NCM 118 A REVIEW (RANDOM)

 ECG
 3-WAY WATERSEAL BOTTLE:
 For pt. suspected with myocardial
 B1 – for (-) pressure while the lungs
ischemia (poor oxygenated blood) –
in on (+) pressure
there is ST segment depression or
 B2 – for drainage
T-wave inversion.
 B3 – for suction
 MYOCARDIAL INFARCTION
 2-WAY WB:
 Nrsg. Respo: Do continuous cardiac
 B1 – for (-) pressure
monitoring.
 B2 – for drainage & suction
 CARDIAC COMPUTED TOMOGRAPHY – like
 1-WAY WB
CT scan.
 All functions
 This is contraindicated to pts. Who
 ADULT (ETT WITH CUFF) – to keep the ETT
have tachyarrhythmias.
in place/avoid dislodgement.
 Sinus bradycardia – HR is 
 CHILD (ETT W/OUT CUFF) – respiratory
60 bpm
centers of children are not yet fully
 Sinus tachycardia – HR is
developed.
bet. 120-160 bpm
 HOLTER MONITORING – to check for
 Supraventricular
arrythmias; monitor for 24-72 hours.
tachycardia – HR is  160
 CHRONIC OBSTRUCTIVE LUNG DISEASE
bpm
(COLD) – other term for COPD.
 HEMATOCHEZIA – bright red stool
 CHRONIC RESPIRATORY AIRWAY DISEASE
 MELENA – black, tarry stool
(CRAD) – other term for Asthma
 HEMATEMESIS
 HOW TO INFLATE THE CUFF OF ETT? –
 Nrsg. Int – assess the pt.’s status
inflate with air. (not water to avoid
(changes in LOC).
aspiration pneumonia).
 UPPER GI BLEEDING
 CATHETER – for removal, clamp/kink;
 Nrsg. Respo: take into account the
bladder training prior to removal using
lab findings (e.g. RBC, Serum
forceps wrapped with a sterile gauze;
Potassium); meds to be
retained; open if the pt. will urinate or void.
administered before, during, and
 INTRAAORTIC BALLOON PUMP – measure
after endoscopic (?) including IV
the urine output qhr – there should be at
Esomeprazole.
least 30cc of urine.
 Health Teaching: Avoid taking OTC
 CARDIOGENIC SHOCK
drugs such as aspirin which has
 If Lasix/diuretics is given
ingredients that may trigger the
(furosemide) – watch out for the
lacerations to occur or may irritate
serum potassium level of the pt ( the stomach.
3.0 – may cause cardiac  DIABETIC KETOACIDOSIS (DKA)
arrhythmia)
 “Hot and dry, sugar is high” –
 HYPERTENSIVE CRISIS HYPERGLYCEMIA
 Watch out for BP (180 (for  “Cold and clammy, sugar is low” -
systolic) and  120 (for diastolic)). HYPOGLYCEMIA
 Meds: Nitropress (Sodium  S/S – 3Ps:
Nitroprusside) – through IV;  Polydipsia – thirst
Corlopam (Fenoldopam)  Polyuria – urination
 CARDIAC CATHETERIZATION  Polyphagia - appetite
 Nrsg Respo: Always wear gloves  Ketones are present
and assess the groin site (where  Metabolic Alkalosis
the femoral artery is) where the  Treat for risk of serious
catheter is inserted. complications to avoid Diabetic
 Complications: Watch out for Coma
irregular heartbeats.  Type 1 – Non-Insulin Dependent
(more Hypoglycemic)
  Type 2 – Insulin Dependent (more  3 Mgt for AP:
Hyperglycemic) 1. Insert NGT – pt. can’t
 Prio. care for rapid respiration with tolerate normal feeding and
deep inspiration – to avoid due to nausea.
respiratory arrest. 2. NPO – to let the pancreas
 Types of insulin to be administered: rest.
 Regular insulin (usually) - 3. Manage pain by giving
administered through IV. Pethidine or Nubain.
 Rapid-acting – ex: Humalog  Review/verify order for giving of
& Novalog (onset 15 mins / Morphine Sulfate because it is a
works within 1-5 hrs). respiratory depressant which may
 Short-acting – ex: Regular cause respiratory arrest.
Humulin and Novolin  Other than giving analgesics,
(onset 30 mins / works position the pt. on his side and
within 5-7 hrs). elevate the HOB to 45º for comfort.
 Intermediate-acting – ex:  BARIATRIC SURGERY – art and science of
NPH & Lente (onset 1-3 weight management that helps reduce the
hrs / works within 24 hrs). weight of severely obese (BMI is 40) pt.
 Long-acting – ex: Lantus &  Take into account pt.’s body image
Ultralente (onset 6 hrs / distortion - treat
works within 24 hrs). depression/anxiety.
 Premixed Insulin – chronic  INTRAABDOMINAL HYPERTENSION –
patients can inject pressure is created in abdominal cavity.
themselves.  Complication: ABDOMINAL
 Nursing Interventions: COMPARTMENT SYNDROME
 Insulin – subcutaneously  Ischemia
(original) to promote  Leads to muscle
slower absorption and less damage/organ dysfunction
pain.  Mgt: abdominal
 RULE: If the pt. is receiving decompression
2 insulins, always draw the  Meds to reduce abnormal
regular insulin (clear) first. arrhythmias: Manitol and
 GOLDEN RULE FOR Sodium Bicarbonate.
POTASSIUM FOR DKA: “NO  Complication: Bladder is comprised
P(EE) NO K” – means that if – to prevent this, check for any
there is not enough urine transurethral bladder pressure.
output, then do not give  FOR UNSCONSCIOUS PT. IN THE ER
potassium to the pt. to  No relatives – make the doctor affix
prevent damaging of his/her signature to be witnessed
kidneys (renal by another doctor or HCP.
failure/damage).  With relatives – it should be
 LIVER FAILURE nearest kin’s (wife, husband,
 Characteristics: brother, sister, mother, father, etc.)
1. Severe liver dysfunction signature.
2. Hepatic Encephalopathy –  PHYSICAL ASSESSMENT – the top prio
assess for  LOC – intubate the should be assess for the respiratory rate (if
pt. with ETT and/or connect to 25, the pt. is a candidate for mechanical
mechanical ventilation. ventilation).
3. “Liver flap” or “Flapping  RA 10173 (DATA PRIVACY ACT) – main
tremor” context is that the personal data is
 ATTENTION!! – For severe liver considered to be sensitive personal
failure, anything that is given is information.
considered to be POISON for the pt.  PT. W/MECHANICAL VENTILATION W/PEEP
 ACUTE PANCREATITIS OF 5 (which is the highest)
  Assessment to reduce PEEP – pt. 3. Identify barriers in quality of care
develops surgical subcutaneous 4. Modify using creativity for upgrade
emphysema – accumulation of air  NURSE RESEARCHERS – should have good
 Mgt: Prick the site w/needles to interpersonal relationship. However:
release air.  They cannot assume total
 PNEUMONIA – occurs when there is responsibilities in the research.
inflammation (1st sign), fever, cough, etc.  Other members should help and
 Elderly pts. – the 1st sign/s is must have their own
alterations in LOC and dehydration. responsibilities.
 ACUTE RESPIRATORY DISTRESS SYNDROME  MAIN REASON FOR NURSING RESEARCH –
– to know if the pt. is responding well, validating and refining practices; upgrade
check for proper position of the pt. or develop innovations.
w/mechanical ventilation and monitor ABG  EBP (PICOT and SPIDER)
values. 1. Improves pt.’s outcome
 NURSING PRACTICE (PROFESSIONAL 2. Reduce cost
DEVELOPMENT) – consider the ff: 3. Contribute to the practice
1. Latest updates/changes,  CARE BUNDLES – Ex: checklist before
modifications in the nrsg practice performing any procedures.
2. Latest technology, management,  VAP – when pt. is on ventilator for
practices. prolonged period of time.
3. Be an advocate – nurse as mediator  CAUTI – when pt. is on catheter for
between the pt. and family or pt. and prolonged period of time.
HCP. – take everything into acct except  RA 9173 (PHILIPPINE NURSING ACT OF
confusing policies of the hospital. 2002) – scope of nursing practice is that our
 CRITICAL CARE UNIT - improve quality of profession exists to achieve the most
care, patient safety through clinical support. positive outcome keeping in mind our
 Assess pt.’s LOC, personal, and social contract and obligation to our
family values society.
 CRITICAL CARE NURSES – provides care that  Nurses should be: educated,
is always respectful and responsive to the competent, and assumes authority,
needs and values of the pt. and his/her roles, functions, or responsibilities.
wishes.  COMPUTERIZED PROVIDER ORDER ENTRY
 They are experts on: (CPOE) – includes the medications for each
1. Giving good judgment patient, diagnostic exams, laboratory
2. Having respectful behavior findings, EXCEPT: doctor’s professional fee
(GMRC)  CLINICAL GOVERNANCE – report/review
3. Specialized training (speed & any adverse events/misses in our
accuracy) profession for upgrading.
 The action to maintain high standard of  Venous Bleeding – dark red (unoxygenated)
professional decorum is to prioritize pts.  Arterial Bleeding – bright red
with disturbed sensory perception.  Capillary Bleeding – few
 ETHICAL DILEMMAS
1. Gather relevant data
2. Outline ethical issues
3. Goals to modify
 1 principle of ethics – autonomy
(self-governing) – Ex: assess pt. and
consider his/her wishes.
 END STAGE OF LIVER FAILURE – encourage
the pt. to interact with the family for
comfort measures.
 STANDARDS OF PROFESSIONAL PRACTICE
1. Establish competencies
2. Evaluate using EBP