CV review Flashcards
Which IV fluid should be avoided in patients with cerebral edema? and why ?
Hypotonic solution, it can reduce serum osmolality and create a fluid shift that increase cerebral edema
Proper timing of the IABP requires identification of the _______, correlating with the closure of the ____ ____and the beginning of the ______. In order to visualize the dicrotic notch; the IAP setting my be ____ : ____.
Dicrotic notch; aortic valve; diastole; 1;2
Proper inflation timing of the IABP is confirmed when the ______augmentation occurs at the _____ ___ or the beginning of the _______ The entire cycle of inflation and deflation occurs during the ________ and _______
Diastolic; dicrotic notch; diastole; beginning of diastole; end diastole
A serious known complication with the IABP is ____________
Limb ischemia.
Potential complications associated with removal of Swan-Ganz catheter?
Pulmonic valve rupture Air embolism Ventricular arrhythmia
The Swan-Ganz catheter is placed in the__________ artery through the ______(left or right) heart
pulmonary ; right
In order to delay the progression of ______ventricular failure for patients with pulmonary artery hypertension, effective treatments is aimed at reducing the _______ which will (increase/decrease) _____afterload for the right ventricle
right; PVR; decrease
NYHA Class I
No limitation of physical activity
NYHA Class 2
Slight limitation of physical activity, comfortable at rest. ordinary physical activity results in fatigue, palpitations, dyspnea.
NYHA Class 3
Marked limitation of physical activity less ordinary physical activity results in fatigue, palpitations, dyspnea.
NYHA Class 4
Unable to carry any physical activity without discomfort
Inadequate cardiac pumping causes ______ _____ to back up into the _____ and ______ leading to _______ CVP
excessive volume; lungs; right ventricle; Elevated
Common precipitator of cardiogenic shock is
MI
Beta blocker (increase/decrease)_____ cardiac contractility therefore (increase/ decrease) cardiac index
Decrease
Which class of antiarrhythmic medications has been shown to reduce cardiac mortality most significantly in patients with heart failure and reduced EF? _____which are_____
Class II; beta blockers
Class I of antiarrhythmic medications include:
Sodium channel blockers
Class II of antiarrhythmic medications include:
Beta blockers
Class III of antiarrhythmic medications include
Potassium channel blockers
Class IV of antiarrhythmic medications include
Calcium channel blockers
__________improve mortality related to Stroke
Calcium channel blockers
Which of the following malignancies is the most common cause of cardiac tamponade?
Lung Carcinoma
Unexplained new R-waves and anterior ST depression indicate __________
posterior MI
Dronedarone is contraindicated in which kind of HF patients NYHA _____(class)
NYHA Class III and class IV
True or False: beta blockers do not have to be stopped in patients who was taking BBlockers prior to HF diagnosis
True. Starting will make worse, continuing existing beta blocker doesn’t affect
Cardiogenic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR
Elevated; low; increased
Septic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR
low; initial high; low
Hypovolemic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR
low; low; high
Autoimmune reaction from sensitization to myocardial cells at time of myocardial infarction is called _______syndrome
Dressler
Action of digoxin in heart failure is to the _________ of ______pump resulting in an increased in _____________ and promoting _________through the __________pump which increases________
inhibition; Na-K-ATPase ; intracellular sodium; calcium influx; sodium-calcium; contractility
Secondary cause of sudden hypertension in young adults is ________ and is usually the result of _______. Pt will have (hyper or hypokalemia) and may have ______ on exam
Renal artery stenosis; Fibro muscular dysplasia; hypokalemia; renal bruit
Hypocalcemia would show __________on an EKG tracings; an appro
Prolonged QT;
______ HF is best characterized y a stiff ventricle which requires an adequate ____ ____ to generate adequate ____ ____
Diastolic; filling pressure; stroke volume
Which condition predisposes a patient to have esophageal varices bleeding? why?
End stage liver disease; because ESLD can lead to prolonged PT and aPTT> that can lead to portal HTN
For treatment of DKA, ____ activates ____ _____ _____ in many cells, causing _______ to enter cells and _________serum ______Levels
Insulin; Sodium-Potassium ATPases; potassium decreasing; potassium
A pacemaker spike that is not followed by a complex indicates a
FAILURE TO CAPTURE
When the pacemaker fails to sense the heart’s intrinsic activity it is ___________; In that case, _______ _____ can be indicated
failure to sense; increase sensitivity
When the pacemaker is over-sensing, as evidenced by the ______ ____ _______ ____, ______ should be decreased
absence of pacemaker spikes; Sensitivity
Optimal CPP is considered to be ___ to ____ mmHg
50-70
CPP is
MAP-ICP
Recommended ventilator setting include minimizing _____ to maintain a _______ above _____ and decreasing _______ ____ to a ______ ____ goal of ________cm H2O
FiO2; PaO2, 55; Tidal volume; Plateau pressure; <30cmH20
Cushing’s triad includes: _____, ______ and ______ ____ _and is associated with ________ ICP due to several factors including ____ _____, _____ and _____
Hypertension, bradycardia, irregular respiration. elevated, cerebral edema, bleeding and tumor
Excessive vomiting or gastric suctioning can result in loss of ________ _______ which can lead to which ABG abnormlity?
Hydrochloric acid; metabolic alkalosis.
The clinical presentation of hypovolemic shock is related to
the inadequate volume of circulating blood
Kussmaul respirations occur in _____ and Is to correct _____ ______
DKA; Metabolic acidosis .
FLuroquinolones Levofloxaxin or ciprofloxacin can lead to _________
Rupture tendinitis
Why are corticosteroids dangerous in patients with post MI pericarditis? It inteferes with __________of MI to _________resulting in _______and increased risk for _______________ wall rupture.
conversion; scar tissue resulting in wall thinning and increased risk of post-MI wall rupture.
Short acting ACEI
Captopril , start if unsure of reaction to ACE
best point of auscultation for S2
Erb’s point
The aortic valve area is located under the ______right ______space at the _____sternal border.
second; intercostal; right
The tricuspid valve area is located at the ______, ______space at the _____sternal border.
fourth, left; intercostal; left
The mitral valve area is located at the ______, ______space at the________ ______.
Left fifth intercostal; mid-clavicular line.
The pulmonic valve area is located at the ______, ______space at the________ ______.
second left intercostal; left sternal border
The key to accurate ICP measurement is to use the ______________ which is the _________ or the __________. The landmark is to approximate the __________ of _______
same landmark each time ; tragus of the ear; outer canthus of the eye ; foramen of monro
Metabolic acidosis should not be corrected with bicarbonate until pH is _______ and bicarbonate is ___________
<7.1 ; 6
CVP reading is reassessed by re-performing _______, ______ and a ______ ____ ____ test
zeroing, leveling; square wave form
Additional oxygen should not be withheld due to fear of __________. Goal of patient with resp distress is to maintain sufficient oxygen to achieve SaO2 > ________ and PaO2______
losing hypoxic drive; 88%; 55mmhg
Rapid Shallow Breathing Index less than _______ breaths/min/L may predict _____success. and the formula is _____/ (TV/1000)
105; vent weaning; RR
Patient with rapid afib lose adequate (atrial or ventricular filling)_________ in addition to loss of _______ _____. as a result , SV is ______resulting in (hypo/hypertension) _____
ventricular filling; atrial kick; decreased; hypotension
Defibrillation may cause _________ _____if the electrical current lands on the second half of the ______ , which is the ______ _______ _______. May consider _______for immediate intervention with cardioversion
ventricular defibrillation; T wave, absolute refractory period; Amiodarone
The main difference between cardioversion and defibrillation is ___________ based on the
the timing of the shock ; cardiac cycles
Synchronized cardioversion senses the _______ _______and delivers a shock during the __________stage of the cardiac cycle, avoiding delivery of shock on the________which may lead to _______ _______
QRS complex; repolarization stage; T wave; ventricular fibrillation
ARDS patients have the best outcomes when tidal volumes are ______. Tidal volume of ____ml/kg
low; 6
In patients with cholestasis, the__________ is typically elevated to at least four times the upper limit of normal.
alkaline phosphatase
Increasing ______in ARDS may improve ________and in combination with low _______ventilation, improve ________
PEEP; oxygenation; tidal volume; mortality
Status epilepticus is continuous seizure lasting more than _______minutes or _____or more seizures without full ________of ________. Accumulation of metabolic waste products (lactic acid) and inefficient _______and _____exchange. leading to _____and _______, and ______
30; two; recovery of consciousness; oxygen; CO2; hypercapnia; hypoxia, ACIDOSIS (low pH)
According to the ARDS net protocol, VT should be adjusted to maintain Plateau pressure ________ to prevent _______
less than 30mmHg; barotrauma
Low tidal volume ventilation begin at ______and volume can be adjusted downwards to _____
8ml/kg to 6ml/kg
How often do we check plateau pressure
4 hour after change in PEEP or Vt
Central Neurogenic Diabetes insipidus is characterized by (increased/decreased urinary specific gravity_________, increased/or decreased urine osmolality ________ (value ) serum osmolality is (increased or decreased) ________and urine output is (increased or decreased).
decreased; decreased; increased serum; increased urine output
SIADH is characterized by (high /low Na+) ; urine output (H/L)_____specific gravity (H/L)
low; low; high
Goal in CN Diabetes insipidus is to correct the_________and restore fluid balance by promoting _________and ________retention
ADH deficiency; sodium; water
In the acute phase of CNDI, _________ ____is provided in the form of either _______, ________, _______
desmopressin, vasopressin or lypressin
CNDI occurs in 3 phases; First phase consists of ___________due to inhibition of ________. Second phase is ____ t_____urine output because the release of ___________. The third phase is _______or ____excessive _________due to depletion of stored _____ or loss of functioning ____that produce ______
polyuria; ADH; near-normal; stored ADH. transient or permanent urine output ; ADH; Cells; ADH
Cicatracurium infusion is a ________and require the use of ___________such as __________
paralytics; sedation; propofol
When caring for an External Ventricular Drain, the ECV can be _______during transport to prevent excessive _______with a change in body position
closed; draining
When caring for an External Ventricular Drain, the ECV can be temporary closed for ______,______, _____,________ to prevent excessive draining
crying; sneezing, vomiting; coughing.
ARDS is an _________lung condition that leads to _____of ______and _____of blood and plasma into air space, resulting in low ______levels in blood
inflammatory; injury ; lung tissue; leakage; oxygen
ST elevation in II, III, aVF is __________occlusion and indicate _______wall MI
Right coronary artery; inferior.
ST elevation in I, V5, V6 is __________occlusion and indicate _______wall MI
Circumflex artery; lateral
ST elevation in V1-V4 is __________occlusion and indicate _______wall MI
Left anterior descending (LAD) ; anterior (REMEMBER (LAD-ANT)
What is the greatest determinant of oxygen delivery?
Cardiac output
3 things about Spontaneous Breathing Trial (SBT ) : - should shorten ____________ - Should follow the _______ _______after_______ - Require active collaboration between _______ and _________
time to extubation; Awakening trial; sedation; respiratory therapist ; critical care nurse.
Central cord syndrome results from trauma and is associated with damage to the __________ ______ that carry information directly from the _____ _____ to the ____ _____
large nerve fibers; cerebral cortex; spinal cord.
Complications most frequent during acute hospitalization for SCI include ____, _____, _____
resp failure, pulmonary edema, PNA, and PE
Which medication should the CC nurse anticipate for a patient with suspected malignant hyperthermia?_________________
DANDROLENE
Dandrolene interferes with __________ _______by inhibiting ______ion release from the _______ _________. The initial dose is _______mg/kg , should be repeated every ________ until reversal of the reaction occurs or a total dose of _____ is reached. If there is an insufficient response, another ________ should be considered
muscle contraction; calcium; sarcoplasmic reticulum. 2.5; 5 minutes; 10mg/kg
In malignant hyperthermia, there is a massive increase in ______, one of the early signs is a high ____________, despite an increased in minute ventilation setting on the ventilator.
CO2, END tidal CO2
A low ScVO2 is a reflection of decreased ________ or increased ___________. In malignant hyperthermia, ScVO2 is __________ due to significantly increased ______ ________
oxygen delivery; O2 consumption; decreased; oxygen consumption
Hypotonic solutions such as ______ and ______ may worsen intracranial hypertension and are contraindicated
D5W and NS
Hypotonic solutions such as ______ and ______ may worsen intracranial hypertension and are contraindicated. _________, helps reduce the risk of seizures; ________osmotic effects can help decrease elevated intracranial pressure. _________ increased metabolic rate and ________ _______, so prompt _______ is indicated for patients with intracranial hypertensive.
D5W and NS; Antiepileptics; Mannitol; Fever; promotes vadodilation. fever treatment.
It was initially believed that hyperventilating resultant _________ would decrease the blood flow and thus decrease _______. Studies shown that ____________ leads to _____ _____and worsened outcomes..
vasoconstriction;’ ICP; hyperventilation; cerebral ischemia.
______and _________Reduce patient ventilator dyssynchrony
Sedation and paralysis
ECMO allows external _____ of _______ and addition of _______ to blood , a process inhibited in ________
removal ; CO2; O2 ; ARDS
the risk of high dose PTU is
Sudden and sever liver failure
One of the criteria for diagnosis ARDS is respiratory failure not fully explained by _______ or _______
cardiac failure or fluid overload
ARDS is due to _______ ______ producing diffuse ______ _______; lung compliance is __________ and there is impaired ______ ______ due to _______-______mistmatching
Alveolar injury; alveolar damage; gas exchange; ventilation-perfusion
Common associated with patients receiving continuous infusion of dexmdetomidine?
hypotension , bradycardia
Management of TBI include adequate _____ _____ to avoid _____ _____. CPP should be maintained at least ______mmHg, ICP should be < ___ -__mmHg. If needed, ________ should be given.
Blood pressure; cerebral ischemial 60; 15-20; diuretics
In patient that is status epilepticus, the priority is to stop ________ and first line treatment is __________ and one medication is -_________ and should be given as soon as possible
seizing; benzodiazepines; lorazepam
CPP is an indicator of the pressure driving ________ ____
cerebral blood flow
CPP can be increased by raising ________ using _______ or by lowering ________ using ________,_______ or _______
Blood pressure; vasopressors; ICP; ventriculostomy drainage; sedation, or mannitol.
CPAP and BIPAP machine decreases the _________ and decreases _______ ____, opens ______ ____ and increases the _______ _______ of oxygen.
work of breathing, intrapulmonary shunt; collapsed alveoli; driving pressure
After a Transsphenoidal hypophysectomy, there is an increased risk of insufficient_______ _____ resulting in _______ ______.
ADH release; Diabetes Insipidus.
____________can be used to reduce patient-ventilator dyssynchrony
Neuromuscular blockade
It is imperative for sedation to be given with ________ medications
paralytics
Synergy Model, clinical inquiry is the ongoing process of ______ and ______ practice and creating -_______ changes through research ________ and ______ learning
questioning; evaluating; practice; utilization; experiential
The ability to facilitate learning for patients/families, nursing staff, other members of the healthcare team, and community. Includes both formal and informal facilitation of learning
facilitation of learnig.
Abdominal perfusion pressure is ______________ minus ____________
MAP- intra-abdominal pressure; normal pressure range from ___ to ____ mmHg
Intraabdominal pressure above ______ is intra abdominal ___________
12 mmHg: Hypertension
In critical care, BS is best maintained below _________
180
Mainstay of diagnosis of SAH is ____________ with or without _____ _____. if both negative, it effectively __________ the diagnosis of SAH. if still in doubt _____ _______ should be considered
Non-contrast head CT; lumbar puncture; Cerebral angiography
Characteristic of SAH initial symptom is _________ described as the ____ ____ ____ . In addition _________ are common. Patient mental status may vary from _____ to _____ ______
sudden headaches; most painful ever; mental status changes; awake; deeply comatose.
Hydrocephalus after SAH is caused by obstruction of _______ flow by blood products , it is considered (acute vs chronic)_________or adhesions OR by a reduction of _______ _______ at the _____ _______. It occurs after _____ weeks, more likely to be associated with _____ ______
CSF; acute; CSF Absorption; arachnoid granulations; 2 weeks; shunt dependence
Systolic BP is kept between_____________ mmHg before aneurysm securement
90-140
Best practices management for ARDS include ________tidal volume and ______PEEP
low; High
It is recommended that ARDS patient maintain a CVP of less than ______and a PaOP less than ______in order to ______ ______ _______
4; 8; pulmonary microvascular pressure
Low pulmonary microvascular pressure can prevent further ________ _______and potentially allow reabsorption of existing _______ _______
pulmonary edema; pulmonary edema
First line of treatment and the mainstay of seizure management is __________
benzodiazepines
lorazepam can be given 2mg IV every _____minutes x _____doses
2; 5
The goal of treatment of status epilepticus is to ____________ before _______injury occurs
stop the seizure activity; neuronal
The second line of treatment in status epilepticus is ____________; A bolus of dose of _____mg/kg and another ____ mg/kg dose can be considered.
Dilantin; 20; 10
________lobe masses can manifest in sensory deficits, visual neglect, difficulty with right/left discrimination.
Parietal
___________lobe masses can include any of the following symptoms: Hemiparesis, visual fields deficits, memory deficits, speech and language deficits.
Temporal
___________lobe masses can present with hemiparesis, difficulties with high-level functions, personality changes, behavior and mood changes and fluent speech deficits.
Frontal
CPOT are use for ________ICU patient
non-communicating
__________ to 30 degree minimizes _____ and optimizes _____
HOB elevation ; ICP; CPP
__________ can be given to a patient who is shivering. but if ineffective, a _______ agent is highly effective agent when another sedative is not able to control the shivering . _______, _______, ______ are all other agents that can be used for shivering
Demerol; Paralytic agent; magnesium sulfate, precede, and propofol
Sildenafil is a _________________found in high consentration in the _________prevents the breakdown of ____________ __________ ________ which promotes vascular ____ ____ _____ and decreased ______ _______. For patients with pulmonary HTN, ___________ can improve _______ tolerance, functional class and _____________ hemodynamics.
Phosphodiesterase type 5 ; cyclic guanosine monophosphate. smooth muscle relaxation; pulmonary HTN; sildenafil; exercise; cardiopulmonary.
Isolated right ventricular dysfunction will lead to ________congestion not,, _____________congestion
Vascular; pulmonary
SIADH symptoms are (weight gain/loss)_________ (high or low Na+) ______ and high or low urine spec gravity__________
Weight gain; low sodium, Anuria, high spec gravity
DIC, platelet count is _______because platelets are used up during excessive ______
low; clotting
Bleeding Esophageal varices treatment (VOB)
Vasopression, Octreotide gtt Balloon tamponade.
Preferred method of Feeding in ICU, except in _______
Enteral ; new onset GIB
Is organ failure a contraindication for Enteral feeding?
NO
Intra-abdominal HTN first step in management
Diuretics
_______agents are also use in Intraabdominal HTN
paralytics
______ _____should be monitored in intraabdominal HTN. Normal is ________
Bladder pressure, normal is <12mmHG
As far as electrolyte imbalances go, Hypocalcemia and _______commonly occur together
Hypomagnesemia
positive _______sign reflects a twitching of the facial nerve, occur in _____________(what thyroid condition)
Chovtestk ; parathyroidism
About ________of calcium in plasma that is biologically active is in ionized form
1/2
_________of _________ provides 3x more calcium compared to ______ ______
1 g of calcium chloride; Calcium gluconate
Low ionized calcium in renal failure is related to __________ ______
Phosphate retention
Diagnostic criteria for AKI
increase in Cr 1.5X baseline increase in Serum Cr > or equal 0.3 in 48 h
Arrhythmia associated with both low K and low mag
Torsade de pointes
2 drugs to watch for prolonged QT
Sotalol and Haloperidol
Fluids Contraindicate in SIADH is________ ______, it worsens ___________
hypotonic solution; hyponatremia
Medication that does not decrease K+ __________________ because it is a
spironolactone; potassium-sparing diuretics
In a patient with DKA, do not initiate insulin Gtt until serum K is ________
at least 3.3
ACid base imbalance in DKA is and also is _________respitations
Metabolic acidosis; Kussmal’ respirations
Spleen’s role in lymphocyte production and ______- ___ stimulation it is intergral part of the ________system. Monitor splenectomy patient for _______
B cell; immunological . infection
In Hyperkalemia, ________ activates ____ ____ in many cells, causing _____ to enter cells and _____serum _____
Insulin; Na+K+-ATPase , K+; decreasing ; potassium
Symptoms of DI are : _________, (H/L) Spec gravity , (H/L) Na+ , and presence of _____ ______
polyuria, low; high; Pituitary tumor
Treatment of SIADH (HDV)
Hypertonic saline Dietary fluid restriction Vasopressin-receptor antagonists (TOLVAPTAN)
In DKA, ______shift from intracellular to extracellular in response to _____ _____(acid base imbalance)
K+; metabolic acidosis
Which dose is not given to ET tube in case IO access cannot be obtained?
AMIODARONE
Calculate MAP formula is
Systolic BP + 2 (DBP) / 3
Asian males and from Thailand at risk for
BRUGADA SYNDROME
LBBB will show slurring in R wave in which leads
I and V6
CO =
HR x SV = Cardiac output in ml then convert to Liters
MRSA
gram positive coverage with Vancomycin
Anaerobes Cover with
metronidazole
Diflucan will be used for
Fungal
post op fever differentials: Inflammatory response/ cascade, SIRS
PE (DVT) ; incisional abscess, lines, tubes, NG tube (sinusitis)
Normal SVR
800-1200 dynes
Normal PVR
<250 dynes
Normal CVP
2-6 mmHg
An _______ heart sound is caused by volume overload of the ventricle and is associated with heart failure
S3
A pericardial friction rub is heard in what condition______usually as a results of ________
Pericarditis; MI
An _________ heart is heard when ventricle is stiff, such is found in _________
S4; hypertension
A systolic ejection fraction is caused by ________ or ________of a valve
Stenosis, regurgitation
What is the major side effect of Nesiritide? If it occurs the nurse should _____________or_______. She should ________ her patient to encourage improvement in BP . When BP is adequate, restart infusion at ______________than the original infusion
Hypotension; decrease infusion by 30%; shut it off; reposition; 30% less
Because all four chambers of the heart are enlarged, _________cardiomyopathy patients are at risk for _________ they should be _________With _______
Dilated; MI, PE, DVT; anticoagulated with Warfarin.
As a compensatory mechanism in cardiogenic shock the _______nervous system and _______system will be initiated, there will vasoconstriction and retention of sodium and water. Preload is _______ in cardiogenic shock
Decreased
In chest tube, the water seal chamber as as a _________ between the patient’s _______ and the _______,thereby preventing the ______and fluid to re-enter the ______ cavity.
barrier; lungs; environment; air ;pleural
Temporal Lobe is known as the _________ area which affects _____________. Damage of Wenicke’s area leads to the inability to _______ ______and ______ _______. This is identify as __________ _______
Wenicke’s , verbal reception; interpret speech; comprehension of words; Wecnike’s aphasia.
Damage to left frontal lobe or right frontal lobe can cause
Expressive aphasia
Patient with bleeding esophageal varices, should protect _________and vasoconstrictors such as _________ -and high dose of _________ would be first to stop bleeding and increase BP
Airway; octreotide, Vasopression
Chronic __________ result in the release of digestive enzymes in the body including _________A2. It breaks down the cellular structure of the __________ beds and endothelium and leading to tissue damage throughout the body _________
Pancreatitis: Phospholipase A2; capillary; MODS
CO
4-8
Dizziness and palpitations during drain phase in peritoneal exchange is because
too-rapid fluid shift leading to a vagal response.
What is the best method of monitoring dialysis effectiveness during dialysis?
Rate of urea clearance.
In treating DKA, once the glucose level is less than _________, Fluid ______should be started to slow the drop in glucose and slowly correct the ________ to less than ____ .
300; D5NS; Anion Gap; 20.
The patient failed to respond to the initial insulin infusion dose, because it should drop serum glucose by ________ if not -____________the infusion rate
50mg/Dl; double
Definite treatment of DIC
Treatment of underlying or potential causes
Complication of blood transfusion is __________. When the cell lysis, _________ is released. Monitor electrolytes after _______ PRBCS
Cell lysis; intracelluar potassium; 2 units
When after liver involvment, be careful when starting
Statins
Normal Urine output
0.5ml/kg/hr
What is normal SVO2
60-80%
The _________phase is the phase in which urine output is the lowest . Administering fluids at this time will not result in increased _______ but in a greater ______ ________
OLIGURIC ; Urine output; fluid retention
The _________the kidney are putting out large amounts of fluid; but not filtering;Fluid intake is required to preven t________
non-oliguric phase; hypovolemia
The tidal volume settings for a patient with ARDS
5-8ml/kg
The tidal volume settings for a patient with ARDS_______
5-8ml/kg
Excessive tidal volume and high PEEP increase the risk for _________ and ___________
Volutrauma and bauratrauma
What is the preferred vent mode for a patient receiving neuromuscular blockade?
Assist control
ITP (idiopathic thrombycytopenia purpura) is a result of
Low platelet count; autoimmune
Severe complication when an ileostomy is placed
DEHYDRATION
Normal Doll’s eyes_____________ reflex; the eyes appear to move to the _______direction of head turn. it represents _______and ______damage and may be part of the clinical exam to help determine _____ _____
oculocephalic ; opposite; pontine; midbrain; brain death.
Requires the patient to be hemodynamically stable ______
hemodialysis
ASH
Syncome, heart failure, Angina (Significant mortality fro it )
GB is a ________ weakness; impaired _______function; ______ pain. Death is usually from ________if the _______muscles leading to _____ ______ ______
Motor; respiratory ; acute; weakening; respiratory; acute respiratory distress.
DI usually present with H/L BP with H/L HR and Hypovolemia due to
Low; High ; increased urinary output
Low _________will result in numbness and tingling to extremities
Magnesium
Elevated ICP would result in
Widened pulse pressure, pupillary changes and posturing
Aggressive correction of hyponatremia result in ___________which results in ______and _______of brain cells. If not corrected lead to _____ _____ ____
Osmotic demyelinization; shrinking; lysing ; quadriparesis; flaccidity and neurological deficits.
Blunt/penetrating trauma to the right rib 7-9th ribs and complaining of RUQ tenderness, monitor for signs of
LIVER LACERATION
wait for cocaine to be removed from system before beta blocker is ____________Coronary artery spasms.
constriction occurs with both ; Beta blockers will constrict, cocaine
Cocaine is a sympatomimetic ; ALPHA STIMULANT;
Jittery, high BP,
Blunt/penetrating trauma to the left rib 9-10th ribs and complaining of LUQ tenderness, SHOULDER PAIN monitor for signs
SPLEEN INJURY
Blunt/penetrating trauma to the left rib 9-10th ribs and complaining of LUQ tenderness, SHOULDER PAIN monitor for signs . Peritoneal signs are delayed until
SPLEEN INJURY : adequate blood accumulates to peritoneum
List the 3 major components of tissue perfusion or oxygen delivery:
Cardiac output, PaO2 and Hemoglobin
Cardiogenic shock is associated with HR that is ______BP that is ______Cardiac output that is _______, PaOP that is _______and SVR that is _________. Same hemodynamics value in hypovolemic shock except that PaOP is _____
HIGH; LOW; LOW; HIGH;HIGH
In cases with suspected hypovolemic shock, watch for _____
Vomiting, diarrhea, poor po intake
Benzodiazepines overdose is usually link with which acid base imbalance and why ?
RESPIRATORY ACIDOSIS; because benzo overdose lead s to increase serum carbonic acid
_______can treat sepsis with persistent hemodynamic instability
Steroids (hydrocortisone)
List SIRS criteria and parameters to measure:
- RR > 20 breaths/min 2. HR > 90bpm 3. Hypothermia <36C (96.8) or hyperthermia >38 , 100.4 F 4. WBC >12000 or less than 4000, >10% immature bands. 5. PaCO2 <32 mmHg
Pulmonary artery pressure measures (R or L)
Left pressure
Normal wedge pressure
< 15 mmHg
In cardiac tamponade
Normalized high PA, wedge pressure and eventually equalized.
SVR calculating formula
MAP-CVP/ CO x80
Dobutamine + Dry patient
Arrhythmias
Only give Bicarb when pH is less than ____and bicarb less than _____
7.2; 12
Elevated liver functions
FFPs indicated unless contraindicated.
Platelets non functionants
ESRD Leukemia
Octreotide is given because
Reduce splanchnic blood flow, inhibit gastric acid secretion, and may have gastric cytoprotective effect
GIB interentions: Patient must be ______for blakemore tube,
Octreotide, Blakemore tube ,
HGB increase___ after 1 unit; HCT ____
1-2 per unit for Hgb 2-3 per unit for hct
pre-albumin
not affected by volume status or calcium
pre-albumin Why more accurate ?
not affected by volume status or calcium
Chronic liver patients with low sodium because
Liver disease patient because of third spacing
CaO2 is _________ oxygen content, calculated with formula
arterial ; CaO2 = 1.34 x hemoglobin concentration xbSaO2 + (0.0031 x PaO2)
Causes of pericardial effusion
- uremia 2. cytology/malignancy 3. Anticoagulation 4. Trauma
To decrease VAP
Oral care with chlorhexidine and moisturizer lip balm Daily wean trials Cuff pressure 20-25 cmH20 Changing ventilator circuits only when soiled HOB 35-45
Sensory and motor impairment occurs in injury below nipple like
T3 and T4
Decreased FEV1/FVC ratio in obstructive lung disease such as__________reduced vital capacity seen in
Asthma and chronic bronchitis restrictive lung disease
_________followed by loss of consciousness followed by period of brief lucidity followed by decompensation . and most common involved artery is the
epidural hematoma; Middle meningeal artery.
________________have gradually worsening confusion and pain; source of bleeding is _______veins
Subdural hematoma; bridging
hypoventilation and hypercapnia can ________(Increase or decrease)
ICP
Explain Cheyne Stoke respirations. Causes are
progressively increase rate and depth of respirations f/b gradually decreasing rate and depth of ventilation and apnea ; Increased ICP, hepatic and HF, meningitis and drug overdose.
Peripheral nerve stimulator also known as ___________is administered to assess________when _______blocking agents are given to _________
Train of four monitor ; neuromuscular transmission when neuromuscular blocking agents ; block musculoskeletal activity.
Describe train of four
When 4 twitches are seen, 0-75% of the receptors are blocked. • When 3 twitches are seen, at least 75% of the receptors are blocked. • When 2 twitches are seen, 80% of the receptors are blocked. • When 1 twitch is seen, 90% of the receptors are blocked. • When no twitches are seen, 100% of receptors are blocked.
______allows for removal of CO2 and allow O2 entrance
ECMO
Inhaled , not IV nitric oxide serve as ________vasodilator, and use to decrease shunting and promote oxygenation
pulmonary
hARD ASS MRS MSD Heart murmur
Aortic Regurg =Diastolic Aortic Stenosis: Systolic Mitral regurgitation: Systolic Mitral Stenosis: Diastolic
Aortic stenosis characteristics is SAD
Syncope Angina Dyspnea
In Pulmonary embolism, when the _________vasculature is occluded, Pulmonary artery pressure is elevated, as a result _________is elevated in ______ventricle
Pulmonary; afterload; right ventricle
Potent vasodilators should be avoided in _______ ______because their vasodilatory effects will cause increased in ______
cerebral edema; ICP
Reduced FEV1/FVC is seen in
COPD
Which medication is prescribed after a myocardial infraction to aid in prevention of remodeling________and its action is to block RAAS stimulated by _________
ACEI; renal hypoperfusion
The normal diastolic pressure in the pulmonary artery is approximately ______mmHg
10
The diastolic pressure in the right ventricle is close to ______
0
Findings that suggest proximal migration of the catheter tip back into the right ventricle
sudden decrease in the PA diastolic pressure loss of dicrotic notch Ventricular ectopy
True or false: Patient with cardiomyopathy have frequent ventricular dysrhythmias.
True
Useful in systolic dysfunction but detrimental in diastolic dysfunction_________
Vasodilators.
Acceleration - deceleration injury will most likely cause
Shearing of aorta
Which lead is the most specific for the patient with occlusion of the RCA, for ST segment monitoring
III
Classic signs of Hypertrophic cardiomyopathy: syncope, chest pain, _______and _________ like murmur that ________with squatting
- sudden cardiac death, and AORTIC stenosis like murmur that DECREASES with squatting.
A serious complication of anteroseptal MI, seen in lead _____ to _____ is
V1-V4 ; Ventricular septal rupture
A serious complication of Inferior wall MI seen in lead ____ ____ ____ is ______–and the murmur is loudest at the _____ and the clinical presentation resembles_____
`II, III, avF ; Papillary muscle rupture; apex; Acute pulmonary edema
Describe the voltage criteria for left ventricular hypertrophy?
Depth of S wave in V1 or V2 + Height of R wave V5 and V6 is 35mm or greater
Nestiride is contraindicated in ______shock because of its _______and that shock is associated with low
cardiogenic; vasodilatory; heart rate.
The first stage of compensation in HF is stimulation of ________nervous system which causes _______ and ______ These effects increase myocardial _______consumption and diminish time for ______filling.
sympathetic; vasoconstriction ; tachycardia; oxygen, diastolic.
The 2:1 block can be type I or type II because with 2;1 block there is not __________
progressive lengthening of the PR interval.;
Type I block is a block at the _____node
AV
Type I block is a block at the _____node; And because the ___usually is supplied by the ______ ____-artery Type I is seen is ____MI
AV; AV node; Right coronary; inferior
Type II block is a block at the ___________And because the ___usually is supplied by the ______ ____-artery Type II is seen is ____MI
Bundle of His; bundle of His; Left anterior descending ; anterior
2:1 AV block is more likely to be type ____ if the _____is wider than ______
II; 0.11 seconds
The SA noted is supplied by _____ or ______ _____ _______ artery
right or left.
Type I block is also called
Wenckebach
Fever and new murmur indicates______
Bacterial Pericarditis
Chest pain and pericardial friction rub are seen in ______
Pericarditis
Chest pain and syncope seen in ________ ________and_____ ____ _____
Hypertrophic cardiomyopathy ; severe aortic stenosis
Sotalol (beta pace ) has both Class _____ and class ___properties
II (beta blockers) III (potassium blockade)
The difference between the PAd (Pulmonary artery diameter) and the Pulmonary Artery Occlusive Pressure (PAOP) also called____________ should be _______ or _____if more than ______mmHg, _______is present
right to left gradient ; 5mmHg or less; 5, pulmonary HTN
IABP is used to ______ ________and increase _______________ ____ _____, when discontinued, watch for signs of
decrease afterload; myocardial oxygen supply ; increase afterload; and decrease myocardial oxygen supply
Deflation of the IABP should occur at what point in the cardiac cycle _______ because to have the balloon inflated at all during _______ would cause an increase in ______
Immediately before SYSTOLE ; systole; AFTERLOAD
Drugs contraindicated in hypertrophic cardiomyopathy are ____ ____ and ______ ____
Nitrates; Diuretics; positive inotropes, they decrease venous return needed for adequate cardiac filling.
The most likely cause of cardiac arrest is ___________ so ______is the top priority
Vfib; defibrillation
Which muscle maintain normal ______ _____ function therefore ______ valve function? if damaged, what happens? ______ ______ regurgitation
left ventricle; mitral ; Papillary muscles. Acute mitral
Wolff Parkinson-White syndrome patients should not have which class of medications?
Verapamil.
Drugs not indicated for severe diastolic dysfunction are______
INOTROPES.
Wellen’s syndrome is characterized by ____ __ ___ ______in lead ___ and ___ and it is associated with proximal ____ ____ _____ artery disease and a high risk of _____ ____ ____
deep T wave inversion ; V2; V3;left anterior descending; sudden cardiac death.
Contraindicated in dissecting thoracic Aortic dissection
Fibrinolytics
Ventricular noncompliance is associated with S—
4
What is the most common cause of Atrial tachycardias?______ and ______
re-entry and accessory pathways
What is the most common cause of ectopic beats? __________usually seen with use of ________
ENHANCED AUTOMATICITY ; catecholamines
most common cause of torsade de pointes
Triggered activity related to repolarization problems.
___________toxicity in patients receiving nitroprusside longer than _____ hours. That medication may also cause ________ by causing _______ or _________shunt
Thiocyanate; 72; methemoglobinemia ; intrapulmonary
Nitric oxide, nitroprusside, nitroglycerin, local anesthetics; and hurricane spray and sulfa drugs can all lead to ________________
Methemoglobinemia
In Methemoglobinemia, _______________is converted to methemoglobin, a non-oxygen carrying form of ________resulting in decrease _______ ________
Hemoglobin; hemoglobin; oxygen saturation
Treatment of Methemoglobinemia is to first _______ the medication and administer __________the antidote
stop; methylene blue
The nitroprusside-induced intrapulmonary shunt results in _______ and ________ related to ______ _______ mismatch and admixture of ______________ and _________
hypoxia; hypoxemia; ventilation-perfusion; nonoxygenated blood to oxygenated blood.
If the ventricles are depolarized before the atria in a junctional rhythm, the p- wave will be __________ the QRS complex
after
The most common cause of death after vascular surgery
MI
Mnemonic for location of infarcts
LII-LI- ASS (backwards) ALL
Mnemonic for location of stenosis
(h) ARD- ASS- MRS- MSD
Mnemonic for sensory, motor or both CN
Some Say Marry Money But My Brother Says Bad Business Marry Money
Mnemonic for location for listening to heart sounds
All People Enjoy Time Magazine.
ABI is to measure
Peripheral artery occlusive disease
Any ABI less than 0.9 is _________
Peripheral arterial disease (PAD)
Causes of pericardial effusion
- uremia 2. cytology/malignancy 3. Anticoagulation
Causes of high AG Metabolic Acidosis CAT MUDPILES
Congenital heart disease/ Carbon monoxide Aminoglycosides
Theophylline
Methanol
Uremia
DKA,
Paraldehyde Ion, isoniazid,
Inborn errors of metabolism
Lactic acidosis
Ethanol ( due to lactic acidosis)
Salicyclates/ASA
The most common conditions that results in effusion are:
Cardiac Failure Pneumonia Malignant Neoplasms
Symptoms include dyspnea, cough, and occasionally sharp, nonradiating, pleuritic chest pain.
Pleural effusions.
_______capnia, (acidosis/alkalosi)_________, (increased or decreased) ________blood levels of 2, 3-BPG, and (increased or decreased) _________body temperature all shift the oxyhemoglobin dissociation curve to the right and should therefore increase the _______
Hypercapnia; acidosis; increased; increased; P50
