Emergency Nursing Made Extremely Easy, Second Edition will help the nurse improve these vital skills. I'm proud to introduce you to the newest edition of Emergency Nursing Made Incredibly Easy—a great tool to help you navigate the challenging yet rewarding world of emergency nursing.
Meet the emergency nurse
What do you do?
Where do you work?
What makes you special?
Advocacy
Role call
Stuck in the middle
Clinical judgment
Why be critical?
Developing critical thinking skills
Always asking questions
I realize we have different ideas. about emergency care, but let's do what's best for acts as a liaison between patient and family and other members of the healthcare team. respects the patient's values and cultures • acts in the patient's best interest. harm prevention in the community by educating families about poison safety, use of car supports and safe sleeping tips for infants to prevent sudden infant death syndrome. No matter what it looks like, make sure you put your critical thinking on for the next steps. you are not familiar, look it up and read about it.
Critical thinking and the nursing process
In addition to the answers to diagnosis-related questions, also read the following: If you are not familiar with the medications or treatments, look them up in a trusted source or consult a colleague.).
Caring practice
Collaboration
Cultural diversity
Keep an open mind
Education
Staff as students
Becoming an emergency nurse
Learning by doing
Gaining credentials
Help wanted
Safety first
What’s in it for me?
Nursing responsibilities
Assessment
Planning
What’s the problem?
Implementation
A call to intervene
Evaluation
Emergency essentials
Information station
Danger details
Patient particulars
Injuries sustained
Vital vitals
Systematic systems
Primary survey
A is for Airway
Insert a nasopharyngeal or oropharyngeal airway if necessary; however, remember that an oropharyngeal airway can only be used on an unconscious patient.
Primary assessment of the trauma patient
If a nasopharyngeal or oropharyngeal airway does not provide an open airway, the patient may require intubation.
B is for Breathing
C is for Circulation
D is for Disability
E is for Exposure and Environment
Remember that the primary ABCDE survey is a rapid assessment designed to identify life-threatening emergencies that need to be treated before the assessment can proceed.
Secondary survey
Family matters
A little TLC
History counts
Triage
Patients who can be assessed as Level II include those with head injuries, chest pain, stroke, asthma, and sexual assault injuries. Such patients may report to the ED with signs of infection, mild respiratory distress, or moderate pain.
Once divided
Many people with non-urgent conditions come to the ED because it is their only source of medical care; this increase in non-urgent cases has necessitated a means to quickly identify and treat those patients with more serious conditions. The triage nurse must be able to quickly assess the nature and urgency of the problems for many patients and prioritize their care based on that assessment.
Stay in touch
Multidisciplinary teamwork
The whole goal
Team huddle
Working with registered nurses
The buddy system
Working with doctors
Working with advanced practice nurses
Meet the team
The roles of a lifetime
On a role
Working with licensed practical nurses
Working with respiratory therapists
Respiration-related roles
Clinical tools
Clinical pathways
Follow the path
Tried and true
Outlines and timelines
Practice guidelines
Let an expert be your guide
The evidence is in
Consider the source
Protocols
First things first
Input from experts
Transport
Not so simple
Interfacility transport
ED on wheels (or wings)
Movin’ out
Cha-ching
Intrafacility transport
Movin’ in
Communication
All in the know
Best practices
Best for all concerned
Emergency research
Share and share alike
Evidence-based care
Research and nursing
Conduct a literature review. The goal of this step is to see what has been published about the identified problem
Collect data. After the study is approved, the nurse can begin conducting the study and collecting the data
Analyze the data. The nurse analyzes the data and states the conclusions derived from the analysis
An evidence-based example
First, last, and always
The purpose of the multidisciplinary team is comprehensive care of the emergency patient. Although evidence-based practices can confirm or refute traditional practice, their purpose is to improve patient outcomes.
Holistic care
What is holistic health care?
A new dimension
Holistic care issues
Patient and family issues
Family ties
Slipping on emotional turmoil
Circle out of round
Unprepared for the worst
Lend a hand
Lend an ear, too
Because you asked
Living with the decision
Cultural considerations
Consider culture
Cognitive issues
Fair to compare
It’s a factor
Invasion of personal space
Assessing cultural considerations
Medications
Pain control issues
Help is at hand
Don’t be fooled
Choose a tool
Silent suffering
Body and mind
Pain particulars
Pharmacologic pain management
Nonopioids are number 1
Common pain-rating scales
Opioid option
Adjuvants are all right
The image gives me a break away .. from the pain. may imagine himself on the beach as you describe the sounds of waves and birds and the feeling of warm sun and a breeze on the patient's skin.).
A trio of opioids
Sensory input
Too much or too little
Ethics issues
The value of values
Code of ethics
End-of-life decisions
Unsolvable mysteries
A question of quality
Consulting the committee
In case of cardiac arrest (sudden stopping of the heart), an emergency patient may be described with a status code. When cardiac arrest occurs, you must ensure that resuscitative efforts are initiated or that unwanted resuscitation does not occur.
Who decides?
CPR may be effective in reestablishing a heartbeat, but may still be considered useless because it does not change the patient's outcome. This status code describes the orders written by the physician and describes which resuscitation measures should be performed by the nurse and should be based on the patient's wishes regarding resuscitation measures.
Where there’s a will, there’s a law
It takes two
Standards deviation
Donations accepted
Culture affects, among other things, the patient's and relatives' feelings about illness, pain and problems at the end of life. Nurses should pay particular attention to assessing for nonverbal signs of pain in an unconscious patient.
Neurologic emergencies
Understanding neurologic emergencies
Check the records
History
Friends and family fill in
Current health
Common complaints
Details, please
Previous health
Lifestyle
Physical examination
Top-to-bottom examination
Mental status
No easy answers
Three-part exam
Quick check of mental status
Descriptions and definitions
Looking at LOC
It’s hard to say
Language changes
When, then who
Using the Glasgow Coma Scale
Thought content
Insight on insight
Lost in emotion
Cranial nerve function
Under pressure
Depression and elderly
Identifying cranial nerves
Get on some other nerves
See about sight
To assess the oculomotor nerve, check pupil size, pupil shape, direct and consensual response to light and gaze directions. When assessing pupil size, look for trends such as a gradual change in the size of a pupil or the appearance of uneven pupils.
Funny face
Bouncing and spinning
Check the pipes
Shrug it off
Recognizing pupillary changes
Test tongue toughness
Sensory function
This is gonna hurt
Motor function
Feats of strength
Grace and gait
Extreme coordination
Present and absent actions
Superficially speaking
To test the plantar reflex, use an applicator stick, tongue blade, reflex hammer handle, or wrench and slowly stroke the side of the patient's sole from the heel to the big toe. The upward movement of the big toe and the fanning of the other toes – called the Babinski reflex – are abnormal.
Write it down
To test the pharyngeal reflex of CN IX and CN X, instruct the patient to open his mouth wide. To test the abdominal reflex and invulnerability of the T8, T9, and T10 thoracic spine segments, use the tip of the handle on the reflex hammer to tap one side and then op-.
Diagnostic tests
Imaging studies
Babinski reflex in infants
Angiography
Steady, Freddie
Computed tomography spine scanning
Computed tomography brain scanning
Magnetic resonance imaging
Sharper images
Spinal radiographs
If ordered, give the patient an analgesic before the procedure if they have existing pain to make them more comfortable. Remove the patient's cervical collar as soon as cervical x-rays show no damage and a written order for removal has been obtained.
Other tests
Lumbar puncture
Why do it?
Contraindications and cautions
Treatments
Heads up!
Surgery
Be ready before and after
Craniotomy
Selected drugs used in neurologic emergencies
Selected drugs used in neurologic emergencies (continued)
Condition and complexity count
Explain that he will likely be transferred to the intensive care unit initially for close monitoring, will wake up with a bandage on his head to protect the incision, and may have a surgical drain. Provide emotional support to the patient and his family as they deal with the concept of surgery.
Cerebral aneurysm repair
Common disorders
Traumatic brain injury
To put it bluntly
Open and exposed
On the decline
What causes it
How it happens
Case closed
Contusions and lacerations occur as the soft tissue of the brain slides over the rough bones of the skull, including the base of the skull. The brain can also withstand rotational shear forces, which are particularly damaging to the brain.
What to look for
What tests tell you
How it’s treated
It’s surgical
It’s supportive
Hidden hematoma
What to do
Metabolic medicine
Types of head injury
Short-term disruption of the reticular activating system that may or may not be associated with loss of consciousness. Immediate and profound loss of consciousness for a minimum of 6 hours with possible decerebrate or decorticate posture; the consequences of injury can be severe and are associated with residual neurological dysfunction.
Types of head injury (continued)
Seizure watch
Individuals with anterior fossa skull fractures may have periorbital ecchymosis (spring bear eyes), anosmia (loss of smell due to first cranial nerve involvement), and pupillary abnormalities (second and third cranial nerve involvement). CSF rhinorrhea (leakage through the nose), CSF otorrhea (leakage from the ear), hemotympanum (blood collection at the eardrum), ecchymosis over the mastoid bone (battle sign), and facial paralysis (seventh cranial nerve injury) accompany skull fractures.
Increased intracranial pressure
Discontinuity and displacement of bony structures occur in severe fractures, but most skull fractures are non-displaced. Signs of medullary dysfunction, such as cardiovascular and respiratory failure, accompany skull fracture at the back of the fossa.
Tip the scales
Elevated ICP can be caused by any condition that increases any of the three components of the intracranial vault. Under normal circumstances, a change in the volume of one of the intracranial contents causes a reciprocal change in one or more of the components to maintain a stable pressure.
After a concussion
Varied LOC (Initially) (The patient may become restless, anxious, or quiet, or you may notice that he needs increased stimulation to be awakened.). The patient with increased ICP typically undergoes diagnostic testing to determine the underlying cause of the problem.
What to avoid
Seizures
Primary and secondary
A CT scan may indicate abnormalities in the internal brain structures, such as a tumor or cyst, but most patients with an epileptic seizure will have a normal CT scan of the brain. MRI can indicate abnormalities in the internal brain structures, but is not indicated in an emergent situation.
Continuous
The hallmark of an epileptic disorder is recurrent seizures, which can be classified as partial or generalized. Vagus nerve stimulation is also becoming a popular option for the long-term treatment of patients with certain seizure disorders.
What to do for the patient with a generalized tonic–clonic seizure
If multidrug therapy fails, treatment of chronic seizures may include surgical removal of a focal lesion or ablation of a nerve pathway to achieve long-term seizure reduction.
Identifying types of seizures
Monitor a patient receiving anticonvulsants for signs of toxicity such as nystagmus, ataxia, lethargy, dizziness, drowsiness, slurred speech, irritability, nausea, and vomiting. Monitor vital signs continuously during the infusion and for 10 to 20 minutes after the infusion is complete.
Tonic–clonic seizure interventions
Status epilepticus
If the patient has a history of anticonvulsant use, measure a drug level and send the sample to the laboratory. Turn the patient or patient's head to the side to allow secretions to drain.
Spinal cord injury
After the seizure, reassure the patient that he is okay, orient him to time and place, and inform him that he has had a seizure.
Dangerous damage
Specifically speaking
Types of spinal cord injury
The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent further cord damage. If the patient has a helmet in place, remove it if possible, according to facility policy.
Distention prevention
Stroke
The sooner the better
Number three
Risk factor facts
Ischemic stroke
Hemorrhagic stroke
TIA and older adults
If the area of bleeding is small or located in non-inhibitory tissue, the patient may have minimal neurologic deficits. Even if the pressure returns to normal, it may be too late to save brain cells.
Left is right and right is left
If the bleeding is heavy, ICP increases rapidly and perfusion to surrounding tissues stops. If a clot forms in the vessel, reduced blood flow through the vessel also promotes ischemia.
Stroke signs and symptoms
A CT scan immediately shows signs of hemorrhagic stroke and ischemic (thrombotic or embolic) stroke within 72 hours of the onset of symptoms. Cerebral angiography shows details of disturbances or displacements of the cerebral circulation due to occlusion or bleeding.
Go with the flow
CT scans should be obtained within 25 minutes of the patient's arrival at the emergency room and results should be available within 45 minutes of arrival to determine if bleeding is present. DSA is used to evaluate the patency of the cerebral vessels and shows signs of cerebral vessel occlusion, a lesion, or vascular abnormalities.
Drugs of choice
Drugs for acute stroke management
Suspected stroke algorithm
Under the knife
Who’s suited for thrombolytic therapy?
They will evaluate the patient, complete a neurological assessment, report findings and facilitate prompt and appropriate care of the patient. Secure and maintain the patient's airway and anticipate the potential need for ET intubation and mechanical ventilation.
Multiple monitors
Your institution may have a stroke protocol and a stroke team composed of specially trained providers who respond to potential stroke patients. When a patient exhibits signs and symptoms of stroke, the patient should first be evaluated with a stroke screening tool, such as the National Institutes of Health Stroke Scale or the Cincinnati Stroke Scale (Jauch, 2010).
Anticonvulsant, antiplatelet, anticoagulation
Subarachnoid hemorrhage
Women are more prone
The rupture is followed by hemorrhage, with blood entering the subarachnoid space normally occupied by CSF. Sometimes blood also flows into the brain tissue, where the subsequent clot can cause potentially fatal increased ICP and damage to the brain tissue.
Without warning
Making the grade
Grading of cerebral
Repair options include clipping, clipping, or even coiling the aneurysm (in the case of giant aneurysms). Limit stimulation (such as bed rest, limited visitors, and avoidance of coffee and physical activity) to minimize the risk of rebleeding and avoid increased ICP until the aneurysm is secured.
Watch out
If the patient develops vasospasm—evidenced by focal motor deficits, increased confusion, and worsening headache—initiate treatment as ordered. Turn the patient frequently and take measures to reduce the risks associated with bed rest.
Rebound effects
The ambulance crew reports that the patient suffered a brief period of loss of consciousness after the injury, but is now lucid, vomiting and complaining of a headache. A brief period of loss of consciousness, followed by a lucid period and complaints of vomiting and headache, may indicate a concussion.
Cardiac emergencies
Understanding cardiac emergencies
Health history
Chief complaint
Personal and family health
Complaints of chest pain or pressure
Where, what, and why?
In their own words
The heart of it
Cardiac questions
Differentiating chest pain
Inspection
First impressions
Check the chest
Arms and legs, too
Light the way
Neck next
Then go for the jugular
Palpation
Palpate the potentials
Refill, please
And compare
Regular and equal
Palpating the apical impulse
What a thrill!
Percussion
Border patrol
Auscultation
Erb and friends
Upward, downward, zigward, zagward
Heart sound sites
Listen for the “dub”
Listen for the “lub”
Major auscultation, man!
The third heart sound - known as S3 or ventricular gallop - is a low murmur best heard by placing the bell of the stethoscope at the apex of the heart.
Kentucky galloper
Tennessee walker
What S 4 says
Interpreting abnormal
If you detect a murmur, identify where it is loudest, determine when it sounds during the cardiac cycle, and describe its pitch, pattern, quality, and intensity. To identify the radiation area, listen from the place where the noise seems loudest to the farthest place where it is still heard.
Pinpoint its presence
Identifying heart murmurs
Pitch
Pattern
Quality
Intensity
Rubbed the wrong way
Bothersome bruits
Cardiac monitoring
A test with 12 views
The standard 12-lead EKG uses a series of electrodes placed on the patient's limbs and chest wall to assess the heart from 12 different views. The waveforms obtained from each lead differ depending on the location of the lead in relation to the electrical stimulus wave, or depolarization, passing through the myocardium.
Practice pointers
Precordial lead placement
An abnormal Q wave has a duration of 0.04 seconds or more, a depth greater than 4 mm, or a height one-fourth of the R wave. Remember that aVR normally has a large Q wave, so ignore this guidance when looking for abnormal Q waves.
Cardiac marker studies
Abnormal Q waves indicate myocardial necrosis, which develops when depolarization cannot follow its normal path due to damaged tissue in the area.
Release those enzymes!
Heart enzymes
Release of cardiac enzymes and proteins
Echocardiography
Echocardiography aka Echo
Motion mode
Echo in 2-D
TEE combination
Echo abnormalities
A closer look at TEE
Instruct the patient that conductive gel will be applied to the chest and a quarter-sized transducer will be placed directly over it. Because pressure is applied to keep the transducer in contact with the skin, warn the patient that he or she may experience minor discomfort.
Hemodynamic monitoring
Explain the procedure to the patient and advise them to remain still during the test, as movement can distort the results.
Getting involved
Controversial contraindications
Arterial blood pressure monitoring
Putting hemodynamic monitoring to use
Pulmonary artery pressure monitoring
PAP purposes
PAP’s parts
PAP and PAWP procedures
Document the date and time of catheter insertion, the site of catheter insertion, the type of flushing solution used, the type of dressing used, and the patient's tolerance of the procedure. Also ensure that the lumen centers are correctly marked to serve the appropriate catheter ports.
Irritation prevention
Do not leave the balloon wedged for long periods of time, as long-term entrapment can lead to pulmonary infarction. Maintain a pressure of 300 mm Hg in the pressure bag to allow a lavage flow rate of 3 to 6 mL per hour.
Cardiac output monitoring
On the rocks or room temperature
To be continued
Better assessor
Monitor the patient for signs and symptoms of inadequate perfusion, including restlessness, fatigue, changes in level of consciousness (LOC); decreased capillary refill time; decreased peripheral pulses; oliguria; and pale, cool skin. Record the patient's cardiac output, cardiac index and other hemodynamic values and vital signs at the time of measurement.
Drug therapy
Adrenergics
Classified by chemical
Which receptor
Mimicking norepinephrine and epinephrine
Understanding adrenergics
Doing it like dopamine
Excitatory or inhibitory
How heartening
Understanding adrenergics (continued)
Rapid rates
Fascinating rhythm
Alpha active
Adrenergic blockers
Impending impulses
Understanding adrenergic blockers
Classified information
Alpha-adrenergic blockers work by interrupting the action of sympathomimetic drugs on alpha-adrenergic receptors.
A mixed bag
Not very discriminating
Reducing resistance
Selective (or not)
Highly discriminating
Intrinsically sympathetic
Widely effective
Selective or nonselective
Antianginals
Reduce demand, increase supply
The top three
Antiangina effect
Down with everything
Understanding antianginal drugs
Calcium channel blockers are commonly used to prevent angina that does not respond to nitrates or beta-adrenergic blockers.
Preventing passage
Rate reduction
Conduction reduction
Antiarrhythmics
Benefits vs. risks
Understanding antiarrhythmics
Class IA antiarrhythmics control arrhythmias by altering the myocardial cell membrane and interfering with the autonomic nervous system control of pacemaker cells.
No (para)sympathy
Rhythmic risks
Understanding antiarrhythmics (continued)
Make a IB line for the ventricle
Slowing the seeds of conduction
Receptor blockers
Strength reducers
One way to two way
Class IB drugs work by blocking the rapid influx of sodium ions during the depolarization phase of the heart's depolarization. The calcium channel blockers used to treat patients with arrhythmias are verapamil and diltiazem.
Depressing the pacemaker
These drugs block calcium movement during phase 2 of the action potential and the slow conduction and refractory period of calcium-dependent tissues, including the AV node.
Anticoagulants
Low is good
Anticlumping
Once does it
Broken bindings
Understanding anticoagulants
Although the risk of serious side effects is low, you should monitor the patient's platelet count. A drop in platelet count is cause for alarm and should be treated and monitored closely.
No new clots
Circulate freely
Warfarin vs. coagulation
Antihypertensives
Know the program
Where and how
Calcium stoppers
Direct dial
Understanding antihypertensives
Without ACE inhibition
With ACE inhibition
Less water, less work
Cardiac glycosides and PDE inhibitors
Slower rate
The short and long of it
Boosting output
Diuretics
Understanding cardiac glycosides and PDE inhibitors
High potency, big risk
Understanding diuretics
In the loop
Potassium-sparing effects
Sodium stoppers
Stability with time
Thrombolytics
Coronary artery bypass graft
Why bypass?
CABG varieties
Understanding thrombolytics
Types of surgery used to treat disorders of the cardiovascular system include coronary artery bypass grafting (CABG), vascular repair, and insertion of a ventricular assist device (VAD). Explain to the patient that he will wake up from surgery with an endotracheal (ET) tube in place and connected to a mechanical ventilator.
Vascular repair
He will also be connected to a cardiac monitor and have a nasogastric tube, chest tube, indwelling urinary catheter, arterial lines, epicardial pacing wires, and possibly a PA catheter in place. Some facilities insert PA catheters and arterial lines in the operating room prior to surgery.
Repair review
Percutaneous coronary intervention
Plaque, meet Balloon
Other treatments
Synchronized cardioversion
Electrifying experience
Repeat, repeat, and repeat again
In sync
Defibrillation
Positively speaking
Adjustable
Act early and quickly
Charge!! And discharge!
Rhythm restoration
Document the procedure, including the patient's ECG rhythms before and after defibrillation; the number of times defibrillation was performed; the tension used during each attempt; whether a pulse returned; the dosage, route and time of medications administered;
Transcutaneous pacemaker
Defibrillator paddle placement
Dire straits
Proper placement
Now to pacing
Set the beat
Proper electrode placement
When fully recorded, the patient's heart rate should be approximately the same as the pacemaker rate set on the device.
Them bones, them bones
Check back with the vitals
Acute coronary syndrome
Plaque’s place
Degree and duration
It hurts when I do this
My, my, MI pain
Identifying symptoms of MI
And many more
MI relief
Patency protection
Pinpointing infarction
On admission, monitor and record the patient's ECG, blood pressure, temperature and heart and breath sounds. Monitor the patient's oxygen saturation levels and notify the practitioner if the oxygen saturation falls below 90%.
Treating the heart
Aortic aneurysm
Thin and thinner
Wide vessel, slow flow
Blood forces
When symptoms arise
Acute expansion
Emergency measures
ABGs and arterial lines
Rupture response
Cardiac arrest
Adult BLS cardiac arrest algorithm
ACLS adult cardiac arrest algorithm
Cardiac arrhythmias
Asymptomatic to catastrophic
Organized by origin and effects
A matter of degree
That’s not all
When life-threatening arrhythmias develop, rapidly assess the patient's LOC, pulse and respiratory rates, and hemodynamic parameters. Assess the patient for predisposing factors, such as fluid and electrolyte imbalance, and signs of drug toxicity, especially with digoxin.
Cardiac contusion
Prepare the patient for cardioversion, electrophysiological studies, an angiogram, placement of an internal cardiac defibrillator, or placement of a pacemaker as indicated. If a temporary pacemaker is to be inserted, monitor the patient's heart rate regularly after insertion and watch for signs of pacemaker failure and decreased cardiac output.
Understanding cardiac arrhythmias
If the QRS complex is narrow and irregular, control the rate with calcium channel blockers or beta blockers. If the patient is stable, follow the ACLS protocol for cardioversion and drug therapy, which may include calcium channel blockers, beta-blockers, amiodarone, or digoxin.
Understanding cardiac arrhythmias (continued)
Resuscitation; follow ACLS protocol for defibrillation, ET intubation, and administration of epinephrine or vasopressin, amiodarone or lidocaine, and, if ineffective, magnesium sulfate or procainamide. Amiodarone or lidocaine may be given to treat ventricular arrhythmias, and digoxin may be given to treat pump failure.
Close watch
Myocardial ischemia, MI, untreated ventricular tachycardia, R-on-T phenomenon, hypokalemia, hyperkalemia, hypercalcemia, hypoxemia, alkalosis, electric shock, and hypothermia. Continue CPR; follow ACLS protocol for ET intubation, temporary pacing, and administration of epinephrine or vasopressin and atropine.
No if hypo
Myocardial ischemia, MI, aortic valve disease, heart failure, hypoxia, hypokalemia, severe acidosis, electric shock, ventricular arrhythmia, AV block, PE, cardiac rupture, cardiac tamponade, hyperkalemia, and electromechanical dissociation. Assess the patient's pain level and administer analgesic therapy as ordered, monitoring it for effectiveness.
Cardiac tamponade
Administer fluid replacement therapy, including blood component therapy, as directed, usually to maintain systolic blood pressure above 90 mm Hg.
Pericardial pressure
Understanding cardiac tamponade
In cardiac tamponade, the accumulation of fluid in the pericardial sac causes compression of the cardiac chambers. The compression restricts blood flow to the ventricles and reduces the amount of blood that can be pumped out of the heart with each contraction.
When pressure is low
Keep an eye on the increase
Monitor the patient's respiratory status for signs of respiratory distress, such as severe tachypnea and changes in the patient's LOC. Anticipate the need for ET intubation and mechanical ventilation if the patient's respiratory status worsens.
Heart failure
If the patient has trauma-induced tamponade, assess for other signs of trauma and initiate appropriate care, including the use of colloids, crystalloids, and blood component therapy under pressure or with rapid-volume infusions if massive fluid replacement is required; administration of protamine sulfate for heparin-induced tamponade; and vitamin K administration for warfarin-induced tamponade.
When the left loses its faculties
When right goes wrong
Blame it on the left
Just can’t pump enough
It all goes to swell from here
Increased sympathetic activity
Renin–angiotensin–aldosterone system
Ventricular dilation
Ventricular hypertrophy
Compromising situation
Kidneys’ contributions
Counteracting hormone
Later, on the left
On the right side
PA monitoring typically shows increased PAP and PAWP, left ventricular end-diastolic pressure in left-sided heart failure, and increased right atrial pressure or CVP in right-sided heart failure. ACE inhibitors for patients with left ventricular dysfunction to reduce the production of angiotensin II, leading to preload and afterload reduction.
Pump up the potassium
Place the patient in the Fowler's position to maximize chest expansion and give supplemental oxygen, as ordered, to facilitate breathing. Prepare patient for surgery or insertion of an IABP or ICD, or transfer to CCU if indicated.
Hypertensive crisis
Begin teaching patients about heart failure and measures to reduce the risk of complications.
Teaching about heart failure
Rapid rise
Faulty mechanisms
Up with pressure
Maintaining flow
Taking control
Regulating reabsorption
Strain for the brain
What happens in hypertensive crisis
