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Exam IV Med Surg
Types of Shock
Hypovolemic
Depleted Volume
Cardiogenic
Pump Failure
Obstructive
Indirect Pump Failure
Distributive
Lost Vascular Tone
Neurogenic
Anaphylactic
Septic
2 mins
Albumin Lab Value
3.5 - 5.5 g/dL
49 secs
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)
3 mins
Dobutamine
Mechanism
Beta-1 Agonist
Inotropic
Indications
Heart Failure
Side Effects
Tachycardia
Arrhythmias
Considerations
Closely Monitor Patients
Other Meds May Increase Potency
1 min
Preoperative Care
Preop Education
Surgical Procedure
NPO
Turn, Cough, Deep Breathe, Incentive Spirometer
Lower Extremity Exercises
Compression Stockings or SCD's
Pain Management
Safety
Informed Consent
Physical Preparation
Preop Checklist
Handoff to Surgery
Universal Precautions
2 mins
Postoperative Care
Head to Toe Assessment
Complications
Hemorrhage
Clotting
Pain
Dehiscence or Evisceration
Respiratory Complications
Paralytic Ileus
Infection
2 mins
Postoperative Fever
5 W's
Wind (Days 1-3)
Atelectasis
Pneumonia
Water (Days 3-5)
Urinary Tract Infection from Catheter
Walking (Days 4-6)
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Wound (Days 5-7)
Infection
Wonder Drugs (Days 7+)
Drugs
2 mins
ECG Interpretation
Rate
Rhythm
P Waves
Upright, Rounded, Before Every QRS
PR Interval (< 0.20 seconds)
Normal QRS (< 0.12 seconds)
2 mins
Parts of an ECG
PQRST
P Wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T Wave
Ventricular Repolarization
2 mins
ECG: Sinus Bradycardia
Rate
< 60 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Atropine
1 min
ECG: Sinus Tachycardia
Rate
> 100 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Treat Underlying Cause
2 mins
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
2 mins
ECG: Atrial Fibrillation
Rate
Variable Rate
Rhythm
Irregular Rhythm
P Wave
No P Wave
PR Interval
No PR Interval
QRS Interval
QRS < 0.12 Seconds
1 min
Endocarditis Assessment
Infection of Inner Layer and Valves
Assessment
Fever
Fatigue
New or Changed Murmurs
Roth's Spots
Splinter Hemorrhages
Janeway Lesions
Osler's Nodes
Considerations
Heart Failure
Embolization
2 mins
Endocarditis Interventions
Interventions
IV Antibiotics
4-6 Weeks
Anticoagulants
Good Hygiene
Considerations
Closely Monitor
Antibiotic Prophylaxis
Dental Procedures
Invasive Procedures
1 min
Acute Pericarditis Assessment
Pericardial Sac Inflammation
Assessment
Sharp Chest Pain
Increased with Inspiration
Pain Decreased by Leaning Forward
Pericardial Friction Rub
Diffuse ST-Elevation
T Wave Inversion
Fever
Considerations
May Be Asymptomatic
Cardiac Tamponade
2 mins
Acute Pericarditis Causes
Idiopathic
Infection
Trauma
Cardiac
Myocardial Infarction
Autoimmune Diseases
Uremia
Tumor
Radiation
2 mins
Unstable Angina
Assessment
Chest Pain with Rest or Exertion
Limits ADLs
> 15 Minutes
Less Likely Relieved by Nitroglycerin
ST Depression
Fatigue
Considerations
Acute Coronary Syndrome (ACS) Treatment
Emergency Treatment
2 mins
Stable Angina
Assessment
Chest Pain with Exertion
Relieved within 15 Minutes
ST Depression
Interventions
Nitroglycerin
Up to 3 Doses q 5 Minutes
Rest
Antiplatelet Medication
CABG
Angioplasty
2 mins
Nitroglycerin
Mechanism of Action
Decreases Preload
Indications
Angina
Up to 3 doses q 5 mins
Side Effects
Headache
Hypotension
Contraindications
Viagra (Sildenafil)
Nursing Considerations
Assess Blood Pressure
Protect From Light
Use Glass Bottle and Special Tubing
Gloves for Applying Topically
2 mins
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