
periodically
Pre-procedure cognitive assessment
If opioid-tolerant or opioid-naive
Pain assessment
Sedation assessment (precedes resp depression)
Assessment for appropriateness of PCA
Respiratory assessment
*Tolerant - 60 mg for a week or longer
*Naive - less than tolerant criteria
At risk for rhabdomyolysis (crush syndrome) and compartment syndrome
Observe for:
Hypovolemic shock
Crush injuries
Spinal cord injury
Erythema and skin blistering
Fractures
Acute kidney injury (from acute tubular necrosis)
Destroyed skeletal muscle cells empty contents into circulation, causing kidney
problems
Rhabdomyolysis
S/S: muscle pain & weakness, elevated CK, dark brown urine
Can lead to acute kidney failure (Tx: Fluids)
Increased pressure within muscle compartments
Extreme pain, decreased/absent CMS (circulation, motor, sensory)
Compartment syndrome
Leads to decreased perfusion --> loss of limb
Tx: Fasciotomy
Stop loss of fluid
Replace fluid
Treatment of hypovolemic shock Two large-bore IVs (18 G)
0.9% NS, whole blood, or PRBCs
Warm fluids with massive transfusions to prevent hypothermia
Fix cause (stent placement, thrombolytics for MI)
Decrease preload (diuretics, venous vasodilators)
Decrease SVR* (arterial vasodilators, balloon pump, LVAD - left ventricular assist
device)
Treatment of cardiogenic shock
Decrease HR (digoxin, b-blockers)
Increase contractility (digoxin, dopamine)
*systemic vascular resistance
, Correct obstruction
Pneumothorax: needle decompression/chest tube
Treatment of obstructive shock PE: embolectomy
Abdominal compartment syndrome: laparotomy
Cardiac tamponade: pericardiocentesis (drain fluid from heart sac)
Collect blood cultures
Broad-spectrum IV antibiotics, then narrow after organism ID'ed
0.9% NS for hypotension --> fix preload
Treatment of septic shock Vasopressors if not responsive to fluids --> fix afterload
Anticoagulants to prevent DIC*
*disseminated intravascular coagulation (clotting & bleeding)
Prevent further damage by cervical spine and back stabilization
Maintain patent airway and assist with breathing PRN
Treatment of neurogenic shock Cautious fluid resuscitation (preload)
Vasopressors --> increase BP (afterload)
Atropine --> increase HR
Stage 1 - Compensatory
Stages of Shock Stage 2 - Progressive
Stage 3 - Irreversible
Mild decrease in BP triggers autonomic nervous system and RAAS to compensate
ANS --> increase epi/norepi --> increase BP
also releases cortisol --> increase BG
RAAS --> release renin & aldosterone --> vasconstriction & fluid/Na+ retention -->
increase BP
Shock - Compensatory Stage Laura:
>100 bpm
> 20 breaths/min
PaCO2 <32
Cold, clammy skin
Confused/agitated
Respiratory alkalosis (deep rapid breathing, lightheaded, n/v, muscle twitching)
BP becomes low enough that body can't compensate anymore
MAP decreased
lack of O2 to heart --> ischemia and impaired pumping
Capillary leakage --> hypovolemia
Metabolic acidosis
Laura:
Shock - Progressive stage
Systolic <90
MAP < 65
Fluid resuscitation required for BP
HR >150 bpm
Rapid, shallow respirations, crackles
Lethargy
PaO2 < 80, PaCO2 > 45
Profound hypotension, hypoxemia, acidosis
Requires mechanical ventilation & vasopressors
Shock - Irreversible stage
MODS (multiple organ dysfunction syndrome)
Family care conference to plan for end of life
