Exam #2 Flashcards
(290 cards)
1
Q
what are some assessments for oxygenation?
A
ABG, Pulse Ox, work of breathing, skin color, secretions, auscultation
2
Q
what is the O2 range for NC?
A
1-6
3
Q
what is the FiO2 for NC?
A
24-44%
4
Q
what is the O2 range for Face mask?
A
5-8
5
Q
what is the FiO2 for facemask?
A
40-60
6
Q
what is the O2 range for the venturi mask?
A
4-11
7
Q
what is the FiO2 for the venturi mask?
A
24-50%
8
Q
what is the O2 range for partial rebreather?
A
8-11
9
Q
what is the FiO2 range for the partial rebreather
A
50-75%
10
Q
what is the O2 range for a non rebreather?
A
10-15
11
Q
what is the FiO2 range for a non rebreather?
A
80-95%
12
Q
what is the O2 range for HFNC?
A
30-60
13
Q
what is the FiO2 for a HFNC?
A
100%
14
Q
what type of pressure is provided with CPAP and BPAP?
A
positive pressure
15
Q
what flow of pressure does Bipap have?
A
in and out
16
Q
why would someone need to be intubated?
A
swelling of airway, cant clear secretions, seizures, surgery, tired for work of breathing, 50/50 rule
17
Q
what supplies are needed for intubatin?
A
et tube, stylet, lubricant, mac/miller blade, larnygoscospe, syringe, flushes, bougjie, CO2 detector
18
Q
what happens to the CO2 detector if you have the ET tube in the right spot?
A
the color will change
19
Q
what lab should be run before intubation?
A
potassium
20
Q
what do you do while waiting on the patient to be intubated?
A
ambu bag at 100% FiO2
21
Q
do you sedate or paralyze your patient first?
A
sedate
22
Q
where should the ET tube be placed?
A
into the trachea 2 cm above the carina
23
Q
right after intubation what assessment should you do?
A
auscultate the breath sounds x2
24
Q
what imaging should be done after intubation?
A
x ray
25
what lab should be done after intubation?
abg
26
what is pantoprazole used for?
stomach ulcer prevention
27
what is propofol used for?
anesthetic used for sedation
28
is propofol fast or long acting?
fast
29
is propofol titratable?
yes
30
what are side effects of propofol?
hypotension, brady cardia, resp depression, hyperlipidemia, elevated triglycerides
31
what is midazolam used for?
sedative
32
is midazolam short or long acting????
33
is midazolam titratable?
yes
34
what are side effects of midazolam?
hypotension, bradycardia, resp depression
35
what is dexmedetomidine?
fast acting sedative
36
what is special about dexmedetomidine?
it has minimal resp effects
37
what are side effects of dexmedetomidine
bradycardia and hypotension
38
what is vecuronium?
fast acting paralytic
39
why is vecuronium used?
it is used to paralyze the patient decreasing any extra oxygen use
40
what should be done for the patient when giving paralytics?
breath for the patient with ambu
41
what is the main side effect to worry about when giving paralytics?
apnea
42
is vec tirtrable ?????
43
what is succinylcholine?
fast acting paralytic that is used for intubation
44
what is the way to give succinylcholine?
iv push
45
what side effect should you watch for when giving succinylcholine
apnea and hyperkalemia
46
how much will succinylcholine raise K
by a point
47
what are signs of hyperkalemia?
chest pain, palpitations, N/v, abdominal pain, weakness, sob
48
what does the rate setting on vent control?
controls how many respirations in a minute
49
what does tidal volume on vent control?
volume of air per breath
50
what is the range for tidal volume?
500-600 ml
51
what is the FiO2 setting on vent control?
the percent of o2 in the air the patient is getting
52
what is PEEP on the vent control?
positive pressure that is the alveoli on expiration
53
what is the purpose of PEEP?
to prevent the lung from collapsing
54
what is pressure support?
constant pressure that is on the long throughout the breat
55
what is the assist control setting on vent?
this setting allows the patient to determine the rate of breath but delivers a steady tidal volume
56
what happens if patient doesnt initiate breaths on AC
the vent breaths for them
57
are there set rate and tidal volume with AC?
yes
58
is there a set rate and tidal volume with SIMV?
yes
59
what is simv vent setting?
typically a weaning mode where the patient can control the rate and tidal volume
60
what mode on the vent is pressure support used?
simv
61
why is pressure support only used on simv
??????????????
62
what is the goal o2 sat for vent patient?
at least 94%
63
how do you perform a breathing trial?
turn down patients sedation??????????????????
64
what lab is constantly drawn on vent patients?
ABG
65
when should extubation be considered?
when FiO2 is on low setting and ABGs are godo
66
what is the max amount of time you should suction vent patietn?
10-15 seconds
67
what oral care should be done for vent patien?
brushing teeth, mouth swabs,
68
what is VAP?
vent associated pneumonia
69
what are symptoms of VAP?
fever, chills, pleuritic chest pain, tachypnea, SOB, orthopnea, poor appetite, bloody sputum
70
if a gastric tube has to be placed what type is preffered?
OG tube
71
what should HOB be at for vent patient?
30 degrees
72
what should be check frequently on ET?
placement, position, and cuff pressure
73
how often should you reposistion et tub?
q 12
74
what should you with tube feedings when laying patient down?
pause
75
what are complications of intubation?
hypotension, fluid retention, barotrauma, tension pnuemo, volutruama, self extubation
76
what should be done if your patient self extubates?
ambu until md crna arives
77
why does intubation cause hypotension?
it reduces cardiac output
78
how do you extubate??? need to know?/??
79
what can cause ARDS?
Aspiration, pneumonia, covid, sepsis, burns, trauma, shock
80
80
what is occurring inside the lung during ARDS?
alveolar membrane is injured, more fluid, and less surfactant
81
what are symptoms of ARDS?
hypoxia, stiff lungs, pulmonary edema, infiltrates on x ray
82
how do you diagnose ARDS?
chest x ray, Pa O2 consistnetly low despite being on 100% FiO2, lungs might sound okay initally,
83
what lab is drawn to differentitate between CHF and ARDS
BNP
84
what does it mean if BNP is above 100?
most likely HF
85
what are vent settings for ARDS?
intubation, low tidal volume and high peep, prone, monitoring for fluid overload
86
what is a tracheostomy?
a hole is placed into the neck
87
what are indications for trach?
long term intubation, efficient suction, less or no sedation, less stress on larnyx/vocal cords, and easier to wean ff
88
what should be done before the trach procedure?
hold anticoags a shift before, NPO at midnight, prepare the room
89
what should be done post op for freshly intubated trach patient?
chest x ray, listen, assess site
90
what is the next step after taking trach patient off vent?
trach collar
91
is CO2 acidic or alkaline?
acidic
92
if CO2 increases what happens to pH
it goes down
93
if HCO3 increases what happens to pH
it goes up
94
is resp acid/alk a quick fix or long term fix?
quick
95
what do your lungs do if your pH is too low?
increased RR to blow off the acidic CO2
96
what do your lungs do if your pH is too high?
decreased RR to retain CO2
97
how long does metabolic acid/alk take to correct?
24 to 48 hours
98
how do your kidney control pH?
excreting or retaining hydrogen and bicarb
99
what do your kidneys do in metabolic acidosis?
excrete hydrogen and retain bicarb
100
what do your kidneys do in metabolic alkalosis?
retain hydrogen and excrete bicarb
101
on the test if ABG comes back odd what do you never do?
REDRAW
102
what can cause resp acidosis?
hypoventilation, COPD, Pneumonia, Obstruction, OD, Pulmonary edema,
103
what are symptoms of metabolic acidosis
headache, confusion, tired, tachypnea, N/v, decreased bp, and cold/clammy skin
104
what can cause metabolic acidosis?
ketoacidosis and lactic acidosis
105
what can cause lactic acidosis?
shock, kidney failure, aspirin, hypotension, diarrhea
106
what can cause metabolic alkalosis?
stomach acid loss, vomit, abusing diuretics, antacids
107
what can cause resp alkalosis?
hyperventilation, fever, hypoxia, aspirin tox,
108
what is the range for pH?
7.35 - 7.45
109
what is the range for Co2?
35-45
110
what is the range for HCO3?
22-26
111
what is the range for PaO2?
80-100
112
what is a uncomped abg?
abnormal ABG that
113
what is a partially comped abg?
abnormal abg where the body is attempting to return balance by adjusting other values
114
what is a comped abg?
pH is normal range but other values are not normal
115
what does the SA node do?
the natural pace maker of the heart that send electrical signals to the atria of the heart
116
what is the natural HR for the SA node?
60 -100
117
where is the SA node found?
near the right atrium
118
where does the AV node get electrical signal from?
the SA node
119
what does the AV node do?
slows down the electrical impulse to allow the ventricles time to fill before contraction
120
what is the intrinsic rate of the AV node?
40=60
121
what is the intrinsic rate of atrial tissue?
60-100
122
what is the intrinsic rate of ventricular tissue?
20-40 HR
123
what is depolarization?
the contraction of the heart muscle
124
what is repolarization?
recharging of the heart muscle
125
what are P waves?
this is when the atria are depolarizing/contracting
126
when a good P wave is present what node is firing appropriately?
SA
127
what is the PR interval?
the time it takes to go from the SA node to AV node
128
when looking at the EKG where is the PR interval?
starts the the end of the P wave and ends at the beginning of QRS
129
what is the QRS complex?
ventricular depolarization/contraction
130
what is the ST segment?
the time between depolarization and repolarization
131
when looking at the EKG what does the ST segment start and end?
starts at the end of the QRS complex and ends at the beginning of the T wave
132
what is the QT interval?
the times it takes for the ventricles to depolarize and repolarize
133
when looking at the EKG what does the QT interval look like
starts at the beginning of QRS and ends at the end of the T wave
134
what meds can cause a prolonged QT?
zofran, levoflaxacin, fluoxetine, sertraline, haloperidol, H2s, BETA Blocker?????
135
what can pronlonged QT lead to?
torsades V tach
136
how long is each ekg strip on the exam?
6 seconds
137
what are the characteristics of a sinus rhythm?
xxx
138
what are the characteristics of normal sinus rhythm?
P wave, QRS, T wave, 60-100 HR, and regular
139
what are characteristics of sinus bradycardia?
P wave, QRS, T wave, HR less than 60 , and regular
140
what are characteristics of sinus tachycardia?
P wave, QRS, T wave, HR greater than 100 , and regular
141
what are the symptoms of sinus brady?
sob, dyspnea, hypotension, LOC change
142
what can cause sinus brady?
athlete, old age, SA node issues, Meds, increased ICP, MI
143
what are non pharm interventions for sinus brady?
stimulation
144
when should you do interventions for sinus brady?
only do interventions if the patient is symptomatic
145
what interventions should you do for sinus brady?
First atropine, Epi, Dopamine
146
what should be done with the sinus brady patient if they cant be treated with meds
External pacer
147
what prevents atropine from working?
av blocks
148
what causes sinus tach?
fever, dehydration, hypoxia, hypotension, caffeine, drugs,
149
what are then treatments for sinus tach?
fever you give antipyretics, anxiety calm them down, dehydration fluids, BB or CCB
150
what are symptoms of sinus tach?
xx
151
what is atrial fibrillation?
this occurs when the atria of the heart are contracting randomly
152
what does atrial fibrillation look like on ekg?
no P wave, no t wave, QRS present, irregular
153
what is controlled a fib?
less than 100bpm
154
what is uncontrolled a fib?
over 100 bpm
155
how do you know if the a fib is controlled or uncontrolled on the exam?
the strips are 6 seconds so you multiply by 10 to determine the HR
156
what causes a fib?
hypertension, stress, sleep apnea, stimulant use, smokers, alcohol
157
what are symptoms of a fib?
tachycardia, palpitations, dizzy, fatigue, SOB, weak, decreased CO
158
what are a fib patients at risk for developing?
stroke from blood clots
159
what are the medications that help with the dysrhythmias for afib?
amiodarone, CCB/Diltiazem, Digoxin
160
what meds to afib patients take to prevent clots
Heparin, warfarin, enoxaparin
161
what long term anticoag do afib patients take?
warfarin
162
what labs are monitored with heparin?
PTT
163
what labs are monitored for patients taking Warfarin?
PT and INR
164
where do you administer enoxaparin?
within one inch of the umbilicus
165
what type of shock therapy may a afib patient get?
cardioversion
166
what must you know med wise about cardioversion?
must be off anticaogs for 24-48 hours due to the risk of dislodging clot
167
what operation might be performed on a afib patient?
ablation to remove heart muscle causing a fib
168
what happens in the body during V tach?
the ventricles are constantly contracting without time to fill
169
what does v tach look like on the EKG?
No p wave, no t wave, QRS present, regular
170
what is the HR like in v tach?
over 100 typically above 160
171
what is the criteria for v tach?
3 or more pvc and HR greater than 100
172
what is sustained v tach?
lasting longer than 30 seconds
173
what is unsustained v tach?
less than 30 seconds
174
what can cause V tach?
MI, K levels being high or low, Blunt chest trauma, Ischemia
175
when your patient is in v tach what is the first thing that you check?
pulse
176
what are the symptoms of v tach?
tachycardia
Palpitations
Dizzy
Fatigue
Sob
weakness
177
what is the pharm and non pharm treatment for v tach in a patient with a pulse?
Medication and getting the stim vagus nerve
178
what medications do v tach patients get?
amiodarone and lidocaine
179
how do you get a patient to stimulate vagus nerve?
bear down like a bm, blow into straw, scare them
180
what is the treatment for v tach without a pulse?
meds, cpr, defib
181
when doing cpr how mang compressions per minute?
100-120
182
when doing cpr how often do you deliver a breath?
6 seconds
183
what is v fib?
this happens when the ventricles are getting unsynchronized electricity causing there to be no contraction
184
what does V fib look like on ekg?
No p wave, no t wave, no
185
what is the treatment for v fib?
cpr and defibrillate
186
what does asystole look like on ekg?
a flat line
187
what is the treatment for asystole?
cpr
188
do you shock asystole right away?
no
189
when do you shock aystole?
the moment there is electrical signal on ekg
190
what type of beat do you shock in asystole?
agonal beat
191
what is the treatment for aystole?
CPR
192
what causes aystole?
Hypovolemia, hypoxia, hydrogen from acidosis, hypothermia, Hypokalemia, hyperkalemia, Toxins like drugs/poisons, Cardiac tamponade, tension pneumo, thrombosis
193
what is cardiac tamponade?
occurs when there is bleeding the pericardium
194
what is tension pneumo?
this occurs when air is trapped inside the pleural space causing deviated trachea
195
what are symptoms of cardiac tamponade?
hypotension, JVD, muffled heart sounds
pulses paradoxes...when there is a drop of 10mmhg of blood pressue on inspiration
196
f
197
what is the treatment for aystole?
epi and cpr
198
are pvc always bad?
no but can be sign of v tach
199
what rhythms are indicating MI?
xx
200
what is coronary artery disease?
this occurs when plaque builds up in the arteries of the heart
201
what are risk factors for CAD?
obese, smoking, alcohol, hyperlipidemia, hypertension, genetics, metabolic syndrome
202
how do you prevent CAD?
quit smoking, lower fat diet, monitor cholesterol, exercise, manage BP, manage diabetes
203
what are symptoms of metabolic syndrome?
elevated fasting glucose, enlarged waist, high triglycerides, low HDL, hypertension
204
what can chronic angina lead to?
necrosis of the heart and MI
205
what is stable angina?
predictable chest pain usually caused by exertion that is relieved by rest
206
how long does stable angina last?
less than 15 minutes
207
what is the treatment for stable angina?
nitroglycerin
208
at what point do you get help for angna
after you take your 3rd nitro
209
what is unstable angina?
chest pain that is unpredictable
210
what are interventions when angina patient comes to the ER?
ekg, nitroglycerin, IV, obtain cardiac labs
211
will angina cause elevated cardiac labs?
no
212
what is myocardial infarction
blockage of the coronary artery
213
what is the bloods reaction to an MI?
the inflammatory response is triggered causing platelets to attract at the blockage site
214
if patients chest pain is releived by nitro are they good to go?
not always because nitro can relax GI
215
what are the symptoms of MI?
dull crushing chest pain, increased BP, low BP, crackles, SOB, Tachypnea, dyspnea, N/v, anxiety, weak, cool, clammy, diaphoresis, grey, decreased o2, impending doom, decreased urinary output
216
where can you feel pain in MI?
Left arm, neck, jaw, back
217
what are possible rhythms when having an MI?
PVC, ST elevated, Upside down t, normal sinus rhythm
218
what labs are you looking at for potential MI patient?
WBC, Potassium, BUN, Creatinine, PTT, INR, PT, creatine kinase, troponin, creatine kinase myocardial bands, urinary output
219
what happens to wbc during MI?
elevated wbc
220
what happens to K during MI?
usually elevated due to it being released from dead tissue
221
why is PT,PTT and INR checked during MI?
need to know base line before giving medications
222
what happens to Creatine kinase during MI?
elevated
223
what can cause elevated creatine kinase?
MI or rhabdo
224
what happens to troponin during MI?
elevated
225
what happens to Creatine kinase myocardial bands during MI?
elevated
226
what can cause elevated creatine kinase myocardial bands?
MI and fast HR
227
what happens to urinary out put during MI?
decreases because of low perfusion
228
what do you give patient if their BUN/creatine levels are high before heart cath?
acetylcysteine to protect their kidney
229
what is are non pharmecutical interventions for MI?
Assessment, history, previous stroke/mi, IV bilateraly, 12 lead ekg, 5 lead ekg, q15 vitals
230
what meds are given to MI patients?
Clopidorgrel, Heparin, Enoxaparin, Ace inhibitors, Oxygen, Morphine, Beta blockers, Nitroglycerin, Aspirin, Statins, Alteplase, Tenecteplase, abciximab, tirofiban, epitfibatide
231
what are the thienopyridine meds?
clopidogrel
232
what do thienopyridine meds do?
prevent clotting
233
what are the RASS medications?
ace inhibitors
234
what is the ending for ace inhibitors?
pril
235
why are ace inhibitors given to MI patients?
prevents ventricular remodeling from forming scar tissue on the heart
236
why is morphine given to MI patietn?
vasodilator, pain reducer, and anxiety
237
why are betablockers given to MI patients?
to decrease workload of the heart and decrease oxygen demand
238
what patietns take statin meds?
CAD with high cholesterol
239
why do MI patients take aspirin?
to thin blood
240
what meds are salicylates?
aspirin
241
what are the thrombolytics used during MI?
alteplase, Tenecteplase
242
what should you watch out for when giving thrombolytics?
Another MI and arrythmias due to muscle being perfused again
243
what do 2b/3a inhibitors do?
they coat platelets and prevent them from clotting together
244
what are the 2b/3a inhibitors?
abciximab, tirofiban, eptifibatide
245
do patients take aspirin if they are taking heparin?
yes
246
what meds should you reconcile with patient before cabg?
blood thinners, metformin, and garlic
247
what is cabg?
a procedure where they bypass a clogged artery of the heart
248
how quick should patient be ambulating after cabg?
3-4 hours
249
what are the interventions for MI?
percutaneous cardiac intervention or CABG
250
what is a PIC?
they go in through artery or vein to find clot suck it up and place metal mesh to hold open occluded area
251
what posistion should patient be in post pic
flat for 4-6 hours
252
when will you pull sheath from PIC?
when dr says its good and when clotting labs are in a good range
253
how do you pull sheath?
give atropine, pain meds, 2 people present, hold pressure for 45 minutes for artery, and 1 hour 15 for combo
254
what should you watch for after pulling sheath?
pain, bleeding, hematoma, absent pedal pulses, chest pain, stroke,
255
what med is given after stent?
diuretics
256
what meds are given post CABG
pain meds, stool softener, protonix, heparin,
257
what labs are monitored post CABG
K, Mag, wbc
258
what diet to post CABG patients need?
high cal high protein
259
what are complications post CABG?
bleeding, BP issues, tamponade, excessive drainage, dysrhythmias
260
what is considered excessive drainage?
more than 150ml per hour
261
what are symptoms of left sided HF?
nocturnal dyspnea, crackles, wheezes, orthopnea, dyspnea, fatigue, weak, palpitations, oliguria, decreased peripheral pulses
262
what are symptoms of right sided HF?
JVD distention, edema, weight gain, anorexic, ascites, hepatomegaly, splenomegaly
263
what are surgical interventions for HF?
impella, lvad, transplant
264
what are nursing interventions for HF?
posistioning, rest, daily weights, oxygen, education on lifestyle changes
265
what nutritional ed for HF?
low sodium, limit fluids, avoid large meals
266
what meds are used to treat HF?
Digoxin, Nitroglycerin, morphine, diuretics, ace inhibitors, dobutamine, betablockers, entresto
267
what should be done before giving a patient nitroglycerin?
iv needs to be in place incase you drop BP too much
268
what do diuretics do for HF patient?
reduce pre and afterload
269
what does dobutamine do for HF?
improves CO without raising heart effort
270
what does entresto do?
increases the loss of sodium
271
what is in entresto?
Sacubitril/valsartan
272
what should be monitored when taking entresto?
Hypotension, dizzy, K level, kidney function
273
what should be monitored in digoxin patients?
K level and digoxin levels
274
what are symptoms of digoxin toxicity?
confusion, irregular pulse, N/v, diarrhea, fast heartbeat, vision changes with lights
275
what is a therapeutic range for digoxin?
0.8 to 2.0
276
what is done for digoxin toxicity?
charcoal or gastric lavage
277
what is pulmonary edema?
fluid around the lung that impairs gas exchange
278
what are symptoms of pulmonary edema?
pink frothy sputum, crackles, dyspnea, confusion, tachycardia, hypertension, hypotension, PVC, anxiety, restless
279
what are non pharm intervention for pulmonary edema
elevated HOB, tripod, rest, high flow o2,
280
what are pharm intervention for pulmonary edema?
diuretics, nitro, morphine, dobutamine
281
what meds should avoid dark leafy greens?
Warfarin
282
what is the antidote for warfarin?
vitamin k
283
what is the antidote for heparin?
protamine sulfate
284
what is the antidote for enoxaparin?
protamine sulfate
285
what are side effects of diuretics?
ototoxic, hypokalemia, and hypotension
286
what are some major side effects of ace inhibitors?
dry cough, confusion and angioedema, trouble swallowing
287
what are symptoms of respiratory acidosis?
hypoventilation, hypotension, headache, cyanotic, drowsiness, hyperkalemia, dysrhythmias
288
what are symptoms of respiratory alkalosis?
hypotension, hypokalemia, hyperventilation, tachycardia, confusion, seizures
289
what are symptoms of metabolic alkalosis?
hypoventilation, dysrhythmias, restless, confusion, N/v
