Intensive Care

Unit
 Intensive Care Unit is a hospital facility for care of
critically ill patients at a more intensive level than is
needed by other patients. Staffed by specialized
personnel.

 ICU care requires a multidisciplinary team that consists

of but is not limited to intensivists (clinicians who
specialize in critical illness care. They will provide
treatment management, diagnosis, interventions, and
individualized care for each patient recovering from
severe illness.
Purpose of ICU
 The purpose of the intensive care unit (ICU) is simple even
though the practice is complex. Healthcare professionals
who work in the ICU or rotate through it during their
training provide around-the-clock intensive monitoring and
treatment of patients seven days a week.

When patients are transferred to the ICU from another

hospital department, treatment orders and planning must
be reviewed and new treatment plans written for the
patient's current status. For example, a chronically ill
inpatient may grow markedly worse within a few hours and
may be transferred to the ICU, where the staff must
reevaluate orders for his or her care.
Description of
ICU
 ICUs are highly regulated departments, typically limiting
the number of visitors to the patient's immediate family
even during visiting hours.

 In addition to the intensivist's role in direct patient care,

he or she is usually the lead physician when multiple
consultants are involved in an intensive care program.
The intensivist coordinates the care provided by the
consultants, which allows for an integrated treatment
approach to the patient.

 The nurse's role usually includes clinical assessment,

diagnosis, and an individualized plan of expected
treatment outcomes for each patient
The patient usually has several
monitors attached to various parts
of his or her body for real-time
evaluation of medical stability.
The intensivist will make periodic
assessments of the patient's cardiac
status, breathing rate, urinary output,
and blood levels for nutritional and
hormonal problems that may arise and
require urgent attention or treatment.
History of ICU
 In 1854, Florence Nightingale left for the Crimean War, where the
necessity to separate seriously wounded soldiers from less-seriously
wounded was observed. Nightingale reduced mortality from 40% to 2%
on the battlefield, creating the concept of intensive care.
 In 1950, anesthesiologist Peter Safar established the concept of
"Advanced Support of Life," keeping patients sedated and ventilated in
an intensive care environment. Safar is considered the first intensivist.
 In response to a polio epidemic (where many patients required constant
ventilation and surveillance), Bjørn Ibsen established the first intensive
care unit in Copenhagen in 1953.The first application of this idea in the
United States was pioneered by Dr. William Mosenthal, a surgeon at the
Dartmouth-Hitchcock Medical Center. In the 1960s, the importance of
cardiac arrhythmias as a source of morbidity and mortality in
myocardial infarctions (heart attacks) was recognized. This led to the
routine use of cardiac monitoring in ICUs, especially in the post-MI
setting.
PATIENTS IN THE ICU
TYPES OF PATIENTS
 Patients come into the MICU from a variety of places: the
floors, the ER, as transfers from other hospitals, as
postops, as boarders from other services, and sometimes
as “direct admits”, bypassing the ER. The interesting thing
about the MICU is that we literally see a bit of absolutely
everything, unlike the specialty ICUs. If you work here
long enough, you’ll see patients that would normally be in
every other ICU environment (except maybe fresh postop
cardiothoracic patients – that ICU will bump more stable
patients out to make room). We see cardiac patients,
sometimes with intra-aortic balloon pumps; we see neuro
patients, occasionally with monitored bolts in place, we’ve
done adult ECMO a few times, and we even sometimes
get general-surg postop cases..
MICU Equipments
1.) Mechanical
Ventilator
Definition
is a method to mechanically assist or
replace spontaneous breathing.
circumstances for which ventilation is
required then additional measures are
often required to "secure" the airway
during positive pressure ventilation to allow
unimpeded passage of air into the trachea
and avoid air passing into the esophagus
and stomach.
Commonly this is by insertion of a tube into
the trachea which provides a clear route for
the air.
This can be either an endotracheal tube,
inserted through the natural openings of
mouth or nose
or a tracheostomy inserted
through an artificial opening in
the neck.
Mechanical ventilation is often a life-saving
intervention, but carries many potential
complications including pneumothorax,
airway injury, alveolar damage, and
ventilator-associated pneumonia.
Indications:
Mechanical ventilation is indicated when
the patient's spontaneous ventilation is
inadequate to maintain life.
also indicated as prophylaxis for imminent
collapse of other physiologic functions, or
ineffective gas exchange in the lungs
Common medical indications for
use include:
 Acute lung injury (including ARDS, trauma)
 Apnea with respiratory arrest, including cases from intoxication
 Chronic obstructive pulmonary disease (COPD)
 Acute respiratory acidosis with partial pressure of carbon dioxide (pCO2) >
50 mmHg and pH < 7.25, which may be due to paralysis of the diaphragm
due to Guillain-Barré syndrome, Myasthenia Gravis, spinal cord injury, or
the effect of anaesthetic and muscle relaxant drugs
 Increased work of breathing as evidenced by significant tachypnea,
retractions, and other physical signs of respiratory distress
 Hypoxemia with arterial partial pressure of oxygen (PaO2) with
supplemental fraction of inspired oxygen (FiO2) < 55 mm Hg
 Hypotension including sepsis, shock, congestive heart failure
 Neurological diseases such as Muscular Dystrophy Amyotrophic Lateral
Sclerosis
Because mechanical ventilation only serves
to provide assistance for breathing and
does not cure a disease, the patient's
underlying condition should be correctable
and should resolve over time.
2.) ECG
Electrocardiography (ECG or EKG) is a
transthoracic interpretation of the electrical
activity of the heart over time captured and
externally recorded by skin electrodes.
 It is a noninvasive recording produced by an
electrocardiographic device.
The etymology of the word is derived from
electro, because it is related to electrical
activity, cardio, Greek for heart, and graph,
a Greek root meaning "to write".
is the most commonly performed cardiac
test
This is because the ECG is a useful
screening tool for a variety of cardiac
abnormalities.
ECG machines are readily available in most
medical facilities; and the test is simple to
perform, risk-free and inexpensive.
What information can be
gained from the ECG?
the heart rate
the heart rhythm
whether there are “conduction abnormalities”
(abnormalities in how the electrical impulse
spreads across the heart)
whether there has been a prior heart attack
whether there may be coronary artery disease
whether the heart muscle has become
abnormally thickened
How is the ECG performed?

You will lie on an examination table, and 10

electrodes (or leads) are attached to your
arms, legs, and chest.
The electrodes detect the electrical impulses
generated by your heart, and transmit them
to the ECG machine.
The ECG machine produces a graph (the ECG
tracing) of those cardiac electrical impulses.
The electrodes are then removed. The test
takes less than 5 minutes to perform.
 12 Electrode Placement
RA on the right arm, avoiding bony
prominences.
LA in the same location that RA was placed,
but on the left arm this time.
RL on the right leg, avoiding bony
prominences.
LL in the same location that RL was placed,
but on the left leg this time.
 V1 in the fourth intercostal space (between ribs 4 & 5)
just to the right of the sternum (breastbone).
 V2 in the fourth intercostal space (between ribs 4 & 5)
just to the left of the sternum.
 V3 between leads V2 and V4.
 V4 in the fifth intercostal space (between ribs 5 & 6) in
the mid-clavicular line (the imaginary line that extends
down from the midpoint of the clavicle (collarbone).
 V5 horizontally even with V4, but in the anterior axillary
line. (The anterior axillary line is the imaginary line that
runs down from the point midway between the middle of
the clavicle and the lateral end of the clavicle; the lateral
end of the collarbone is the end closer to the arm.)
 V6 horizontally even with V4 and V5 in the midaxillary
line. (The midaxillary line is the imaginary line that
extends down from the middle of the patient's armpit.)
3.) Nebulizer
device used to administer medication to
people in the form of a mist inhaled into
the lungs. It is commonly used in treating
cystic fibrosis, asthma, and other
respiratory diseases.
Nebulizers accept their medicine in the
form of a liquid solution, which is often
loaded into the device upon use
The reason they are inhaled instead of
ingested is usually to target their effect to
the respiratory tract, which speeds onset of
action of the medicine and reduces side
effects compared to other means of
delivering these medicines.
medicine is inhaled through a tube-like
mouthpiece, similar to that of an inhaler.
 however, is sometimes replaced with a face
mask, similar to that used for inhaled
anaesthesia, for ease of use with young
children or the elderly
4.) Defibrillator
treatment for the life-threatening cardiac
arrhythmias, ventricular fibrillation and
pulseless ventricular tachycardia. Defibrillation
consists of delivering a therapeutic dose of
electrical energy to the affected heart
This depolarizes a critical mass of the heart
muscle, terminates the arrhythmia, and allows
normal sinus rhythm to be reestablished by the
body's natural pacemaker, in the sinoatrial
node of the heart.
Manual external defibrillator
used in conjunction with (or more often
have inbuilt) electrocardiogram readers,
which the healthcare provider uses to
diagnose a cardiac condition
The healthcare provider will then decide
what charge (in joules) to use, based on
proven guidelines and experience, and
will deliver the shock through paddles or
pads on the patient's chest.
5.) Pulse Oximeter
• It is a medical device that indirectly
measures the oxygen saturation of a
patient's blood and changes in blood
volume in the skin, producing a
• photoplethysmograph
It is a medical device that indirectly
measures the oxygen saturation of a
patient's blood and changes in blood
volume in the skin, producing a
photoplethysmograph
• It is a medical device that indirectly
measures the oxygen saturation of a
patient's blood and changes in blood
volume in the skin, producing a
photoplethysmograph
 Function
 Displays the percentage of arterial hemoglobin in
the oxyhemoglobin configuration. Acceptable
normal ranges are from 95 to 100 percent,
although values down to 90% are common
Typically it has a pair of small light-emitting
diodes (LEDs) facing a photodiode through a
translucent part of the patient's body, usually a
fingertip or an earlobe. One LED is red, with
wavelength of 660 nm, and the other is infrared,
905, 910, or 940 nm
Absorption at these wavelengths differs
significantly between oxyhemoglobin and its
deoxygenated form; therefore, the
oxy/deoxyhemoglobin ratio can be calculated from
the ratio of the absorption of the red and infrared
light
The absorbance of oxyhemoglobin and
deoxyhemoglobin is the same (isosbestic
point) for the wavelengths of 590 and 805 nm;
earlier oximeters used these wavelengths for
correction for hemoglobin concentration.
 Advantages
pulse oximeter is useful in any
setting where a patient's
oxygenation is unstable, including
intensive care, operating, recovery,
emergency and hospital ward
settings, pilots in unpressurized
aircraft, for assessment of any
patient's oxygenation, and
determining the effectiveness of or
need for supplemental oxygen.
 Limitations and
Advancements
 Oximetry is not a complete measure of respiratory
sufficiency. A patient suffering from
hypoventilation (poor gas exchange in the lungs)
given 100% oxygen can have excellent blood
oxygen levels while still suffering from respiratory
acidosis due to excessive carbon dioxide.

 Oximetry is not a complete measure of respiratory

sufficiency. A patient suffering from
hypoventilation (poor gas exchange in the lungs)
given 100% oxygen can have excellent blood
oxygen levels while still suffering from respiratory
acidosis due to excessive carbon dioxide.
6.) Suction
 Suction
 used to clear the airway of blood, saliva,
vomit, or other secretions so that a
patient may breathe.
• prevent pulmonary aspiration, which
can lead to lung infections

•used to remove fluids from the

airways
• facilitate breathing and prevent
growth of microorganisms

• may be mechanical hand pumps or

battery or electrically operated
mechanisms
7.) Cardiac Monitor
Cardiac Monitor
 device that shows the electrical and
pressure waveforms of the cardiovascular
system for measurement and treatment

• electrical connections are made

between the cardiac monitor and the
patient, it is kept at the patient's
bedside
 Purpose
 continuously displays the cardiac
electrocardiogram (EKG) tracing
• Additional monitoring components
allow cardiovascular pressures and
cardiac output to be monitored and
displayed as required for patient
diagnosis
• Oxygen and treatment
saturation of the arterial blood
can also be monitored continuously
• Most commonly used in emergency rooms
and critical care areas, bedside monitors
can be interconnected to allow for
continual observation of several patients
from a central display
DRUG STUDY
 Generic Name / Brand Mechanism of Action Indications Contraindications Adverse Reactions Nursing Responsibilities
Name
B1 and B2 agonist -acute asthma -hypersensitivity -tremors -monitor
Epirephine causing increased attack to -anxiety respiratory
levophed levels of cyclic AMP -hemostasis symphatomimetic -palpitations function, ECG to
(adrenaline) producing -bronchospasm s -tachycardia prevent cerebral
bronchodilation, -anaphylaxis -narrow-angle -dysrhythmias hemorrhage
cardiac and CNS -allergic reactions glaucoma -anorexia -monitor for
stimulation; large -cardiac arrest -organic brain and -dyspnea evidence of
doses can cause -adjunct in heart disease allergic reactions,
vasoconstriction via anesthesia syndrome paradoxical
alpha receptors; -shock -local anesthesia bronchospasm
small dose can cause of certain area -instruct patient
vasodilation via b2 -labor to use this
vascular receptors -cardiac dilation medication before
-coronary other medications
insufficiency and allow at least
-cerebral 5 mins between
arteriosclerosis each, to prevent
overstimulation

Sodium Orally neutralizes -acidosis -hypertension -twitching -assess

bicarbonate gastric acid, which -cardiac arrest -peptic ulcer -hypereflexia respiratory
forms water, NaCl, -alkalinization -renal disease -belching function and pulse
CO2, increases -gastric acid -hypocalcemia -distention rate, depth, lung
plasma bicarbonate, neutralization/ant -alkalosis sounds
which buffers h1 ion acid -assess for CO2 in
concentration, GI tract
reverses acidosis -monitor fluid
balance,
electrolytes, blood
PH, urine output
-advise patient to
notify MD if
indigestion is
accompanied with
Generic Name / Brand Mechanism of Action Indications Contraindications Adverse Reactions Nursing Responsibilities
Name

Midazolam Depresses -pre op sedation -hypersensitivity -nausea -monitor BP, pulse

(dormicum) subcortical levels in -general to -vomiting -watch out for
CNS; may act on anesthesia benzodiazepines -coughing respiratory
limbic system, induction -shock -dyspnea depression
reticular formation, -sedation for -coma -loss of balance especially to
may potentiate diagnostic test -alcohol elederly patient
GABA by binding to -intubation intoxication -caution patient to
specific -acute narrow avoid CNS
benzodiazepine angle glaucoma depressants
receptor including alcohol
for 24hrs after
taking this drug

Naloxone May displace opioid -narcotic -respiratory -tachycardia -assess cardiac

(Narcan) analgesics from their overdose depression due to -increase BP status
receptors to reduce -post op narcotic non-opioid drugs -seizures -monitor VS
its effects depression -cardiac arrest -assess for pain,
-pulmonary patient respiration
edema -instruct patient
to report adverse
reaction
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing
Brand Name Action ns Reactions Responsibilities

Promethazine Acts on blood -motion sickness -hypersensitivity -dizziness -assess

(Phenergan) vessels, GI, -rhinitis to h1 receptor -drowsiness respiratory status,
respiratory system -allergy response antagonist -constipation I and O
by competing with -sedation -sulfite allergy -urinary retention -give 1hr before
histamine for h1 -nausea -child <2yr and 2hrs after
receptor site; -pre op and post -acute asthma meals to decrease
decreases allergic op sedation attack GI upset
response by blocking - -caution patient
histamine; also acts not to exceed
on chemo receptor recommended
trigger zone to dose;
decrease vomiting; dysrhythmia may
increases CNS occur
stimulation; has
anticholinergic
response
Hydrocortisone Glucocorticoid with -allergic and -systemic fungal -depression -monitor patient’s
(solu-cortef) anti inflammatory inflammatory infection -flushing weight, BP.
effect because of its ophthalmic -acute -sweating Glucose and
ability to inhibit processes glumeruloneprhiti -headache electrolyte levels.
prostaglandin -GI disease s -mood changes -assess for
synthesis, inhibit ulceratic colitis -amoebiasis -hypertension systemic
migration of -multiple sclerosis -AIDS- -diarrhea absorption and
macrophages, -treatment of -TB -nausea irritation
leucocytes and synovitis of -nonasthmatic -vomiting -advise patient to
fibroblasts at sites of osteoarthritis bronchial dse. -hemorrhage exercise and take
inflammation -treatment of vit. D and calcium
phagocytosis and keloids supplements
lysomal enzyme -relief of
release. It can also discomfort
cause the reversal of associated with
increased capillary hemorrhoids
permeability perineal itching or
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing
Brand Name Action ns Reactions Responsibilities

Dexamethasone Synthetic -inflammation -psychosis -depression -assess infection;

(Decadron) glucocorticoid with -allergies -hypersensitivity -flushing fever, potassium
marked anti- -neoplasms -idiopathic -sweating depletion, mental
inflammatory effect -cerebral edema thrombocytopenia -hypertesion status
because of its ability -septic shock -amoebiasis -diarrhea -monitor weight
to inhibit -collagen nonasthmatic -nausea daily
prostaglandin disorders bronchial dse. -vomiting -instruct patient
synthesis, inhibit -abdominal to report signs of
migration of distention adverse reactions
macrophages, -increased -advise patient to
leukocytes and appetite avoid exposure to
fibroblasts at sites of persons with
inflammation, infection
phagocytosis and
lysosomal enzyme
release
Terbutaline Relaxes bronchial -bronchospasm -hypersensitivity -tremors -monitor
(bricanyl) snooth muscle by to -insomnia respiratory
direct action on B2 symphatomimetic -headache function
adrenergic receptors s -dizziness -determine that
through -narrow-angle -palpitations patient has not
accumulation of glaucoma -nuasea received
cAMP at B-adrenergic - -vomiting theophylline
receptor sites; tachydysrhythmia therapy before
results are s giving dose
bronchodilation, -monitor for
diuresis and CNs, evidence of
heart stimulation; allergic reactions
relaxes uterine -assess for
smooth muscle. paradoxical
bronchospasm
-should be given
with meals
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing
Brand Name Action ns Reactions Responsibilities

Tranexemic acid Inhibits breakdown -treatment and -hypersensitivity -nausea -assess patient if
(Hemostan) of fibrin clots. It acts prophylaxis of -severe renal -vomiting with active
primarily by blocking hemorrhage insufficiency -headache intravascular
the binding of associated with -patient with -hypotension clotting; obtain
plasminogen and excessive microscopic prothrombin time
plamin to fibrin; fibrinolysis hematuria of the patient
direct inhibition of -prophylaxis for -perform liver
plasmin a\occurs hereditary function test and
only to a limited angioedema blood tests
degree -advise patient to
report visual
abnormalities to
the physician.

Amiodarone Prolongs action -severe -sinus node -headache -monitor I and O

(Cordarone) potential duration ventricular dysfunction -dizziness ratio, ECG
and effective tachycardia -2 or 3 degree -hypotension
nd rd
-assess for CNS
refractory period, -supraventricular AV block symptoms, sight
slows sinus rate with tachycardia -bradycardia and vision
increasing PR and QT -ventricular -neonates, infants -instruct patient
intervals, non- fibrillation to report side
competitive alpha -atrial fibrillation effects
and beta adrenergic not controlled by immediately to
inhibition; increase 1st line agents the prescriptor
PR and QT intervals, and that skin
decrease sinus rate discoloration is
and decreases PVR usually reversible
-advise patient
that dark glasses
may be needed
for photophobia
-instruct patient
to use sunscreen
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing
Brand Name Action ns Reactions Responsibilities

Aminophylline Exact mechanism -bronchial asthma -hypersensitivity -dizziness -monitor

(Truphylline) unknown; relaxes -emphysema to xanthines -palpitations theophylline blood
smooth muscle of -bradycardia -active peptic -sinus levels, I and O,
respiratory system ulcer disease tachycardia respiratory rate
by blocking -nausea -instruct patient
phosphodiesterase -vomiting to avoid
which increases hazardous
cyclic AMP alters activities
intracellular calcium -teach patient if
ion movements GI upset occurs,
take drug with
8oz of water
-advise patient to
increase fluid
intake

Clonidine Inhibits sympathetic -mild to moderate -hypersensitivity -drowsiness -monitor BP/pulse

(Catapres) ve\asomotor center hypertension -bleeding -sedation -check for edema
in CNS which reduce disorders -headache in feet and legs
impulses in -anticoagulants -fatigue daily
sympathetic nervous -orthostatic -monitor I and O
system; BP; pulse hypertension -instruct patient
rate, CO decreased; -nocturia not to discontinue
prevents pain signal -palpitations drug abruptly
transmission in CNS -nausea -caution patient to
by alpha adrenergic -vomitng change position
receptor stimulation -dry mouth slowly
of the spinal cord -malaise
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing
Brand Name Action ns Reactions Responsibilities

Digoxin (Lanoxin) Inhibits sodium -rapid -hypersensitivity -headache -assess apical

potassium ATPase digitalization in to digitalis -drowsiness pulse for 1 min
which makes more acute and chronic -ventricular -hypotension -monitor cardiac
calcium available for CHF fibrillation -nausea status, ECG
contractile proteins, -atrial fibrillation -ventricular -vomiting -advise patient to
resulting in -atrial flutter tachycardia -anorexia maintain a
increased cardiac -atrial bradycardia -carotid sinus sodium-restricted
output, force of -atrial tachycardia syndrome diet as ordered
contraction; -cardionegic -2nd or 3rd degree -teach patient
decrease shock block purpose of drug is
contraction, -paroxysmal atrial to regulate the
decrease HR and AV tachycardia heart’s
conduction speed functioning

Verapamil Inhibits calcium ion -chronic stable -sick sinus -headache -assess fluid
(Isoptin) influx across cell vasospastic syndrome -drowsiness volume: I and O
membrane during -unstable angina -2nd or 3rd degree -edema ratio and record
cardiac -dysrhythmias heart block -nausea -monitor BP and
depolarization; -hypertension -hypotension -constipation pulse, pulmobary
produces relaxation -supraventricular -cardiogenic capillary wedge
of coronary vascular tachycardia shock pressure
smooth muscle; -atrial flutter or -severe CHF -assess for
peripheral vascular fibrillation extravasation
arteries. Increase -advise patient to
myocardial oxygen increase fluid
delivery intake to
counteract
constipation
-advise patient to
comply with
medical regimen
Generic Name / Mechanism of Indications Contraindicatio Adverse Nursing Responsibilities
Brand Name Action ns Reactions
Binds with opiate -relief of -hypersensitivity -sedation -assess pain
Nalbuphine(nuba receptors in the moderate to -drowsiness characteristics
in) CNS: ascending severe pain -sweating before administration
pain pathways in -for pre- -nausea and after tx
limbic system, operatively -dry mouth -monitor VS after IV route
thalamus, midbrain, analgesia -dizziness -instruct px to change
hypothalamus, -supplemental to -headache position
altering perception balance -vomiting slowly to prevent
of end emotional anesthesia orthostatic hypotension
response to pain. -surgical and avoid getting up
Relieves pain anesthesia without assistance
-obstetrical -advise Px to refrain taking
anesthesia CNS depressant for at least
2 hrs after taking the drug

Phenobarbital(lu Depresses activity -all forms of -hypersensitivity -paradoxic assess mental status,
minal) in brain cells epilepsy to barbiturates excitement respiratory dysfunction,
primarily in reticular-status -porphyria -elderly ,toxicity and seizure
activating system in epilepticus -hepatic disease -hang0ver activity
brainstem, also -febrile seizure -respiratory headache -tell Px that hangover is
selectively -sedation disease -diarrhea common
depresses neurons -insomnia -nephritis -rash -teach Px to make position
in posterior -hypertension -local pain, changes slowly
hypothalamus, -DM swelling -elevate side rails to
limbic structure; promote safety
decreases seizure
and motor activity
by inhibiting CNS
impulses
Generic Name / Mechanism of Indications Contraindication Adverse Nursing
Brand Name Action s Reactions Responsibilities

Acts on blood -allergy symptoms -hypersensitivity -dizziness -assess respiratory

Diphenhydramine vessels, GI, -rhinitis to H1 receptor -drowsiness status
(benadryl) respiratory system by -motion sickness antagonist -urinary retention -provide 2L/day to
competing with -nighttime -acute asthma decrease
histamine for the sedation attack secretion
receptor site; -infant colic -lower respiratory thickness
decreases allergic -non productive tract disease -monitor I&O ratio
response blocking cough -instruct Px to use
histamine; causes -anaphylaxis sunscreen to
increase -nasal allergies prevent photo
HR,vasodilatio, -dystonic reaction sensitivity
secretion - -elevate siderails
to promote safety
since dizziness
may occur
-instruct Px to
request assistance
with completion

Phytonadione Needed for adequate -vit. K -hypersensitivity -headache – -monitor for

(aquamephyton) blood clotting (factors malabsorption -severe hepatic nausea bleeding or
II, VII, IX, X) - disease -uticaria bruising
hypoprothrombine -last few week of -assess nutritional
mia pregnancy status
-prevention of -teach Px
hemorrhagic necessary foods
disease of thje high in vit. K to be
new born induced in diet
-advise Px to avoid
IM inj, toothbrush,
flossing; use
Generic Name Mechanism of Indications Contraindicati Adverse Nursing
/ Brand Name Action ons Reactions Responsibiliti
es
Inhibits calcium -Chronic stable - -headache -assess anginal
Nifedipine ioninflux across angina pectoris hypersensitivity -dizziness pain, fluid vol.
(adalat) cell membrane -vasopatic -light status and
during cardiac angina headedness monitor K,LFT
depolarization, -HPN -nausea -instruct the Px
produces -flushing of to limit the
relaxation of skin caffeine
coronary vascular consumption
smooth muscle -advise Px to
and peripheral increase fluid
vascular muscle, intake to
dilates coronary prevent
vascular arteries, constipation,
increase teach Px to
myocardial check for
oxygen delivery in gingival
Px with vasopatic hyperplasia
angina and report
promptly
Generic Name / Mechanism of Indications Contraindication Adverse Nursing
Brand Name Action s Reactions Responsibilities

Assess increase CO, -shock -hypersensitivity -headache -monitor ECG, BP,

dopamine beta 1 and alpha -to increase -ventricular -palpitations and pulse q5 min
receptor, causing perfusion fibrillation -hypertension if BP drops 30
vasoconstriction, in -hypotension -tachydysrythmias -nausea mmHg, stop
blood vessel: when - -vomiting infusion, and call
low doses are pheochromocytom -diarrhea prescriber,
administered causes a -check for
renal mesenteric extravasation:
vasodilatation; beta1 change site q48
stimulation produce -advise Px to
inotropic effects with report all S/E.
increase cardiac
output

Isosorbide Relaxation of Tx and -hypersensitivity to -vascular -asses for pain

dinitrae (isoket, vascular smooth prevention of nitrates headache -monitor for
isordil) muscle, which leads chronic stable -severe anemia -flushing orthostatic BP,
to decrease preload; angina pectoris -increase ICP -dizziness pulse at baseline
afterload thus -cerebral -postural and during Tx
decreasing left hemorrhage hypotension -inform Px that
ventricular -acute MI drug may be
end,diastolic taken before
pressure, systemic stressful activity
vascular resistance -caution Px to
and reducing cardiac change position
oxygen demand slowly.
COMMONLY USED
ABBREVIATIONS
Medication Schedules
ac
= before meals
QD
= every day
Q AM
= every morning
QOD
= every other day
Medication Schedules
PRN
= as needed/whenever
necessary
HS
= hour of sleep/at bedtime
MR x 1
= may repeat x 1
Stat
= at once
Medication Schedules
qh,q1°
= every hour
q2h,q2°
= every two hours
q4h,q4°
= every four hours
BID
=twice a day
Medication Schedules
TID
= three times a day
QID
= four times a day
ASAP
= as soon as possible
q hs
= every night at bedtime
Patient Activity Terms
ad lib
= as tolerated
Up ad lib
= up as tolerated
BRP
= bathroom privileges
BR
= bedrest
Patient Activity Terms
CBR
= complete bedrest
Adm
=admitted/admission
DC or d/c
= discontinue/discharge
I&D
=Incision & drainage
Patient Activity Terms
OOB
= out of bed
CC
=chief complaint
TCDB
= turn, cough, deep breath
BR c BRP
= bedrest c bathroom privilege
Patient Activity Terms
ADL
= activities of daily living
Amb
= ambulatory
S/S
= signs & symptoms
n/v
= nausea & vomiting
 Routes of Medication
Administration
IV
= intravenous
IM
= intramuscular
SQ
= subcutaneous
IVPB
= intravenous piggyback
 Routes of Medication
Administration
p.o.
=by mouth
Supp
=suppository
SL
= sublingual
SD
= side drip
Common Diagnostic
Tests
EKG,ECG
= Electrocardiogram
EEG
= Electroencephalogram
CXR
= Chest X-ray
UGI
= Upper Gastrointestinal
X-rayLGI
= Lower Gastrointestinal X-ray
Common Diagnostic
Tests
MRI
= Magnetic Resonance Imaging
IVP
= Intravenous Pyelogram
Hct
= Hematocrit
BUN
= Blood Urea Nitrogen
Common Diagnostic
Tests
CT
= Clotting Time
GTT
= Glucose Tolerance Test
EMG
= Electromyography
LP
= Lumbar Puncture
GB
= Gallbladder
Common Diagnostic
Tests
CAT Scan
= Computerized Axial Tomography
Scan
USD
= Ultrasound
KUB
= Kidney, Ureter, Bladder
HBT
= Hepato Biliary Tract
Common Diagnostic
Tests
CBC
= Complete Blood Count
Hgb
= Hemoglobin
FBS
= Fasting Blood Sugar
Bt
= Bleeding Time
PPD
= Purified Protein Derivative
Patient/Hospital Related
Terms
E.R.
= Emergency Room
O.R.
= Operating Room
PACU
= Post Anesthesia Care Unit
R.R.
= Recovery Room
Ca
= Cancer
 Miscellaneous
Patient/Hospital Related
Terms
CHF
= Congestive heart failure
FUO
= fever of unknown origin
MI
= Myocardial infarction
OBS
= Organic Brain Syndrome
URI
= Upper Respiratory Infection
 Miscellaneous
Patient/Hospital Related
Terms
UTI
= Urinary Tract Infection
HEENT
= head,ears, eyes, nose, throat
GI
= Gastrointestinal
GU
= Genito-urinary
GYN
= Gynecology
 Miscellaneous
Patient/Hospital Related
Terms
OB
= Obstetrics
COC
=,continuity of care
ABO
= The main blood group
Meds
= medication
LMP
= last menstrual period
 Miscellaneous
Patient/Hospital Related
Terms
ARDS
= Adult Respiratory Distress
Syndrome
AKA
= above knee amputation
A/SGA
= Average/Small Gestational Age
ASHD
= Arteriosclerotic Heart Dis.
 Miscellaneous
Patient/Hospital Related
Terms
IVF
= Intravenous fluid
C/S
= Cesarean Section
CAPD
= Continuous Ambulatory Peritoneal
Dialysis
CPR
= Cardio Pulmonary Resuscitation
 Miscellaneous
Patient/Hospital Related
Terms
CVA
= Cerebro Vascular Accident
FHR
= fetal heart rate
ICP
= intracranial pressure
NSVD
= Normal Spontaneous Vagina
Delivery
 Miscellaneous
Patient/Hospital Related
Terms
PROM
= premature rupture of membrane
PID
= Pelvic Inflammatory Disease
PMI
= point of maximum impulse
VBAC
= Vaginal birth after cesarean section
 Miscellaneous
Patient/Hospital Related
Terms
T&A
= Tonsillectomy & Adenoidectomy
TIA
= Transient Ischemic Attack
C.N.M.
= Clinical Nurse Manager
P.C.C.
= Patient Care Coordinator
ICU
= Intensive Care Unit
 Miscellaneous
Patient/Hospital Related
Terms
SOB
= shortness of breath
N.P.
= Nurse Practitioner
AMNP
= Advanced Medical Nurse
Practitioner
HOH
= hard of hearing
Ectomy
= removal
 Miscellaneous
Patient/Hospital Related
Terms
itis
= inflammation
Otomy
= incision into
PE
= pulmonary embolism
PMH
= past medical history
PTA
= prior to admission
 Miscellaneous
Patient/Hospital Related
Terms
Lap
= laparotomy
ABG’s
= Arterial blood gases
C&S
= culture & sensitivity
U/A, UA
= urinalysis
CVMS
= clean voided urine midstream
 Miscellaneous
Patient/Hospital Related
Terms
BM
= bowel movement
ACLS
= Advanced Cardiac Life Support
AIDS
= Acquired Immune Deficiency
Syndrome
anes.
= anesthesia
 Miscellaneous
Patient/Hospital Related
Terms
A/CRF
= Acute/Chronic Renal Failure
BPH
= Benign Prostatic Hypertrophy
CPD
= Cephalo Pelvic Disproportion
CAD
= Coronary Artery Disease
 Miscellaneous
Patient/Hospital Related
Terms
CNS
= Central Nervous System
TPN
= total parenteral nutrition
CVP
= Central Venous Pressure
GCS
= Glasgow Coma Scale
IOP
= intraocular pressure
 Miscellaneous
Patient/Hospital Related
Terms
ORIF
= Open Reduction Internal Fixation
PEEP
= Positive End Expiratory Pressure
PUD
= Peptic Ulcer Disease
SVC
= superior vena cava
 Miscellaneous
Patient/Hospital Related
Terms
TOF
= Tetralogy of Fallot
TAHBSO
= Total Abdominal Hysterectomy w/
Bilateral Salpingo-oophorectomy
TURP
= transurethral resection of the
prostate
General Terms
c
= with
s
= without
a
= before
p
= after
General Terms
ac
= before meals
R
= right
OD
= right eye (oculus
dexter)
F
= Fahrenheit
General Terms
C
= Celsius, centigrade
Dx
= Diagnosis
Rx
= Treatment
Sx
= Service
General Terms
Tx
= traction, therapy
Bx
= biopsy
Fx
= fracture
c/c
= complaint of
General Terms
w/c
= wheelchair
DAT
= diet as tolerated
amt.
= amount
drsg.
= dressing
General Terms
Os
= mouth or opening
post-op
= post operatively
prep
= preparation
VO
= verbal order
General Terms
KVO
= keep vein open
Tbsp
= tablespoon
Ss
= half
Cc
= cubic centimeter
General Terms
VS
= Vital signs
BP
= Blood Pressure
TPR
= Temperature, Pulse,
Respiration
NPO
= nothing by mouth (non
per os)
General Terms
pc
= after meals
L
= left, liter
OS
= left eye (oculus sinester)
OU
= both eyes
General Terms
H20
= water
R/O
= Rule Out
O2
= oxygen
Pt
= patient
General Terms
PT
= Physical Therapy
AP&L
= anterior posterior &
lateral
noc
= night
gen
= general
General Terms
Approx
= approximately
Mod
= moderate
Gtt
= drop
Neg
= negative
General Terms
per
= by or through
preop
= preoperatively
WNL
= within normal limits
TO
= telephone order
General Terms
Wt
= weight
Tsp
= teaspoon
Cath.
= catheter
Ml
= millimeter
 …end of
presentation…
THANK YOU!