Acute Care & Anemia

Question 1

What are the pharmacokinetic alterations that can occur in acute care?

Answer 1

renal elimination
-renal dysfunction is common w critical illness
-look at Scr

Question 2

How do you treat septic shock?

Answer 2

fluids -lactated ringers
vasopressors – norepinephrine preferred
vasopressin as an add-on

Question 2

What is sepsis?

Answer 2

-organ dysfunction caused by dysregulated response to infection
-NOT a bloodstream infection

Question 3

What is septic shock?

Answer 3

-sepsis associated with cardiovascular collapse/hypotension

Question 4

What is the prophylactic dosing for UFH and LMWH?

Answer 4

UFH- 5000 U SC
enoxaparin - 30 mg subq q12h or 40 mg subq q24h

Question 5

What promotility agents are used in an acute care patient’s bowel regimen?

Answer 5

metoclopramide, erythromycin

Question 6

What are the depolarizing neuromuscular blocking aents?

Answer 6

succinylcholine
-used for rapid sequence intubation
-CI in major burns, crush injury, upper moton neuron disease (ALS)

Question 7

What are the nondepolarizing neuromuscular blocking agents?

Answer 7

aminosteroidal (pancurinium, vecuronium, rocuronium), benzylisoquinolinium (atracurium, cisatracurium)
-AE’s increased ICP, prolonger paralysis/muscle weakness

Question 8

how do you monitor sustained NMB?

Answer 8

train-of-four assessment
-goal is 1-2 out of 4

Question 9

What is used for pain assessment in the ICU?

Answer 9

BPS (Behavioral pain scale) and CPOT (critical care pain observation tool)

Question 10

What is used for sedation assessment in the ICU?

Answer 10

RASS (richmond-agitation-sedation scale) SAS (sedation-agitation scale)

Question 11

What is the BIS?

Answer 11

Bispectral Index
-used for assessing sedation. for patients whom are either in deep sedation, neuromuscular blockade

Question 12

What is the difference between Midazolam and Lorazepam for sedation?

Answer 12

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

Question 13

What adverse effect of dexmedetomidine is of concern?

Answer 13

hemodynamic changes

Question 14

What is used for delirium assessment?

Answer 14

ICDSC and CAM-ICU

Question 15

What medication is recommended for delirium where agitation makes it impossible to get someone off the vent?

Answer 15

dexmedetomidine

Question 16

What are some signs and symptoms of anemia?

Answer 16

exertional dyspnea, angina, tachycardia, fatigue, pallor, spoon shaped nails, inflamed tongue

Question 17

What is a normal MCV range?

Answer 17

80-100
-average volume of RBCs

Question 18

What are the lab results of someone with iron-deficiency anemia?

Answer 18

low Hgb, low MCV, decreased Ferritin, decreased TSAT

Question 19

What are the lab results of someone with B12 deficiency?

Answer 19

low Hgb, high MCV, high RDW, low serum B12, increased homocysteine

Question 20

What are the lab results of someone with Folic acid deficiency?

Answer 20

low Hgb, high MCV, high RDW, low serum folate, high homocysteine

Question 21

What are the normal hemoglobin levels for males and females?

Answer 21

Males: 13.5-18 g/dL
Females: 12-16 g/dL

Question 22

What is the normal ferritin range?

Answer 22

15-200 ng/mL

Question 23

What is the normal TSAT range?

Answer 23

20-50%