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Parallelize them, give sedation, Respiratory Status, Used only to facilitate intubation or in patients already intuibated. Neuromuscular response should be monitored. Monitor ECG, heart rate, blood pressure. Muscle weakness, respiratory distress. Anticholinestrase is antagonist if overdose happens.
Nondepolarizing drug,
contrindicated in myasthenia gravis,
0.1mg/kg,
onset: 4-6min
duration: 120-180 min
SE: tachycardia, htn, increased perphrial vascular resistance, |
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Sedation/ paralizer, vent, RR, Pulse, BP, apnea, level of sedation, LOC, CNS function, monitor for overdose and (propofolo infusion syndrome)
Is a seditive hypnotic,
Cerebroprotective effects, and decreased MAP
CONTRAINDICATED:
Allergies to eggs/soybeans, state of shock, over the age of 3
Dose: 2-2.5 mg/kg
Onset: 10-20 secons
Duration: 10-15min |
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Versed, seditive, LOC and level of Sedation, BP, PULSE, RR, O2 and intubation equipment always available,
Benzodiazapien:
Decreases CNS activity, amneasia, negative inotrope, mild cerebroprotective effects,
Contraindications: State of shock.
0.1-0.3mg/kg,
onset: 35-45sec
duration:10-15 min |
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Pain, BP, Pulse, RR<
Opiate: decreases CNS activity,
Contra: variable dosing, myesthina gravis, Chest wall ragidity with rapid infusion.
up to 150mg/kg,
onset 45-60sec
duration: 30-60 min |
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Definition
Sucks, short trem parlitic, RR, Nuromuscular response, ECG, HR, BP, monitor for malignant hyperthermia, monitor for muscle weakness and respiratory distress.
Depolarizing drug:
Contra: burns, major crush injuries, devenation syndrome, major nerve or spinal chord injury, sever abd sepsis,
Dose: 1-2mg/kg
onset: 30-60 sec,
duration 4-6min
adverse effects: Malignint hyperthermia, increased ICP, increased intra ocular pressure, arythmias, |
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| Those who need immediate care |
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| Those that can wait 20min-2hrs |
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| Those that can wait longer than 2 hrs |
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| Airway, breathing, circulation, D nero, Exposure (get them naked!) |
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| Continuous monitoring of B/P and are access for arterial blood sampling. Inserted into artery attached to pressure tubing and transducer. Transducer converts pressure in artery into electrical signal that's seen as visible wave form on oscilloscope. Used to stabilize hemodynamic status. |
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| Monitors right atrium or superior vena cava while providing venous access. Changes CVP =hypovolemic shock. Blood returning to right atrium decreases, causing CVP to decrease from baseline levels. |
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| Pulmonary Artery Pressure: |
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| (PAP) ranges from 15-26 mm Hg systolic and 5-15 mm Hg diastolic and are constantly visible on monitor. When balloon at cath tip is inflated, the cath advances and wedges into branch of the pulmonary artery. The tip of the cath senses pressures transmitted from the left atrium which reflect ventricular end diastolic pressure (LVEDP). |
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| Volume of blood ejected by the heart each minute 4-7L/min, Measured using thermodilution method when client has pulmonary arery cath with thermister. 5-10 ml of iced or room temperature IV solution (NS or D5W) is injected into proximal port. Solution mixes with blood in right atrium and travels with flow of blood to heart. A temperature sensitive device located on the tip of the cath in the pulmonary artery registers and senses the change in blood temperature. This info is transmitted to cardiac output computer and displays digital value. |
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| is calculated to adjust for differences in body size) Divid the cardiac output by body surface area. Normal range is 2.7-3.2 l/min/m2 of body surface area. |
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| Impedence Cardiography (ICG) |
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| Flexible, fast acting noninvasive monitoring system that consists of 4 ICG electrodes, 4 ECG electrodes and protable ICG monitor. It measures total impedence (resistance) to the flow of electricity in the heart. It's used to assess, plan, and individualize treatment for patients. It provides measures of thoracic fluid, left ventricular function (cardiac output and cardiac index) and, preload, afterload and contractility of the heart. |
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| intracranial Pressure: Monitoring device placed inside the head which senses pressure inside the brain cavity and sends its measurement to a recording device. |
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| Three ways to monitor ICP: |
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• A thin, flexible tube threaded into one of the two cavities, called lateral ventricles, of the brain (intraventricular catheter)
• A screw or bolt placed just through the skull in the space between the arachnoid membrane and cerebral cortex (subarachnoid screw or bolt)
• A sensor placed into the epidural space beneath the skull (epidural sensor) |
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| This method of medication administration involves the infusion of medication directly into the bone marrow. |
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| What are the nursing consierations for intraosseous infusions? |
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Definition
| Improper needle placement (most common), osteomyelitis, compartment syndrome. |
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| Indications for intraosseous infusions? |
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Definition
| Anyone we are unable to get venious accesess (most commonly infants and toddlers) |
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| Set of rules and regulations that governs they procedures that are carried out. |
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| 12. COBRA laws and safety of transfer – ground and air |
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| Consolidated Omnibus Budget Reconciliation Act of 1985. Have to be safe to transfer even if they have no insurance. |
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| Emergency Medical Treatment and Active Labor Act. Requires hospitals to treat patients at their door no matter what. |
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| Opioid Analgesic. Used for severe pain, pulmonary edema, pain associated with MI. It binds to the opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Metabolized by the liver. Widely distributed, best absorption through rectal, subcut, and IM doses. Systemic absorption occurs after epidural injection. IV has a rapid onset, Half life in adults around 2-4hrs. Use cautiously in head trauma, undiagnosed abdominal pain, severe renal, hepatic, pulmonary disease. IM,IV,SC doses for adults vary 4-10mg Q3-4hrs, for an MI 8-15mg. IV continuous infusion rates can vary greatly up to 400mg/hr have been used. Nursing Management: proper pain assessment pre and post administration. Pt’s on a continuous infusion should have additional bolus doses every 15-30min. Assess LOC, BP, resp rate, constipation. Be aware for potential dependence with prolonged use. |
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| Inotropics, Vasopressor. Used to improve blood pressure, cardiac output, urine output in treatment of shock unresponsive to fluid replacement. Doses 10mcg and under produce renal vasodilation and cardiac stimulation. Doses over 10mcg causes renal vasoconstriction. IV only due to extremely short 10min duration, widely distributed does not cross the blood brain barrier. Metabolized in liver, kidneys and plasma, Half life 2minutes. Contraindicated in Tachyarrhythmias, hypersensitivities to bisulfites, pheochromocytoma. Use cautiously in hypovolemia, MI, occlusive vascular diseases. Renal vasodilation dose (0.5-3mcg/kg/min). Cardiac stimulation 2-10mcg/kg/min. Alpha-adrenergic 10mcg/kg/min. Needs to be diluted prior to administration Nursing Management: Should be administered into large vein and assess site frequently. Monitor BP, HR, EKG, pulmonary capillary wedge pressure, cardiac output, CVP, urinary output. Increase rate if hypotension occurs, report changes in vitals. |
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| antiarrhythmics, bronchodilators, adrenergic. Used for management of bronchospasm during anesthesia, treatment of asthma or COPD. Beta(cardiac)-adrenergic action results in positive inotropic and chronotropic effects. Results in accumulation of cAMP at the beta-adrenergic receptors. Well absorbed, unknown distribution, metabolism in lung, liver. 50% is excreted unchanged by kidneys. 2.5-5min half life. Use cautiously in cardiovascular disease. Side effects of nervousness, restlessness, tremors, arrhythmias, angina, hypertension. IV Dosing: 0.02-0.06mg for cardiac arrest and 0.01-0.02mg for bronchospasm. Nursing Management: assess lung sounds and resp pattern, BP, HR. Monitor pulmonary function. |
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| Vasodilators (Nesiritied): |
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| Used with acute decompensated CHF in hospitalized pt’s with dyspnea. Binds to receptors in vascular smooth muscle and endothelial cells and causes smooth muscle cell relaxation and dilation of veins and arteries. Causes a reduction in pulmonary capillary wedge pressure and systemic arterial pressure. Half life 18min. cleared from circulation by binding to cell surface and renal filtration. Contraindicated in cardiogenic shock. Systolic BP under 90, low cardiac filling pressure, valvular stenosis, cardiomyopathy. Use cautiously with CHF. IV only 2mcg/kg bolus followed by 0.01mcg/kg/min continuous infusion. Nesiritied binds to heparin so it must be administered in a separate line. Nursing Management: monitor BP, HR, EKG, resp rate, cardiac index, PCWP, CVP. May cause hypotension, manage with body positioning and IV fluids. Monitor I&O and s/s of CHF. |
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| AVP antagonists (tolvaptan, conivaptan, Vaprisol): |
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| Electrolyte modifiers, vasopressin antagonists. Used to treat hypervolemic hyponatremia in hospitalized pt’s, hypothyroidism, pulmonary disorders, adrenal insufficiencies. Antagonizes vasopressin at V2 receptor sites in the renal collecting ducts, resulting in excretion of free water. Restoration of normal fluid and electrolyte status. 99%protein bound. Metabolized solely by the CYP3A4, 83%excreted as metabolites in feces. 5hr half life. Contraindicated in hypovolemia, Use cautiously in pt’s with impaired hepatic or renal function. Dose: IV 20mg/day after loading dose. Nursing Management: Administer IV in large vein and rotate IV site every 24hrs to minimize vascular irritation risk. Only dilute with D5W. Assess vital signs, discontinue if hypovolemia or hypotension occur, treatment may resume once pt stabilizes. |
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non-opioid analgesic
Well absorbed, small intestine (PO) Distributes widely, rapidly, crosses placenta. It is metabolized in the liver. Inactive metabolites are excreted through kidneys, urine, and in breast milk. Half life 15-20 min in low doses, 30h in high doses.
Blocks pain impulses in CNS, inhibits prostaglandin synthesis producing analgesic, anti-inflammatory, antipyretic effects, and inhibits platelet aggregation.
Onset PO 15-30 minutes, Peak 1-2 hours, Duration 4-6 hours.
Adult dose stroke prophylaxis, MI PO 81-650mg/day in divided doses, q4-6h.
Nursing mgmt – Monitor liver, renal function labs, I&O, ototoxicity, vision changes, bleeding, edema, drug interactions, limit alcohol (GI bleeding), do not give to children or teens, do not crush enteric product. |
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Inotropic/vasodilator agent with phosphodiesterase activity.
Completely absorbed, unknown distribution, it is metabolized in the liver (50%), excreted by kidneys, unchanged (83%), metabolites (12%) Half life is 2.4h, increased in CHF.
Positive intotropic agent with vasodilator properties; increases contractility of cardiac muscle; reduces preload and afterload by direct relaxation of vascular smooth muscle; increases myocardial contractility. Used for short term management of advanced CHF that has not responded to other medication; can be used with digitalis products.
Onset 2-5min Peak 10min, duration variable
Adult dose: IV bol 50mcg/kg given over 10 minutes.
Nsg. mgmt- monitor electrolytes, bp and pulse, ecg continuously during iv, watch for dysrhythmia, monitor for extravasation, change site q48h. Pt. education r/t orthostatic hypotension, and hypokalemia. |
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Adrenergic direct-acting beta antagonist, inotropic agent, cardiac stimulant
Completely absorbed, unknown distribution, it is metabolized in the liver, excreted by kidneys, and has a half life of 2min.
It causes increased contractility, increased cardiac output without marked increase in heart rate by acting on the beta1 receptors in heart. Effective for cardiac decompensation due to organic heart disease or cardiac surgery.
Onset 1-5min, peak 10min, duration <10min.
Doses: Adult IV inf 2.5-10mcg/kg/min; may increase to 40mcg/kg/min if needed.
Nsg. mgmt- assess for hypovolemia, monitor ecg and bp continously, assess for O2 or perfusion deficit, monitor bp and pulse, alt, ast bilirubin daily. Sulfite sensitivity warning, may be fatal. educate pt. to report dyspnea, headache, iv site discomfort, chest pain numbness of extremities. |
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| Nitroprusside Sodium (Nipride): |
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Antihypertensive, vasodilator
Complete bioavailability (absorption), distribution not known, metabolized in RBC’s, tissues, excreted by kidneys, half life of 3 days.
Directly relaxes arteriolar, venous smooth muscle, resulting in reduction in cardiac preload, afterload. Decreased BP in hypertensive crisis. Used to decrease bleeding by creating hypotension during surgery, acute CHF.
Onset 1-2 min, peak rapid, duration 1-10min.
Doses: IV inf dissolve 50mg in 2-3ml of D5W, then dilute in 250-1000ml of D5W, run at 0.5-8mcg/kg/min.
Nsg. mgmt – monitor bp q5minx2h, then q1hx2h, monitor pulse q4h, jvd q4h, ecg continuously, labs, I&O. Light inactivates drug, wrap iv bag in foil or other opaque material. Faint brown tint to solution is normal, blue or brown is not. |
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| Argenine Vasopressin (AVP): |
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Definition
Pituitary hormone
Erratically absorbed, widely distributed in extracellular fluid, metabolized rapidly by the liver, excreted by the kidneys unchanged, half life is 10-20min.
Tx of ventricular fibrillation. Increases coronary artery perfusion during cpr. Promotes reabsorption of water by action on renal tubular epithelium, causes vasoconstriction on muscles in the GI system.
Onset IV unknown, IM 1h, peak unknown, duration 3-8h both IV and IM
Doses: Adult IM/subq 5-10units bid-qid prn; (drug book lists no IV dose)
Nsg. mgmt – monitor pulse, bp when giving IV or subq, monitor I&O, daily weights. |
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| What are indications for intubation |
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Definition
| When loss of reflex present (anesthesia, meds, disese or decreased LOC), provide positive pressure or high oxygent conintration, bypass airway obstruction, facliitate suctioning of secreations. |
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Noninvasive ventilation - Low-flow delivery systems. A simple face mask is used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency. A minimum flow rate of 5 L/min is needed to prevent the rebreathing of exhaled air.
[image] |
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best for the spontaneously breathing client. A non-rebreather mask provides the highest oxygen level of the low-flow systems and can deliver an Fio2 greater than 90%, depending on the client's breathing pattern. This type of mask is often used with clients whose respiratory status is unstable and who may require intubation. The non-rebreather mask has a one-way valve between the mask and the reservoir and two flaps over the exhalation ports. The valve allows the client to draw all needed oxygen from the reservoir bag, and the flaps prevent room air from entering through the exhalation ports.
[image] |
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Used for the comatose and semiconscious if tolerated. Oropharyngeal airways are usually indicated for unconscious patients, because there is a high probability that the device would stimulate a conscious patient's gag reflex. [image] |
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Placed through the nare and are mostly used when the patient has a gag reflex, due to the fact that it can be used on a conscious patient. |
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| f the client requires long-term assistance from an artificial airway, a tracheostomy is considered. A surgical incision is made into the trachea, and a short artificial airway (a tracheostomy tube) is inserted. |
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| Noninvasive positive-pressure ventilation (NPPV) is a technique using positive pressure to keep alveoli open and improve gas exchange without the need for airway intubation. This type of ventilation can deliver oxygen or may just use room air. |
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| used as short-term artificial airways to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions. ET tubes are generally removed within 14 days, however, they may be used for a longer period of time if the client is showing progress toward weaning from mechanical ventilation and extubation. After endotracheal intubation, a mechanical ventilator is employed. Initially, oxygen in high concentration (Fio2 100%) is administered; lower concentrations may be ordered after the client's condition has improved. |
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| What are the indications for a trachyostomy |
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Definition
-Acute airway obstructionwhen oral or nasal intubation is not feasible
-Airway protection
-Prolonged intubation or need of mechanical ventialation
-Decreased airway dead space in combination with other indicators
- Control of pulmonary secretions refractory to conventional methods
-Airway recontruction after trauma of cancer
- Obstructive sleep apnea refractory to conventional therapy |
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| What are the complications of a trachyostomy? |
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Definition
Tracheomalacia: Constant pressure exerted by the cuff causes tracheal dialation and erosion of cartilage
-Tracheal stenosis: Narrowed tracheal lumen is due to scar formation from irritation of the tracheal mucosa by the cuff.
- Tracheoesophageal fistula : Excessive cuff pressure causes erosion of the posterior wall of the trachea. A hole is created between the trachea and the anterior esophagus.
- Trachea-innominate artery fistula: A malpostioned tibe causes its distal tip tp push against the lateral wall of the tracheostomy. Continued pressure causes necrosis and erosion of the innominate artery. THIS IS A MEDICAL EMERGENCY! |
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| Nursing managment for a Tracheostomy? |
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Definition
| Assess & monitor O2 and ventilation (respiratory rate & effort) and VS hourly (if new post op trach); thickness, quantity, odor, and color of mucous secretions; stoma & skin surrounding for signs of inflammation or infection. Provide humidification (if on a vent) & hydration to thin secretions & decrease risk of mucus plugging. Maintain surgical aseptic technique when suctioning to prevent infection. Provide call light. Provide methods of communication. Provide tracheostomy care every 8 hours including: suctioning, remove old dressing, use cotton-tipped applicator & gauze pads to clean exposed outer cannula surfaces. Begin with hydrogen peroxide and follow by NS. Use surgical aseptic technique, remove & clean the inner cannula. Clean stoma site & tracheostomy plate with hydrogen peroxide followed by NS. Place split 4X4 dressing around trach. Change ties prn. Document type of secretions and skin. Provide oral hygiene every 2 hrs. Minimize dust in client's room. Position upright when eating. |
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| nursing management for Endotracheal intubation: |
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Definition
| Maintain a patent airway by assessing position & integrity of tube, apply protective barriers (soft wrist restraints) according to hospital protocol to prevent self-extubation, use caution when moving the client, suction oral & tracheal secretions to maintain tube patency, support ventilator tubing to prevent mucosal erosion & displacement. Assess respiratory status every 1 to 2 hours & prn: breath sounds, respiratory effort, spontaneous breaths. Suction to clear secretions prn. Reposition client to promote mobility of secretions. Maintain adequate (but not excessive) volume in cuff of endotracheal tube. Assess cuff pressure at least every 8 hrs. Assess for air leak around cuff. Administer meds as prescribed: analgesics, sedatives, etc. Provide methods of communication. Repositoin endo tube every 24 hrs according to protocol. Assess for skin breakdown. Provide adequate nutrition. Continually monitor during the weaning process for signs of weaning intolerance (RR >30 or <8, BP or heart changes, O2 <90%, labored breathing, restlessness, anxiety, decreased LOC. Suction oropharynx and trachea prior to extubation. |
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| he above can also apply to this depending on the way the pt. is being ventilated. Maintain a patent airway. Assess position & integrity of tube. Support ventilarot tubing. Oral hygiene is very important. Provide ways for communication. Comfort. Prone if on a PEEP. Monitor the ventilation monitors for right settings. Titrate prn according to MD orders. Continuous pulse oximetry. Provide nutrition. Suctioning. Nonpharmacologic measures for comfort such as music, reduce sound, massage etc. Explain all procedures. Possible soft restraints. |
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Definition
E. Expose - remove clothes F. Fahrenheit - keep warm - TX - G. Get a complete set of vital signs - & get gatgets, H. (head to toe) History - further Pt info, allergies, current meds, prehospital, PMH, include LMP, family input. I. Inspection - Head - to Toe - Inspect, auscultate, percuss, and palpate entire body - (DO NOT FORGET THE POSTERIOR PORTION OF THE BODY) |
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| Important with Chest pain |
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Definition
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Definition
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| What lab is also important with DKA? |
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Definition
| Potaissum levels * watch heart!, maybe give bicarb. |
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Uses a flush system for patency |
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Definition
intra-arterial pressure monitoring pulmonary artery pressure monitoring central venous pressure monitoring |
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Uses a transducer to convert the pressure into an electrical signal. |
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Definition
1 intra-arterial pressure monitoring | 2. central venous pressure monitoring | 3. pulmonary artery pressure monitoring ICP |
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2. central venous pressure monitoring | 3. pulmonary artery pressure monitoring |
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Definition
intra-arterial pressure monitoring | cardiac output |
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Uses Allen test before placement |
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Definition
intra-arterial pressure monitoring |
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Used for obtaining lab samples |
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Definition
1. intra-arterial pressure monitoring | 2. central venous pressure monitoring | 3. pulmonary artery pressure monitoring |
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Uses thermodilution for calculation |
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Definition
3. pulmonary artery pressure monitoring | 4. cardiac output | 5. cardiac index |
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pulmonary artery pressure monitoring AKA? |
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Definition
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Liter of blood per min ¸ m2 |
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Definition
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Measures CO, CI, SV, SVR, and various measures of contractility |
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Definition
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Might be a intraventricular catheter or subarachnoid bolt, epidural or subdural catheter or fiberoptic transducer |
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Definition
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Altered readings from coughing, shivering, pressure or neck rotation |
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Definition
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Term
Jugular venous bulb oximetry |
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Definition
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Term
Assist-control (AC) ventilation |
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Definition
Most common Takes over the work of breathing. If client does not trigger, will delliver minimum amt Responds to inspiration Delivers a preset tidal volume Risk for hyperventilation r/t no change in tidal vol |
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synchronized intermittent mandatory ventilation (SIMV) |
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Definition
Tidal volume and rate present But can also take breaths on own. Used as weaning mode. |
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Bi-level positive airway pressure (BiPAP) |
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Definition
Noninvasive Delivers its pressure and air when breathing in |
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Definition
| Continuious pressure that helps keep airway open |
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Definition
volume of air the client receives with each breath average is 7-10ml/kg |
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Definition
Fraction of Inspired Oxygen oxygen level delivered to the client Needs to be warmed to body temperature and humidified. |
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Definition
Volumes of air that are 1.5-2x norm 6-10x hr Not shown to be usefull. |
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Definition
Positive end-expiratory pressure. Pressure during expiratory phase, Severe gas exchange problem if used. |
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Term
How often to asses resperitory with vent? |
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Definition
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| Assess areas around tubes every ? hours? |
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Definition
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Definition
Peak airway (inspiratory) pressure Pressure needed by the vent to deliver a set tidal volume Can cause barotrauma so alarm is set. |
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How often for mouth care? |
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Definition
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| High pressure alarms posibilies? |
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Definition
fighting machine: kinked vent tubing; bronchospasm; pneumo/hemothorax; pleural effusion; pul edema |
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Definition
system leak or disconnection. |
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Definition
- Barotrauma
- Nosocomial Pneumonia
- Oxygen Toxicity; Pulmonary Fibrosis
- CV Effects
- GI Effects
- Sleep Disorders
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| How to prevent complications from vents. |
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Definition
- Get patient moving!
- Monitor hemodynamic effects of ventilation.
- Suction only as needed.
- Assess secretions.
- Clear tubing of water buildup.
- Ensure proper nutrition and adequate hydration.
- Oral care with chlorhexidine
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Definition
| a set tidal volume and set rate delivered to client |
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Definition
| Means there is an elevation of Co2 |
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Definition
Central Venous Pressure,
PRE-LOAD!!!!!! |
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Definition
Pulmonary capilary wedge pressure.
Estimate of pressure in left arteriol. |
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Definition
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Term
| Neuromuscular blocking agents |
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Definition
| Pavulon, succinylcholine, etc. |
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Term
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Definition
| Ativan, versed, MS, fentanyl, propofol, etc. |
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