Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
Severe Sepsis and Septic Shock Assessment
- Microthrombi
- DIC
- Decreased Oxygen Saturation
- Decreased WBC
- Oliguria
- High Output Heart Failure
- Multiple Organ Failure
Sepsis Assessment
- Systemic Infectious Process
- Fever
- Hypotension
- Change in LOC
- Increased WBC
- Shift to the Left
- Tachycardia
- Tachypnea
- Hyperglycemia
- Edema
Hypersensitivity Type I
- Previous Antigen Exposure
- Immediate Reaction
- IgE Cross-linking
- Presensitized Mast Cells
- Histamine Release
- Vasodilation
- Anaphylaxis
- Allergies
- Epinephrine
Anaphylaxis Intervention
- Assess Airway and Oxygen Needs
- Reassure Patient with Anxiety
- Supine Position
- Methylprednisolone (Solu-medrol)
- Epinephrine
- Diphenhydramine (Benadryl)
- Medical Alert Bracelet
Pulmonary Embolism Causes
- FAT BAT Mnemonic
- Fat
- Air
- Deep Vein Thrombosis (DVT)
- Bacteria
- Amniotic Fluid
- Tumor
- Hypercoagulable
- Central Venous Lines
- Immobilized
Burns Considerations
- Maintain Body Temperature
- Increased Risk of Infection
- Venous Thromboembolism (VTE) Prophylaxis
- Curling's Ulcer
- Excision and Grafting
- Adequate Nutrition
- Contractures
Respiratory Acidosis Assessment
- Decreased pH < 7.35
- Increased PaCO2 > 45
- Reduced Respirations
- Anxiety
- Change in LOC
- Tachycardia
- Cyanosis
- Increased Electrolytes
- ECG Changes
- Muscle Weakness
- Hyporeflexia
Respiratory Alkalosis Assessment
- Increased pH > 7.45
- Decreased PaCO2 < 35 mmHg
- Hyperventilation
- Brainstem Stimulation
- Head Injury
- Shock
- Lightheadedness
- Tingling Lips or Fingers
- Trousseau's
- Chvostek's Sign
- Anxiety
Systemic Inflammatory Response Syndrome (SIRS) Criteria
- Temperature < 36C or > 38C
- Pulse > 90 beats per minute
- Respirations > 20/min or PCO2 < 32
- WBC < 4,000 or > 12,000 or 10% bands
- Subset of Cytokine Storm and Related to Sepsis
Types of Blood Products
- Whole Blood
- Packed Red Blood Cells
- Fresh Frozen Plasma
- Immunoglobulins
- Clotting Factors
- Albumin
- Platelets
- Use within 24 Hours
- Washing Removes Antibodies
- Irradiation Destroys WBCs
IV Solutions
- Hypotonic (< 280 mOsm/L)
- 1/4 Normal Saline (0.225% NaCl)
- 1/2 Normal Saline (0.45% NaCl)
- Isotonic (280-300 mOsm)
- Normal Saline (0.9% NaCl)
- Lactated Ringer's (LR)
- Dextrose 5% in Water (D5W)
- Hypertonic (> 300 mOsm)
- 3% or 5% NaCl
- Dextrose 5% in 0.45% NaCl
- Dextrose 10% in Water (D10W)
Opioids Overview
- Pain
- Weaning
- Cough
- Diarrhea
- Agonists at Mu (μ), Kappa (Κ), and Delta (δ) Receptors
- Decrease Synaptic Transmission
- Respiratory Depression
- Addiction
- Miosis
- Constipation
Nitroprusside
- Direct Release of NO
- Increase cGMP
- Short Half-Life
- Malignant Hypertension
- Cyanide Toxicity
Angiotensin-Converting Enzyme (ACE) Inhibitors
- "-pril" Suffix
- Block Renin Angiotensin-Aldosterone System (RAAS)
- Hypertension
- Heart Failure
- Dry Non-productive Cough
- Hypotension
- Dizziness
- Possible Hyperkalemia
- Angioedema
- Slowly Change Position
- Do Not Stop Abruptly
Angiotensin II Receptor Blockers (ARBs)
- Ends in "-sartan"
- Blocks Angiotensin II Receptor
- Hypertension
- Angioedema
- Renal Artery Stenosis
- Pregnancy
Beta Blockers
- "-olol" suffix
- Decreases Heart Rate and Contractility
- Decreases Peripheral Vascular Resistance
- Decreases Renin Release
- Hypertension
- Heart Failure
- Angina Pectoris
- Asthma and Heart Block Patients
- Assess Blood Pressure and Heart Rate
- Masking Signs of Hypoglycemia
- Do Not Stop Abruptly
Calcium Channel Blockers (Verapamil and Diltiazem)
- Slows AV Conduction
- Angina Pectoris
- Arrhythmias
- Essential Hypertension
- Bradycardia
- Hypotension
- Constipation
- Peripheral Edema
- Gingival Hyperplasia
- Medication Education
Milrinone and Amrinone
- Phosphodiesterase 3 Inhibitor
- Potentiates Beta Receptor Effects
- Inotrope
- Vasodilator
- Acute Decompensated Heart Failure
- Ventricular Arrhythmias
- Hypotension
Patient Position Overview
- Trochanter Roll
- Trapeze Bar
- Ankle-Foot Orthotic (AFO) Devices
- Fowlers Position
- Supine Position
- Trendelenburg
- Side-Lying Position
- Prone Position
- Sims' Position
- Reposition q2 Hours/Prevent Skin Breakdown
- Confirm Body Alignment
Vital Signs - Adult
- Temperature (96.8-100.4 Degrees F) (36-38 Degrees C)
- Rectal
- Tympanic
- Oral
- Axillary
- Temporal
- Respiration (12-20)
- Oxygen Saturation (95%-100%)
- Pulse (60-100)
- Blood Pressure (<120/80)
- Pain
Alveolar Gas Equation
- Partial Pressure of Alveolar Oxygen (PAO2)
- Partial Pressure of Oxygen in the Inspired Air (PIO2)
- PIO2 Normally Approximated = 150 mmHg
- Arterial Partial Pressure of CO2 (PaCO2)
- Respiratory Quotient (R)
- R Normally Approximated = 0.8
- PAO2 = PIO2 - (PaCO2/R)
Patient Needs
- Allergy to Banana, Papaya, Chestnuts and Kiwi
- Asthma
- Spina Bifida
- History of Multiple Surgical Procedures
- Call Light within Reach
- Eliminate Physical Hazards
- Leave Items within Reach
- Bed in Low Position
- Side Rails Up
- Patient Safety
- Health Promotion and Maintenance
- Psychosocial Integrity
Blood Transfusion Administration
- Proper Patient Identification
- Large Bore Needle
- Y Tubing
- Baseline Vital Signs
- Slow IV Infusion
- Monitor During First 15 Minutes or 50 mL of Blood
- Monitor for Reactions
- Do Not Add Anything To Same IV Line
- No Dextrose or Lactated Ringers
- Jehovah's Witnesses, No Transfusions
Transfusion Reactions
- Acute Hemolytic
- Febrile, Non-Hemolytic
- Mild Allergic
- Anaphylactic
- Circulatory Overload
- Sepsis Reaction
- Transfusion-Related Acute Lung Injury (TRALI)
- Massive Blood Transfusion