1. turn on defibrillator 2. select energy lvl ~ 200 J 3. "lead select" 4. apply gel to paddles 5. position paddles on pt 6. check monitor display and assess rhythm 7. "Charging, Stand clear!" 8. press charge 9. "Shock on 3. One, I'm clear. Two, you're clear. Three, everybody's clear" 10. apply 25 lb pressure on both paddles and shock 11. check monitor for rhythm
Proper CPR steps (list 9)
1. check for unresponsiveness 2. call for help 3. position client 4. open airway 5. check for breathing 6.perform ventilations 7. check circulation (pulse) 8. start compressions 9. check for spontaneous pulse
Allen's test verifies patency of radial and ulnar circulation. - compress both ulnar and radial arteries while client forms fist - have client relax and let go of one artery, hand should turn pink - repeat and let go of other artery
how long should pressure be applied on a puncture site for a patient receiving anti-coagulant therapy?
what S&S should be reported to the doc following an arterial puncture?
sitting upright w/ arms and shoulders raised and supported on pillows on overbed table. No coughing or talking
after thoracentesis, place pt on which side and for how long
place pt on unaffected side for 1 hr.
post-thoracentesis CxR is for?
to r/o pneumothorax and check resolution of effusions
T/F. It is important to assess the trach pt for risk for aspiration
what type of trach provides a seal between the upper and lower airway and is used for pts receiving mechanical ventilation?
what type of trach is used for kids under 8 yrs and for those who can protect the airway from aspiration?
what type of trach is used for pts with long or extra-thick necks?
what type of trach is used permanently?
for cuffed trachs, keep pressure below what level to reduce risk of tracheal necrosis due to prolonged compression of tracheal capillaries?
below 20 mm Hg.
provide trach care how often?
what vent mode provides preset ventilator rate and tidal volume but requires pt to initiate breaths?
AC (assisted control) mode
what is SIMV mode?
SIMV (Synchronized Intermittent Mandatory Ventilation) has present vent rate and tidal volume. The pt can initiate breaths but tidal volume depends on client's effort. If pt does not initiate breaths, the vent takes over but synchronizes with pt's breathing pattern.
What is PSV mode?
Pressure Support Ventilation mode. Present pressure delivered during spontaneous inspiration to reduce work of breathing. The pt controls rate and volume. Often used as a weaning mode. However, PSV doesn't guarantee minimal minute ventilation and is often combined with other modes (SIMV, AC).
What is PEEP?
Positive End Expiratory Pressure. Used to increase functional residual and improve oxygenation by opening collapsed alveoli. Must be used in combo with AC or SIMV, can't be used alone. It decreases CO and may cause trauma to lung tissue caused by high tidal volumes and increased ICP.
high pressure alarm sounds on the vent indicates?
- pt biting the tube - need for suctioning - kinks in tubing
low pressure or low volume sounds on the vent indicates?
- tubing disconnections - air leaks around cuff
3 characteristics of Asthma:
- edema - bronchoconstriction - secretions
what test is the most accurate for diagnosing asthma and its severity?
PFT (pulmonary function test)
a decrease in FEV1 or PERF by how much is common for asthma pts?
15-20% below the expected value
short-acting beta agonist (provides rapid relief for asthma)
anticholinergic: blocks parasympathetic NS and allows for sympathetic NS to exert its effects such as bronchodilation
methylxanthine - bronchodilator (cousin of caffeine)
Prednisone class and side effects
corticosteroid (antiinflammatory): Side effects include immunosuppresion, fluid retention, hypgerglycemia, hypokalemia, and poor wound healing.
cromolyn sodium (Intal)
mast cell stabilizer
Status Asthmaticus: what is it and what to do when it happens?
life-threatening; often unresponsive to common tx. Prepare for emergency intubation and potent systemic bronchodilators like epinephrine as well as systemic steroid therapy.
COPD encompasses 2 diseases:
- emphysema - chronic bronchitis
What is emphysema?
loss of lung elasticity that results in destruction of alveoli - hyperinflation - resp acidosis
What are the leading risk factors for developing COPD?
1. smoking 2. Alpha-antitrypsin (AAT) deficiency 3. air pollution
T/F. Most people with emphysema also have chronic bronchitis.
What is used to classify COPD as mild to very severe?
FEV to FVC ratio.
smaller ratio = worse COPD
Why monitor H&H in COPD pts?
to recognize polycythemia (compensation to chronic hypoxia)
Provide COPD pts with 2-4L/min O2 via NC. For pts with chronic hypercarbia, provide more or less O2 and why?
less. because low O2 levels are needed to drive their breathing.
what is Cor Pulmonale?
Right-sided heart failure. - blood flow through lungs is hard (resulting from alveoli stiffness or airway collapse) - thickens right side of heart - poor oxygenation
characteristics of PNA?
inflammation of lungs that results in: - edema - exudate
PNA: what are the 8 risk factors?
- age - infections - smoking - aspiration - chronic lung probs - immobility - mechanical ventilators - immunocompromised status
3 characteristics that set small bowel obstruction apart from large bowel obstruction:
spasmodic colicky pain instead of constant diffuse pain - visible peristaltic waves rather than significant abd distention - sudden projectile vomiting that relieves pain rather than infrequent vomiting
Differentiate WBC count for appendicitis and peritonitis
Usually, 10-18 x10^9/L for appendicitis >20 x10^9/L for peritonitis
Differentiate temperature levels for appendicitis and peritonitis.
Usually, low fevers (<101) for appendicitis higher fevers (>101) for peritonitis
Differentiate diet prescriptions for IBD versus diverticulitis.
- low fiber diet for IBD - high fiber diet for diverticulitis
Difference in age of pts with IBD versus pts with diverticulitis:
- IBD: age 15-40, younger - Diverticulitis: usually over 50
Major complication for ulcerative colitis:
major complication for Crohn's dz:
T-tube drainage range:
- initially may be up to 500ml/day, then gradually decrease overtime. - NEVER >1L/day
major complication of casts:
major evidence that points to compartment syndrome:
unrelieved pain or pain that is out of proportion to the injury. - other points include paresthesia, pallor, diminished pulses
major complication of tractions:
what characterizes osteomyelitis?
bone pain that is worse with movement - other signs include fever, edema, and erythema
the primary concept of pin care to avoid cross-contamination is:
use one cotton tip swab per pin (cotton swab soaked with peroxide or iodine)
what are 3 LATE signs of neurovascular compromise in a pt with a cast/splint/traction?
polar - cool/cold fingers/toes paralysis of fingers/toes pulses - weak
what are 3 EARLY signs of neurovascular compromise in a pt with a cast/splint/traction?
pain - not relieved w/ elevation or meds paresthesia - numbness or tingling pallor - cap refill time >3 sec, blue fingers/toes
name 3 differences between osteoarthritis and rheumatoid arthritis
RA is bilaterally symmetrical, OA is not - RA pain after rest, OA pain with movement - RA is autoimmune, OA is not
should hormone replacement therapy (HRT) be used on a short-term or long-term basis?
short term, generally <5 years
what is considered excess vaginal postop bleeding following a hysterectomy?
more than 1 saturated pad per 4hrs
what characteristics differentiate BPH from prostate cancer during an digital rectal exam?
BPH: enlarged but elastic Prostate Cancer: hard, irregular
what kind of catheter is used following a prostatectomy or a TURP?
an indwelling 3-way catheter
when do you increase bladder irrigation rate?
when you see bright red blood clots flow out (you need to dilute it)
what is continuous bladder irrigation for?
to keep catheter free of obstruction and to keep the irrigation pink or lighter.
what is the normal PSA level?
what is the priority nursing action immediately following a prostectomy?
maintaining continuous bladder irrigation
what should a woman not use prior to a mammogram?
talcum powder or deodorant
when should a baseline screening mammogram be done?
what are Miotics for and what side effect does it cause?
used for Glaucoma
side effect = blurred vision
what happens to the CNS with multiple sclerosis?
plaque deposits in the white matter that damages myelin sheaths
what's used for definitive diagnosis for MS?
MRI brain and spine (for plaques)
What kind of precaution should be used for pts with chicken pox (Varicella)?
What kind of precaution should be used for pts with TB?
What kind of precaution should be used for pts with disseminated varicella Zoster?
What kind of precaution should be used for pts with measles (Rubeola)?
What kind of precaution should be used for pts with HIB?
What kind of precaution should be used for pts with pertussis?
What kind of precaution should be used for pts with mumps?
What kind of precaution should be used for pts with Rhinovirus?
What kind of precaution should be used for pts with rubella?
What kind of precaution should be used for pts with scarlet fever?
What kind of precaution should be used for pts with C. Diff?
What kind of precaution should be used for pts with congenital rubella?
What kind of precaution should be used for pts with Hep A?
What kind of precaution should be used for pts with shingles?
What kind of precaution should be used for pts with impetigo?
What kind of precaution should be used for pts with MRSA?
What kind of precaution should be used for pts with herpes simplex?
What kind of precaution should be used for pts with rabies?
What kind of precaution should be used for pts with rheumatic fever?
What kind of precaution should be used for pts with West Nile fever?
acute glomerulonephritis usually commonly follows what illness?
what is used to confirm or rule out diagnosis of glomerulonephritis?
what is nephrotic syndrome?
glomerular capillary damage resulting in loss of serum proteins and decreased serum osmotic pressure
3 characteristics of nephrotic syndrome:
proteinuria - HYPOalbuminemia - edema
what happens to serum cholesterol, triglycerides, and LDLs in nephrotic syndrome?
they're all elevated
Laryngeal cancer usually affects what gender and age?