Acute Care & Anemia Flashcards
What are the pharmacokinetic alterations that can occur in acute care?
renal elimination
-renal dysfunction is common w critical illness
-look at Scr
How do you treat septic shock?
fluids -lactated ringers
vasopressors – norepinephrine preferred
vasopressin as an add-on
What is sepsis?
-organ dysfunction caused by dysregulated response to infection
-NOT a bloodstream infection
What is septic shock?
-sepsis associated with cardiovascular collapse/hypotension
What is the prophylactic dosing for UFH and LMWH?
UFH- 5000 U SC
enoxaparin - 30 mg subq q12h or 40 mg subq q24h
What promotility agents are used in an acute care patient’s bowel regimen?
metoclopramide, erythromycin
What are the depolarizing neuromuscular blocking aents?
succinylcholine
-used for rapid sequence intubation
-CI in major burns, crush injury, upper moton neuron disease (ALS)
What are the nondepolarizing neuromuscular blocking agents?
aminosteroidal (pancurinium, vecuronium, rocuronium), benzylisoquinolinium (atracurium, cisatracurium)
-AE’s increased ICP, prolonger paralysis/muscle weakness
how do you monitor sustained NMB?
train-of-four assessment
-goal is 1-2 out of 4
What is used for pain assessment in the ICU?
BPS (Behavioral pain scale) and CPOT (critical care pain observation tool)
What is used for sedation assessment in the ICU?
RASS (richmond-agitation-sedation scale) SAS (sedation-agitation scale)
What is the BIS?
Bispectral Index
-used for assessing sedation. for patients whom are either in deep sedation, neuromuscular blockade
What is the difference between Midazolam and Lorazepam for sedation?
Lorazepam - delayed onset, prolonged duration of effect, less titratable, better for elderly
Midazolam- faster onset, prolonged use of med >48 h half life becomes unpredictable
What adverse effect of dexmedetomidine is of concern?
hemodynamic changes
What is used for delirium assessment?
ICDSC and CAM-ICU
What medication is recommended for delirium where agitation makes it impossible to get someone off the vent?
dexmedetomidine
What are some signs and symptoms of anemia?
exertional dyspnea, angina, tachycardia, fatigue, pallor, spoon shaped nails, inflamed tongue
What is a normal MCV range?
80-100
-average volume of RBCs
What are the lab results of someone with iron-deficiency anemia?
low Hgb, low MCV, decreased Ferritin, decreased TSAT
What are the lab results of someone with B12 deficiency?
low Hgb, high MCV, high RDW, low serum B12, increased homocysteine
What are the lab results of someone with Folic acid deficiency?
low Hgb, high MCV, high RDW, low serum folate, high homocysteine
What are the normal hemoglobin levels for males and females?
Males: 13.5-18 g/dL
Females: 12-16 g/dL
What is the normal ferritin range?
15-200 ng/mL
What is the normal TSAT range?
20-50%
