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SEMESTER 7 > Acute and Critical care > Flashcards

Acute and Critical care Flashcards

1
Q

CV: When a pt is in acute cardiac distress, what health history questions will you ask? (3)

A
  • chief complaint
  • precipitating events
  • current medications
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2
Q

CV: When a pt is not in acute cardiac distress what areas of questions should we ask? (4)

A
  1. review presenting illness
  2. general CV status
  3. general health status
  4. pt lifestyle
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3
Q

When doing cardiac assessment what are things that MUST be considered?

A
  • if there is any evidence of CAD or risk seen, assume myocardial ischemic event until ruled out
  • PQRST: rule out other types of chest pain
  • little correlation between severity of pain and its cause may exist
  • not all people use the word “pain”, they may say pressure, heat, discomfort, stabbing
  • keep in mind the other symptoms of cardiac events (dyspnea, cough, fatigue, cyanosis)
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4
Q

What are signs of a vascular disease?

A
  • pale, shiny skin

- sparse hair

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5
Q

What are signs of venous disease?

A
  • edema
  • discolouration
  • frequent ulcerations
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6
Q

When do you see JVD?

A

when central venous pressure is elevated, important to assess fluid overload

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7
Q

What is the risk when using heparin to flush lines?

A

heparin-induced thrombocytopenia

- must monitor platelet count

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8
Q

Flush solutions, lines, stopcocks, and transducers must be changed every ___ hrs.

A

96

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9
Q

To assess JVP, what position must the pt be in?

A

At a 45°

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10
Q

What is a pulsus paradoxus?

A

exaggerated decline in BP by greater than 10mmHg, during inspiration due to TAMPONADE

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11
Q

How do you assess for orthostatic hypotension?

A

3 positions: laying, sitting, standing
there is a positive result if:
- Systolic BP decreases by 20mmHg
- Diastolic BP decreases by 10mmHg

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12
Q

What is the difference between systolic and diastolic? (which is contracted/rest?)

A

systolic: contracted ventricle
diastolic: ventricle at rest

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13
Q

what is pulse pressure?

A

the difference between systolic and diastolic:

SBP - DBP = PP

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14
Q

what is mean arterial pressure?

A

the average BP of the cycle

SBP + 2(DBP) / 3

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15
Q

a narrow pulse pressure means that?

A

there is vasoconstriction, temporary.. the blood is perfusing quickly

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16
Q

a wide pulse pressure means that?

A

the blood is perfusing very slowly, poor perfusion, vasodilation

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17
Q

QRS complex will measure less than ___ sec.

A

0.10

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18
Q

What is the Bazet formula?

A

QTc = QT / square root of RR interval

  • if above 0.5, they are at a higher risk of TORSADES DE POINTES or increase of 0.06 above their baseline
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19
Q

What is fibrinolysis and when would it be indicated? what are contraindications…

A
  • the enzymatic breakdown of a blood clot
  • indicated in pt with STEMI, if treatment is likely to take longer than 120min and pt has NO contraindications such as:
  • active bleeding,
  • past stroke,
  • aortic dissection,
  • prior hemorrhage
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20
Q

A pt comes in with an emergency STEMI, there is detection of a new murmur. What may that indicate?

A
  • rupture of papillary muscle
  • severe damage
  • impending heart failure
  • pulmonary edema
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21
Q

Name 4 pt outcomes for STEMI.

A
  1. pt will be pain free
  2. cardiac output will be in normal range to maintain tissue perfusion
  3. pt will have adequate coping skills to deal with situational crisis
  4. pt will demonstrate adequate knowledge of disease mgmt
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22
Q

What are the 3 types of acute coronary syndrome (ACS)?

A
  1. unstable angina
  2. STEMI
  3. nonSTEMI
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23
Q

What is the first thing that a pt should do if they are having early ACS symptoms?

A

sublingual nitro and call 911 if unrelieved or worsens

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24
Q

Pts with ACS symptoms should be driven by their family member or friend to the hospital. T or F

A

FALSE. they should be driven in ambulance, with the proper equipment and meds

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25
Q

What are the 2 treatments for STEMI?

A
  • PCI

- fibrinolytic

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26
Q

What is the most common cause that leads to SCD or sudden cardiac death?

A

1 pre-existing ventricular dysfunction!!

  • CAD
  • hypertrophic cardiomyopathy
  • WPW syndrome
  • long QT syndrome
  • EF less than 30%
27
Q

How do we reduce risk of SCD?

A

implantation of ICD (implantable cardioverter defibrillator) or antidysrhythmic therapy
- individualized therapy depending on pts condition

28
Q

Who is at risk of endocarditis?

A
  • Congenital heart disease
  • body piercings
  • IV drug misuse
  • prosthetic valve
  • valvular disease
29
Q

What is endocarditis?

A

inflammation of the endothelial part of the heart

30
Q

How do you diagnose endocarditis?

A
  • blood culture test, CXR, echo
31
Q

what is the treatment of endocarditis?

A

longterm antibiotic

32
Q

what are the 2 types of murmur?

A
  • stenosis

- regurgitation

33
Q

What is the normal first line drug for hypertensive emergencies?

A

Sodium nitroprusside

34
Q

BP must be lowered slowly over a period of several minutes to hours because why??

A

if lowered too quickly we can cause cerebral hypoperfusion

35
Q

What are the nursing priorities for someone who is undergoing a hypertensive crisis?

A 
assess BP in both arms
assess symptoms
administer IV meds and monitor for complications
maintain BP in desired range
optimize fluid balance
pt education
36
Q

what are the indications for a pacemaker?

A
  • bradydysrhythmias
  • tachydysrhythmias
  • drug toxicity
  • electrolyte imbalance
37
Q

what are the 3 types of nutrition support?

A
  • oral
  • enteral
  • parenteral
38
Q

What is one way to measure preload?

A

with pulmonary artery occlusion pressure

39
Q

Intraarterial BP monitoring monitors 3 continuous measurements, what are they?

A
  1. systole
  2. diastole
  3. MAP
40
Q

before a catheter can be inserted into a peripheral artery. what must be done and why?

A

Allen test or doppler assessment to assess collateral circulation/perfusion

41
Q

Your patient has an intraarterial catheter to monitor their blood pressure after cardiac surgery. As their nurse, what are your responsibilites?

A
  • to continuously assess perfusion, ensure adequate to vital organs. Do this by assessing MAP.
42
Q

What is the minimum MAP for cerebral and coronary perfusion?

A

cerebral: 50mmHg
coronary: 60mmHg

43
Q

what type of troponin is specific to myocardial muscle?

A

troponin i

44
Q

how long post myocardial injury must we wait until a troponin test will accurately read?

A

3-6hrs

45
Q

A pt comes into the ED with shortness of breath. How can we determine if this is a direct pulmonary issue or acute heart failure with associated pulmonary edema?

A

performing a natriuretic peptide test.

46
Q

What is the BNP gray zone?

A

100-400, the gray zone is so big.. that is the reason why BNP tests are accompanied by many other diagnostics to ensure the diagnosis or HF is accurate.

47
Q

What does a prominent U wave signify on ECG?

A

possible hypokalemia

48
Q

Whats the blood coagulation tests for warfarin and for heparin?

A

warfarin: INR
heparin: PTT or aPTT

49
Q

What anticoagulant drug does not work with PTT tests?

A

LMWH

50
Q

What is considered the antidysrhytmic with the best safety record after STEMI?

A

amiodarone

51
Q

If amiodarone is contraindicated in the pt after a STEMI, what is the next best antidysrhythmic?

A

beta blockers

52
Q

What drugs helps to prevent ventricular remodeling post STEMI? Why?

A

ACEIs and ARBs
- these drugs decrease the workload of the heart to prevent these progressive changes in shape and size and protect the pt from developing HF.

53
Q

What is the goal of pacemakers?

A

to prevent the heart from going bradycardic

54
Q

What is the goal of ICD?

A

to return dysrhythmic action to normal or to defibrillate the heart if it stops

55
Q

What class of antidysrhythmic drugs must be avoided in pts with WPW syndrome and why?

A

class IV, because accessory pathways are not affected by CCBs

56
Q

“treatment of choice for torsades de pointes”?

A

magnesium

57
Q

If a drug has a positive inotropic effect, what does that mean? negative inotropic effect?

A

POSITIVE = increased contractility of the heart

NEGATIVE = decreased contractility of the heart

58
Q

What method of feeding is preferred?

A

enteral!!!

59
Q

What kind of vitamins do dialysis pts need more of b/c of their ability to be filtered out?

A

WATER soluble

60
Q

Those with renal problems should avoid excesses of ___, ___, ____. (avoid them in excess BUT STILL HAVE THEM.)

A

protein, fluid and electrolytes

61
Q

How to estimate GFR?

A 
1.2 x (140-age) x ideal body weight (kg)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          = MALE
serum creatinine (umol/L)

For female, multiply answer by 0.85

62
Q

how to calculate ideal body weight?

A 
male = 50kg + 2.3 (height in inches - 60)
female = 45kg + 2.3 (height in inches - 60)
63
Q

What are the 3 regions of the brainstem that control respirations and their function?

A

MEDULLA OBLONGATA: sends signals to breathing muscles
VENTRAL: controls expiratory
DORSAL: controls inspiratory

SEMESTER 7 (3 decks)

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