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CSC Prep > Ch. 10 All Other Systems > Flashcards

Ch. 10 All Other Systems Flashcards

1
Q

Carotid Stenosis
* Definition
* Causes
* Symptoms
* Treatent of high risk vs low risk

A
  • Narrowing of the carotid artery
  • Often caused by plaque build up
  • Present with TIAs, visual changes, memory loss, vertigo, syncope, bruit or thrill
  • Antiplatelet aggregation (aspiriin or plavix), BP control <130/80, Statin therapy slows progression, Carotid endarterectomy for high risk patients, carotid stending, balloon agioplasty for low risk patients (minimally invasive procedure to widen narrowed artery/vein)
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2
Q

Carotid Endarterectomy
* What to monitor for postop
* Cranial Nerve VII
* CN IX/X
* CN XI
* CNXII

A
  • Monitor for bleeding/hematoma, airway assessment d/t swelling (assess for difficulty breathing and swallowing), Neuro assessment for stroke risk
  • Smile
  • Swallow, gag, speech
  • Shrug shoulders against resistance
  • Stick out tongue midline
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3
Q

Stroke
* 2 types
* Is this common
* Etiology
* Pre-op Risk Factors (2)

A
  • Ischemic/Embolic vs Hemorrhagic
  • Not common ~ 4% after cardiac surgery
  • Aortic debris, post op afib, air embolism, cerebral hypoperfusion
  • Hypertension, Atrial fibrillation, Diabetes, Prior stroke, >65 y.o.
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4
Q

Diagnosis with stroke like symptoms
1. first
2. second
3. third
4. fourth

A
  1. CT scan without dye (many are micro-emboli or watershed territory)
  2. MRI often preferred
  3. Assess Glucose
  4. Other considerations: baseline 12 lead, tropes, coags, platelet count
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5
Q

What is a watershed terroritory stroke

A
  • A watershed stroke, also known as a border zone infarct, is a type of ischemic stroke that occurs when blood flow to the brain’s border zones (furthest away from blood supply) is severely reduced
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6
Q

What does LOE Class 1 Level BR mean?

A

The american heart association has developed a system of rating the strength of their medical recommendations and quality of evidence. The highest level of recommendation is Class 1, Level A

https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/tables/applying-class-of-recommendation-and-level-of-evidence

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7
Q

NIH stroke scale NIHSS
* What does it do
* Score range

A
  • Grades severity of stroke but does not diagnose the stroke
  • Score range from 0 to 42, no deficits to devastating
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8
Q

Initial priorities in BP management in stroke
* how fast should we lower the BP
* what medications
* Treat hyperglycemia to what range
* Highest cause of epsilepsy in the elderly

A
  • slowly
  • nicardipine 5mg/hr up to 15 mg/hr max
  • Clevidipine IV
  • Hydralazine IV
  • 70-180 is normal
  • Acute ischemic stroke (there is some risk for seizure)
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9
Q

Endovascular therapies for ischemic stroke
* tPA vs. tPA + Thrombectomy
* What is the window for thrombectomy

A
  • Should receive tPA regardless
  • Mechanical thrombectomy if they present within 6-16 hours of last known state of wellness and have an anterior circulation large vessel occlusion. May also be reasonable in patients with a contraindication to IV fibronolysis
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10
Q

3 Hallmark Signs of Delirium
PADIS guideline
* Definition
* Which is more common, Hyperactive or Hypoactive

A
  1. Inattention
  2. Confusion
  3. Disorganized thinking
    * This is a guideline for the order of treatment in delirium. Pain, Agitation, Delirium, Immobility, Sleep disruption
    * Hypoactive delirium is most common, increased mortality 3x
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11
Q

Highest Risk factors for developing AKI
* Gender, age, what kind of surgery,
* Baseline renal function
* Hx of what

A
  • Female, >65, Cardiac surgery
  • Baseline renal dysfunction
  • Liver dysfunction, Stroke, smoking, Long CPB time, Strong abx
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12
Q
  • What does proteinuria mean
  • Casts in the urine
  • Normal urine electrolytes
  • Normal Urine to BUN ratio
A
  • Proteinuria means kidney dysfunction because only a small amount of protein is normal
  • Casts mean tubular cell death
  • Urine Na 40-100 mEq/L
  • 10:1 - 15:1
  • BUN 6 - 24, Creat .6 - 1.2
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13
Q

Prerenal AKI
* Def
* Cause
* Is the kidney permanently damaged
* Urine Na

A
  • Cause of injury to kidneys occurs befor the blood reaches kidney
  • Caused by hypoperfusion
  • Kidney structure and function is preserved
  • Urine Na+ <40 mEq/Li
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14
Q

ATN
* Def
* Signs
* Treatment

A
  • Injury occurs at the nephron; there is structural damage to the kidney
  • BUN/creat ratio normal but they’re both elevated, BUN >25, Creat >1.2
  • Dialysis if indicated, Prevent acidosis, electrolyte imbalance and uiremia, stop nephrotoxic medications
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15
Q

ATN Acute Tubular Necrosis
* 2 types
* what type of damage
* Recovery time

A
  • Toxic ATN caused by drugs or bacteria (vanco, gent, aminoglycosides, antivirals). This causes widespread damage but is reversible with recovery <8 days
  • Ischemic ATN causes irregular damage along tubular membranes. Tubular cell damage and cast formation. Poor prognosis with recovery time >8 days
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16
Q

Most Nephrotoxic medications
(5)

A
  • Amphotericin B
  • Contrast Dye
  • Nsaids
  • Vancomycin
  • Ciprofloxacin
17
Q

*What are the kidneys supposed to do?
ATN Phase 1
* Def
* Symptoms
* Na, Uring specific gravity
* treatment

A
  • retain sodium and excrete other electrolytes
    *Oliguric phase
  • Inability to excrete fluids and wastes, Sig increase in BUN and creat, fluid overload, metabolic acidosis because urine not releasing acid,
  • NA low but urine specific gravity elevated > 1.01,
  • often required dialysis
18
Q

ATN Phase 2
* Def
* Symptoms
* what to watch for

A
  • This is the Diuretic phase
  • Gradual improvement in renal function, increase in GFR and often develop polyuria,
  • Kidney can often clear volume but not solute or waste so watch electrolytes closely, monitor for fluid deficit
19
Q

ATN Phase 3
* Def
* can progress to
* GFR usually returns to
* What % will recover

A
  • Recovery phase
  • Can progress to CKD
  • GFR usually returns to <80% within 2 years
  • 33% will have chronic renal insufficiency, 60% recover
20
Q

Indications for Dialysis
* Abbreviation

A
  • AEIOU
  • Acid/base imbalance
  • Electrolyte imbalance
  • Intoxications (ODs/toxins)
  • Overload (fluid)
  • Uremic symptoms
21
Q

What drug prevents contrast induced nephropathy

A

Acetyl Cysteine

22
Q

Uremic Syndrome
* Def
* Symptoms

A
  • This is elevated Blood Urea Nitrogen
  • Lethargy, Fatigue, Coma, Hyperkalemia, Fluid overload, Anemia, Pulm edema, effusions, pleuritis, decreased appetite, N/V, ascites
23
Q

SLED
Disequilibrium syndrome
Advantage of CRRT

A
  • Slow Low Efficiency Dialysis
  • Dialysis disequilibrium syndrome is the collection of neurological signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis or CRRT
  • Can use in pts with hemodynamic instability
24
Q

Meds Removed by Dialysis

A
  • B LIST MED
  • Barbituates, Lithium, Isoniazid, Salicylates, Theophylline, methanol, ethylene glycol, depakote
  • Hold BP meds until after dialysis
25
Q

LABORATORY NORMS
* BUN
* Creat
* Urine specific Gravity
* Osmolality
* Urine Sodium
* Urine Protein

A

* 6-20 mg/dL
* 0.6 - 1.2
* 1.010 - 1.020
* 500 - 800 mOsm/L
* 40 - 100 mEq/24h
* 30 - 150 mg/24h

26
Q

Postrenal AKI
* Def
* S/S

A
  • also known as obstructive nephropathy, occurs when waste builds up in the kidneys due to an obstruction in the urinary tract below the kidneys
  • High urine Na, BUN to creat ratio normal but both elevated
27
Q

Electrolytes associated with Acidosis
Electrolytes associated with Alkalosis

A
  • Hyperkalemia, Hypermagnesemia, Hyperchloremia, Hypercalcemia, Hyperphosphatemia
  • Hypokalemia, hypomagnesemia, Hypochloremia, hypocalcemia, Hypophosphatemia
28
Q

What does potassium do to myocardial tissue

A

Causes a change in the resting action potential of the cell

29
Q

In the Presence of what, potassium is excreted by the renal tubules

A

Aldosterone (RAAS - Ace inhibitor will cause potassium build up)

30
Q

Cardiac Symptoms Related to
* Hyperkalemia / hypermagnesemia
* Hypokalemia / hypomagnesemia

A

*Cardiac stability
* Tall tented T waves, wide QRS, prolonged PR, Wide p waves, progressing to asystole or VFfib, N/V, diarrhea, numbness in hands and feet, flaccid paralysis, apathy, confusion
* Ventricular ectopy, Depressed ST segment, prolonged QT, muscle cramping and spasms, Cardiac irritability, U wave, can potentiate Dig toxicity

31
Q

Hyperkalemia protocol
* contains

A
  • Insulin
  • Sodium Bicarb
  • Albuterol, Dialysis
  • Loop diuretici
  • Lokelma potassium binder
  • Kayexalate potassium binder
32
Q

Chvostek’s sign
* Indicates
* Defintion

A
  • Hypocalcemia
  • Cheek twitching
33
Q

Trousseau’s Sign
* Indicates what
* Def

A
  • Hyperphosphatemia and Hypocalcemia
  • Italian pinching type of spasm
34
Q

Hypocalcemia
Hypercalcemia
Calcium is also needed to
Which one lasts longer

A

*This is stability plus the two hypocalcemia signs
* Prolonged QT, hypotension, Low CO, Ventricular ectopy, Chvostek’s and Trousseau’s signs, PRBC transfusions
* N/V, bone and muscle weakness, muscle cramping, lethargy, depression,
* Calcium is needed to clot, Calcium gluconate lasts longer

35
Q

Hypophosphatemia
Hyperphosphatemia
Which electrolytes have an inverse relationship to eachother?

A
  • Acute confusion, muscle weakness, incoordination, speech difficulty, numbness, tingling, seizures, coma
  • N/V, anorexia, muscle weakness, hyperreflexia, tetany, tachycardia
  • Phosphate and calcium have an inverse relationship to each otheri
36
Q

Hyperchloremia
Hypochloremia

A

* Metabolic acidosis, excessive sodium chloride administration, decreased renal perfusion leading to kidney injury
* Metabolic alkalosis, hypochloremia = volume depleted patient,

CSC Prep (8 decks)

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