Medical Terminology and Emergency Procedures, Exams of Nursing

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Pulmonary artery - One of two arteries that carry venous (oxygen poor) blood from heart to lungs What type of intubation is preferred with emesis with aspiration? - ETT. LMA or combitube acceptable. What emergency would a cricothyrotomy typically be performed? - Airway obstruction Atropine would be given in which emergency? - Symptomatic bradycardia Adenosine would be given in which emergency? - SVT Amiodarone would be given in which emergency? - V. Tach What medications can be given for a sever case of hyperventilation? - Versed, Valium, or Propofol PVC's are treated with which medicine? - Lidocaine Epi is given in which two emergencies? - V. Fib and asystole Max dose of epi for cardiovascular disease pt -

.04mg A beta blocker would be given in which emergency? - Hypertension A fluid bolus of NS and ephedrine can be given with what emergency? - Hypotension What medications are used to treat malignant hypothermia? - Dantrolene, IV cold saline (not Ringer's) Nasopharyngeal airway - When tongue is obstructing airway. Tube is lubricated and passed through the nose into nasal cavity. Sits in oropharynx behind tongue. Well tolerated and can be used on awake pts. Oropharyngeal airway - Also placed to position tongue in more anterior position. Often interfere with intra oral procedures. Not tolerated well with awake pts. Laryngeal mask airway (LMA) - Device that sits over top of larynx. Can be placed blindly. Does not protect against aspiration. Inflated with 30cc to create seal. Endotracheal intubation - End of tube passes through vocal cords and terminates half way between vocal cords and bifurcation of trachea. Important to listen to both lungs after placement. May or May not be cuffed. Combitube - Generally used for specific emergencies. Both cuffs inflated. Pts predisposed to bronchospasm - Allergies, asthma, copd, bronchitis

Bronchospasm - Generalized contraction of smooth muscles of small bronchi and bronchioles in lungs causing restriction of air flow of air to and from lungs. Maximum dose of epi for healthy pt - .2mg Liver - Protein and lipid synthesis, bio transformation, detoxification and storage of vitamin A, E, D, K, and B12. Causes of seizures - Liver failure, renal failure, sickle cell disease, brain tumor, meningitis, previous stroke and hypo-hyperglycemia. Medications to treat seizures - Tegretol, Klonopin, Neurontin, luminal, Dilantin, depacon Main function of kidneys - Maintain volume and composition of body fluids. Body's main source of filtration and excrete metabolic end products and toxins. Islets of langerhans - Located in pancreas. Secrete insulin and glucagon. Insulin helps the body store sugar to keep glucose levels in a steady state. Adrenal glands - Secretes epinephrine and norepinephrine. Controls electrolyte balance and carb metabolism. Thyroid - Regulates body's basal metabolic rate.

Pterygoid plexus - Network of veins corresponding to 2nd and 3rd parts of maxillary artery Olfactory nerve - 1st cranial nerve that controls smell Optic nerve - 2nd cranial nerve that controls sight Internal jugular vein - Drains much of blood from head and neck Purkinje fiber system - Causes muscles of heart to contract. Spreads impulse rapidly along heart muscle. Brachiocephalic artery - Branches into right common carotid in neck and right subclavian artery in arm. Hematocrit - % blood volume made up of red blood cells. Men: 42-52% women: 37-48%. Anything below 35% considered anemic. Mental artery - Supplies blood to chin. Ischemia - Reduced blood flow in coronary arteries. Lack of oxygen to heart cells weakens, but does not kill them. Maxillary artery - Supplies blood to maxilla, teeth, sinuses, and portion of nose.

Medulla oblongata - Coordinating region for impulses. The seat of many autonomic centers. Normal levels of hemoglobin - Males: 13-18 mg/dL Females: 14-16 mg/dL Oropharynx - Located between soft palate and epiglottis. Facial nerve - 7th cranial nerve. Supplies motor fibers to muscles of facial expression. Trigeminal nerve - 5th cranial nerve. Supplies sensation to teeth and jaws. Vagus nerve - 10th cranial nerve. Supplies fibers to many parts of body. (Ears, tongue, pharynx, larynx, thoracic/abdominal viscera). Pulmonary veins - Return oxygenated blood to left atrium from lungs. Only veins that carry oxygenated blood. Superior vena cava - Drains head, neck, and upper extremities into right atrium. Adrenal glad - Secretes epinephrine, norepinephrine, and corticosteroids. Ectopic focus - Displaced central point of origin for cardiac dysrhythmias.

Inferior alveolar artery - Supplies blood to teeth, mandible, lower lip, and chin. Inferior vena cava - Drains lower extremities and abdominal viscera into right atrium. Brachial artery - Supplies blood to shoulder, arm, forearm, and hand. Facial artery - Supplies blood to face, tonsil, palate, and submandibular gland. T's of pulseleas electrical activity - Toxins, trauma, thrombosis, tension pneumothorax, tamponade H's of pulseless electrical activity - Hydrogen ion, hypoxia, hypovolemia, hypoglycemia, hypo/hyperkalemia, hypothermia. Pulseless electrical activity (PEA) - Normal appearing tracing, but patient has no pulse. Asystole - Cessation of all contractions. "Flat line" usually follows v. fib or v. tach. Treated with CPR. Ventricular fibrillation v. fib - Course v. fib with prominent, erratic baseline or fine v. fib with far less pronounced vacillations. No p, qrs, or t. Often precedes asystole. Class III - Pt has severe systemic disturbance or disease.

Class IV - Patient has a severe, life threatening systemic disorder. Class V - Patient is moribund with little chance of survival. Surgery is done in desperation. Class II - Patient has mild to no systemic disturbance. Smokers included. Class I - Patient has no organic, biochemical, psychiatric, or physiological disturbance. Beta blockers - Reduce the rate and force of contraction of the heart. (Atenolol) Vasodilators - Reduce the pressure vasculature. (Norvasc, lisinopril, diovan) Diuretics - Reduce the volume of fluid in system. Used to treat coronary artery disease. (HCTZ, Lasix) Hypertension - Blood pressure of 140/90 or greater. (Hx of nosebleeds, headaches, and dizziness) Rate of ventricles - 20- Rate of AV node - 40-

Rate of atria - 60- Arrest rhythms - Ventricular dysrhythmias Rate of SA node - 60- Social history review of systems - Patients smoking and alcohol history/current use should be noted along with illegal drug use. Ventricular foci - Located in ventricles Supraventricular foci - Located above level of ventricles in atria. Antibiotic prophylaxis for total joint replacement patients - Previous joint infection, 2 yrs following joint replacement, malnourishment, hemophilia, diabetes type I, immunosuppressed or immunocompromised patients. AV blocks - PR length is prolonged or varies in length due to impulse being partially or completely blocked as it attempts to travel from atria to ventricles via AV node. Patients who need antibiotic prophylaxis - Previous infective endocarditis, prosthetic valves, cardiac transplant patients who develop valvulopathy, congenital heart disease. Congestive heart failure -

Condition caused by the heart is unable to handle blood volume coming back to it from either the lungs or peripheral circulation. 3 characteristics of normal heart rhythms - Rate, regularity, and rhythm. MVP (mitral valve prolapse) - One or more of valve flaps don't close completely allowing redundancy of valve leaflets into left atrium. Rheumatic heart diseases - Condition caused secondary to rheumatic fever (beta hemolytic streptococci) which damages the heart valves, primarily the mitral valve, and causes heart murmur. MI (myocardial infarction) - Heart attack. Six should be performed on patient until 6 months after. Right sided heart failure - Increased pressure of fluid in blood vessels causes fluid to leak into body's tissues causing peripheral edema and ascites Left sided heart failure - Increased pressure of fluid in blood vessels causes fluid to leak into lungs. Patients often present with shortness of breath. Review of systems musculoskeletal - Weakness of extremities, atrophy of muscles, frequent cramping of muscles. Review of systems neurologic - Weakness of extremities, hx of projectile vomiting, headaches, visual disturbances, any unexplained pain or numbness in body. Review of systems pulmonary -

Shortness of breath, dizziness, chronic cough, wheezing, productive cough. Review of systems genitourinary - Painful urination, blood in urine, frequent urination, incontinence, discharge in urine. Review of systems gastrointestinal - Loss of appetite, swallowing, change in taste, nausea, vomiting, diarrhea, constipation. Review of systems skin - Bruising, bleeding, discoloration. Review of systems cardiovascular - Headaches, dizziness, nosebleeds, shortness of breath, chest or arm pain, edema. Review of systems general - Weight loss, loss of appetite, weakness, fatigue. 4 key questions to ask patient in evaluation - Are they currently under physicians care, do they take any meds, do they have any allergies and reactions they have, review of systems. Asthma - Usually associated with allergies. Increased secretions in the muscles membranes lining bronchioles. Mucus plugs block smaller bronchi making movement of air in and out if lungs difficult. More difficulty with expiration. Focus (foci) - Site in atria or ventricles which is center for generation of impulse. Cushing's disease - Non life threatening. Hyper secretion of glucocorticoids.

Glucocorticoids - Allow the body to respond to stress. Addison's disease - Life threatening. Hypo secretion of glucocorticoids. Cirrhosis - Fibrosis or scar tissue in liver. Patients with cirrhosis may have difficulty metabolizing medications and may have prolonged effects of medications. Risks of liver cirrhosis - Prolonged effects of medications, prolonged mental depression can cause hepatic coma, trouble clotting, peripheral edema, ascites. Dyspnea - Difficulty breathing or breathlessness. Bronchitis - Inflammation of the mucous membranes lining the bronchial tubes. Sx should be delayed. Smoking - Predisposes patients to laryngospasm and bronchospasm. Upper respiratory infection (URI) - Common cold or cough which produces increased secretions in airway. Best to delay surgery. Involves sinuses, nasal passages, pharynx, and larynx. Diabetes mellitus - Metabolic impairment where the body is unable to metabolize glucose properly causing increased blood glucose levels. This prevents the body from metabolizing carbs properly. Type I -

Insulin dependent diabetes. Type II diabetes - Non insulin dependent Considerations for diabetic patients - Patients with diabetes do not heal as quickly and are more prone to infection. Often placed on antibiotics. Fasting blood sugar (FBS) - 125 mg/dL normal or in control Insulin overdose - Give patient sugar, candy, or sugar containing beverage. Glucose IV or glucagon IM if patient is sedated. Emphysema - Enlargement of alveolar sac in lungs along with destruction and scarring of alveoli which makes less surface area available for exchange of O2 and CO2. Smokers. Risks of kidney disease - Patients with kidney disease may have difficulty eliminating medications from their body. Sx should not be scheduled on same day as dialysis. Epilepsy - Seizures. If an incident occurs during anesthesia Valium IV can be given. TIA (transient ischemic attack) - Mini stoke. Sudden neurological loss of function with full recovery in 24 hrs. Cerebrovascular accidents (CVA/stroke) - Neurological impairment caused by disruption of blood supply to area of brain.

Ischemic stroke - 85% caused by occluded blood vessel. Hemorrhagic stroke - 15% caused by ruptured artery (aneurysm) Trimester to best perform surgery - 2nd trimester. Most risk to fetus in 1st trimester. Obesity - 20 % above ideal body weight [(wt in lbs/height in inches)2] x 703 Modifiable risk factors of stroke - High blood pressure, diabetes, heart disease, smoking, TIA, increased red blood cells, sickle cell disorder. Unmodifiable risk factors for stroke - Male, age 55 or older, two times African American, previous stroke, heredity. Considerations for obese patients - Use of a large blood pressure cuff, difficult venous access, patients should be treated in upright or semi fowler position. Protease inhibitors - Patients with HIV take this medications. It prolongs effects of benzodiapam derivatives. INR - International normalized ratio. Patients on anticoagulants usually maintain INR 2-3. Patients usually discontinue anticoagulant 3 days prior to surgery. 1.5 or less needed to operate.

Prothrombin time - Effectiveness of anticoagulant. Right atrium - Receives blood from inferior and superior vena cava (peripheral circulation). Lower airway - Trachea, bronchi, lobular bronchi, bronchioles, and alveoli. Peripheral nervous system - Consists of sensory and motor nerves. Laryngopharynx - Located behind voice box. Internal respiration - Takes place at cellular level. O2 in bloodstream enters cells. CO2 leaves cell and returns to blood. Upper airway - Nasal passages, sinuses, pharynx, and larynx. Max O2 hemoglobin - 1.34 mL Anemia - Decreased amount of hemoglobin concentration. Below 35% Diaphragm - Dome shaped muscle that separates the chest cavity from abdominal cavity. Most important muscle of inspiration.

Cerebellum - Main motor coordinating area. Stroke volume - Total amount of blood pumped out of left ventricle in one beat. 60 mL. Left atrium - Receives oxygenated blood from lungs via pulmonary vein. Tidal volume - Normal breathing 500 cc of air is inhaled and exhaled. Basilic veins - Located on inner (medial) aspect of forearm. Dead space - No gases are exchanged. 150 cc. Extends from pharynx to bronchioles. Allows CPR to take place. O2 capacity - Blood has a certain amount of O2 it can carry depending on hemoglobin available. Nasopharynx - Located above back of soft palate. External respiration - O2 is inspired and enters the body by coming in contact with blood and alveoli. Pharynx - Located between nose and trachea. 3 parts nasopharynx, oropharynx, laryngopharynx

Synapse - A junction between two neurons. Hypoxia - Lack of O Automaticity - Ability of heart muscle to contract on it's own without nerve stimulation. Best places to check for patients pulse - Carotid arteries and radial arteries. Trachea - Wind pipe. Neurons - Nerve cells Tachycardia - HR above 100 bpm Sensory nerves - Receive messages from environment and and conduct messages back to CNS. CAC (cardioacceleratory center) - Located within medulla. Sympathetic fibers travel down spinal cord to SA node. When stimulated release norepinephrine with increases HR and strength of contractions. Cardiac output - Total amount of blood pumped from left ventricle in one minute.

Brain stem - Pons, medulla oblongata, midrain Cephalic vein - Located on outer (lateral) aspect of forearm. Epiglottis - Soft tissue valve located at base of tongue covers larynx. Allows air into lungs and keeps foreign material out. AV node - Located between atria and ventricles. Bundle of His cause ventricles to contract. Thoracic cage - Consists of ribs, sternum, intercostal muscles, diaphragm. Accessory muscles of respiration - Sternocleidomastoid, scalenes, abs which are most important. Central nervous system (CNS) - Consists of brain and spinal column Median cubital vein - Bridge between cephalic and basilic veins. Sinuses - Frontal, maxillary, sphenoid, ethmoid CIC (cardioinhibitory center) - Parasympathetic fibers reach vagus nerve and release acetylcholine which decreases HR and force of contractions.

Spinal column - Cerebrum, cerebellum, medulla oblongata Right ventricle - Sends deoxygenated blood to lungs via pulmonary artery. Respiration rate - 12-16 per minute QRS complex - Ventricular depolarization Left ventricle - Pumps oxygenated blood to peripheral circulation via aorta. Cricothyrotomy/coniotomy - The passage of a large needle through the cricothyroid ligament. Used in upper airway obstruction. T wave - Ventricular repolarization Angina pectoris - Chest pain. Caused by ischemia. Can be treated with nitroglycerin. Robinul or atropine - Inhibits parasympathetic stimulation of increased saliva. Decreases secretions. Erythrocytes - Red blood cells

Dorsal venous plexus - Back of hand. Normal HR - 60-100 bpm Bradycardia - HR of less than 60 bpm Blood pressure - Systolic/diastolic. Normal BP 120/80. Flow of blood through the heart - Inferior/superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary valve, pulmonary artery, lungs, pulmonary vein, left atria, mitral valve,eft ventricle, aortic valve, aorta, peripheral circulation. Antecubital space - Anterior surface of elbow located between arm and forearm. SA node - Located in right atrium. Acts as pacemaker. Produces sinus rhythms. Systolic phase - Both ventricles contracting simultaneously. P wave - Atrial depolarization Phlebitis - Inflammation of vein

Capillaries - Smallest arteries where the exchange of O2, CO2, cell by products, and nutrients are exchanged between blood and cells of body. Diastolic phase - Both atria contracting simultaneously. Autonomic nervous system - Sympathetic and parasympathetic nervous system Motor nerves - Carry out responses from CNS. Cardiac cycle - One alternate contraction and relaxation of atria and ventricles followed by a short pause. Cerebrum - Thought area of brain. Sympathetic nervous system - Speeds things up. Innervates arteries and veins causing vasoconstriction and increased heart rate. Thoracic and lumbar spine. Parasympathetic nervous system. - Slows things down. Decreases heart rate and blood pressure. Skull and sacrum. Aorta - Main trunk from which arterial system proceeds. Hemoglobin - Supplies O2 to body's tissues. Composed of one protein (globin) and four non proteins (hemes)

Lingual artery - Supplies blood to tongue of floor of mouth. Treatment for hypovolemia - Pressure to area, cauterization, IV fluid replacement. Treatment for malignant hypothermia - Activate EMS, hyperventalite w/ 100% O2, dantrolene sodium, IB cold saline NOT ringers lactate, ice packs to groin, axilla, neck, cold saline lovage to stomach, bladder, rectum, transport to hospital. Treatment for anaphylaxis - Activate EMS, 100% O2, monitor vitals, epinephrine, Benadryl, decadron, ACLS protocol while waiting for EMS Treatment for stroke (CVA) - Activate EMS, not time if incident, monitor vitals closely, place in position of comfort, 100% O2, IV access give bolts of NS/lactated ringers solution, do not treat BP unless greater than 220/120, transport to hospital, note time Treatment for mild allergic reaction - Place patient in upright or reclined position, 100% O2, monitor vitals, Benadryl Treatment for seizures - IV access, Valium 5mg IV or medazolam 3mg, continue to monitor vitals, activate EMS Treatment of syncope (fainting) - Tredelenburg position, ABC's, head tilt chin lift, 100% O2, monitor vitals, relax/reassure patient Treatment of acute adrenal deficiency - Terminate procedure, monitor vitals, tredelenburg position if hypotensive, activate EMS,IV access, steroid administration, fluid bolus, transport to hospital

Treatment of hypoglycemia - Activate EMS, IV access, measure blood sugar with glucometer, 1 amp of glucose, IV infusion of dextrose or glucogan IM if no IV Treatment of intra arterial injection - Activate EMS, secure catheter DO NOT REMOVE, 10 cc lidocaine w/o epinephrine, ice pack to limb Propofol - Mimics barbiturates. Rapidly redistributed and metabolized due to being highly bound to fat.Does not tend to predispose to laryngospasm and has antiemetic properties. Discard after 12 hrs. Treatment for high blood pressure 200/100 - Terminate procedure, check monitor function, attempt to determine cause, record vitals every 5 min, consider EMS, IV access, beta blockers (labetalol, esmolol, atenolol) Treatment for asystole/PEA - CPR, epinephrine IV may repeat every 3-5 min, one dose of vasopressin may be given to replace 1st and 2nd dose of epi Treatment of ventricular fibrillation - Activate EMS, CPR/AED, cont CPR and establish IV, give epinephrine 1 mg every 3-5 min, CPR/repeat shocks as above, may give single dose vasopressin to replace 1st and 2nd dose epi, amiodarone, lidocaine, and magnesium considered as well. Treatment of ventricular tachycardia - 100% O2, amiodarone 150mg IV over 10 min, prepare for synchronous cardio version Treatment for premature ventricular contractions (PVC) - Try to determine cause (ie hypoxia) and correct, lidocaine IV repeat every 5-10 min until 3mg/kg administered Treatment of supraventricular tachycardia -

Place patient in supine position, adenosine 6mg, after 1-2 min adenosine 12mg, 3rd dose given in 1-2 min as needed. MONA - Morphine, oxygen, nitroglycerin, aspirin Treatment for symptomatic bradycardia - Terminate procedure, 100% O2, establish IV, atropine, may need ER for transcutaneous pacing. Treatment for heart attack - Activate EMS, closely observe vitals, 100% O2 via mask, make pt comfortable/reassure, attach AED/defibrillator, aspirin 325mg, establish IV with normal saline slow drip, morphine 2-4 mg every 5- 10 min Symptoms of heart attack - Chest pain, anxiety, weakness, sweating, cardiac dysrhythmias, drop in blood pressure. Black - Nitrogen Yellow - Compressed air Topical anesthetics - Benzocaine and lidocaine. Treatment for angina attack - 100% O2 via mask, nitroglycerin under tongue 3 times every 5 min, if not relieved by third dose pt is having a heart attack, monitor pt, loosen tight clothing, put pt in comfortable position. Hypnosis - Loss of consciousness. Patients want to lose consciousness and feel that they are asleep. (Propofol, brevital)

Relaxation and immobility - Essential for patient to be relaxed and immobile during procedure. (Versed, Propofol, brevital, ketamine) Treatment for hyperventilation - Terminate treatment and remove foreign bodies from mouth and surgical instruments from sight, maintain airway, verbally calm patient, monitor vitals, NO O2, have pt breathe into bag to recapture CO2. Advanced: IV versed, Valium, Propofol, continue to monitor vitals, discontinue breathing bag, activate EMS if condition deteriorates. Gray - Carbon dioxide Hypercarbio - Increased CO2 levels Treatment for emesis with aspiration - Activate EMS, keep IV, 100% O2 via bag/mask, turn patient on right side with head down (tredelenburg), tonsil suction, removal of visible foreign bodies, intubation, transport to care facility. Scavenging system - Reduces levels of noxious agents to acceptably low levels by exhausting then outside operating room. Ventilator - Breathes for patient. Using bellows type apparatus with positive and negative pressures to move gases in and out of lungs. Vaporizer - Facilitates the conversion of liquid anesthetic agents to gases suitable for delivery.

Anesthesia machines - Provides O2 and NO2 to the patient. The flow meter determines ratio and rate at which gases are delivered. Typical GA regimen - Consists of anxiolytic, narcotic, and IV anesthetic agent. Capnography - Monitoring the patients CO2 in expired air Halogenated hydrocarbons - Inhalation agents that come in liquid form and are poured into vaporizers that allow for controlled evaporation and release for administration of gas. Sevoflurane, desflurane, isoflurane. Non de polarizing agents - Used for long procedures. Their mode of action is to block acetylcholine receptors at neurotransmitter junction causing prolong muscle relaxation. (Rocuronium, curare, pavulon) Anticholinesterases - Reverse effects of depolarizing agents (muscle relaxers) Depolarizing agents - Cause depolarization of muscle with contraction and prolonged relaxation (succinylcholine). Used for intubation and treatment of laryngospasm. Can cause dysrhythmias especially in children and can trigger malignant hypothermia. Muscle relaxants - Block nerve impulses at neurotransmitter junction where nerve stimulation causes muscle to contract causing paralysis. Steroids - Prevent swelling by stabilizing cell membranes and also prevent acute adrenal deficiency and nausea. (Decadron, solu medrol, solu cortel)