Exam #2 Flashcards
what are some assessments for oxygenation?
ABG, Pulse Ox, work of breathing, skin color, secretions, auscultation
what is the O2 range for NC?
1-6
what is the FiO2 for NC?
24-44%
what is the O2 range for Face mask?
5-8
what is the FiO2 for facemask?
40-60
what is the O2 range for the venturi mask?
4-11
what is the FiO2 for the venturi mask?
24-50%
what is the O2 range for partial rebreather?
8-11
what is the FiO2 range for the partial rebreather
50-75%
what is the O2 range for a non rebreather?
10-15
what is the FiO2 range for a non rebreather?
80-95%
what is the O2 range for HFNC?
30-60
what is the FiO2 for a HFNC?
100%
what type of pressure is provided with CPAP and BPAP?
positive pressure
what flow of pressure does Bipap have?
in and out
why would someone need to be intubated?
swelling of airway, cant clear secretions, seizures, surgery, tired for work of breathing, 50/50 rule
what supplies are needed for intubatin?
et tube, stylet, lubricant, mac/miller blade, larnygoscospe, syringe, flushes, bougjie, CO2 detector
what happens to the CO2 detector if you have the ET tube in the right spot?
the color will change
what lab should be run before intubation?
potassium
what do you do while waiting on the patient to be intubated?
ambu bag at 100% FiO2
do you sedate or paralyze your patient first?
sedate
where should the ET tube be placed?
into the trachea 2 cm above the carina
right after intubation what assessment should you do?
auscultate the breath sounds x2
what imaging should be done after intubation?
x ray
what lab should be done after intubation?
abg
what is pantoprazole used for?
stomach ulcer prevention
what is propofol used for?
anesthetic used for sedation
is propofol fast or long acting?
fast
is propofol titratable?
yes
what are side effects of propofol?
hypotension, brady cardia, resp depression, hyperlipidemia, elevated triglycerides
what is midazolam used for?
sedative
is midazolam short or long acting????
is midazolam titratable?
yes
what are side effects of midazolam?
hypotension, bradycardia, resp depression
what is dexmedetomidine?
fast acting sedative
what is special about dexmedetomidine?
it has minimal resp effects
what are side effects of dexmedetomidine
bradycardia and hypotension
what is vecuronium?
fast acting paralytic
why is vecuronium used?
it is used to paralyze the patient decreasing any extra oxygen use
what should be done for the patient when giving paralytics?
breath for the patient with ambu
what is the main side effect to worry about when giving paralytics?
apnea
is vec tirtrable ?????
what is succinylcholine?
fast acting paralytic that is used for intubation
what is the way to give succinylcholine?
iv push
what side effect should you watch for when giving succinylcholine
apnea and hyperkalemia
how much will succinylcholine raise K
by a point
what are signs of hyperkalemia?
chest pain, palpitations, N/v, abdominal pain, weakness, sob
what does the rate setting on vent control?
controls how many respirations in a minute
what does tidal volume on vent control?
volume of air per breath
what is the range for tidal volume?
500-600 ml
what is the FiO2 setting on vent control?
the percent of o2 in the air the patient is getting
what is PEEP on the vent control?
positive pressure that is the alveoli on expiration
what is the purpose of PEEP?
to prevent the lung from collapsing
what is pressure support?
constant pressure that is on the long throughout the breat
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
what happens if patient doesnt initiate breaths on AC
the vent breaths for them
are there set rate and tidal volume with AC?
yes
is there a set rate and tidal volume with SIMV?
yes
what is simv vent setting?
typically a weaning mode where the patient can control the rate and tidal volume
what mode on the vent is pressure support used?
simv
why is pressure support only used on simv
??????????????
what is the goal o2 sat for vent patient?
at least 94%
how do you perform a breathing trial?
turn down patients sedation??????????????????
what lab is constantly drawn on vent patients?
ABG
when should extubation be considered?
when FiO2 is on low setting and ABGs are godo
what is the max amount of time you should suction vent patietn?
10-15 seconds
what oral care should be done for vent patien?
brushing teeth, mouth swabs,
what is VAP?
vent associated pneumonia
what are symptoms of VAP?
fever, chills, pleuritic chest pain, tachypnea, SOB, orthopnea, poor appetite, bloody sputum
if a gastric tube has to be placed what type is preffered?
OG tube
what should HOB be at for vent patient?
30 degrees
what should be check frequently on ET?
placement, position, and cuff pressure
how often should you reposistion et tub?
q 12
what should you with tube feedings when laying patient down?
pause
what are complications of intubation?
hypotension, fluid retention, barotrauma, tension pnuemo, volutruama, self extubation
what should be done if your patient self extubates?
ambu until md crna arives
why does intubation cause hypotension?
it reduces cardiac output
how do you extubate??? need to know?/??
what can cause ARDS?
Aspiration, pneumonia, covid, sepsis, burns, trauma, shock
what is occurring inside the lung during ARDS?
alveolar membrane is injured, more fluid, and less surfactant
what are symptoms of ARDS?
hypoxia, stiff lungs, pulmonary edema, infiltrates on x ray
how do you diagnose ARDS?
chest x ray, Pa O2 consistnetly low despite being on 100% FiO2, lungs might sound okay initally,
what lab is drawn to differentitate between CHF and ARDS
BNP
what does it mean if BNP is above 100?
most likely HF
what are vent settings for ARDS?
intubation, low tidal volume and high peep, prone, monitoring for fluid overload
what is a tracheostomy?
a hole is placed into the neck
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
what should be done before the trach procedure?
hold anticoags a shift before, NPO at midnight, prepare the room
what should be done post op for freshly intubated trach patient?
chest x ray, listen, assess site
what is the next step after taking trach patient off vent?
trach collar
is CO2 acidic or alkaline?
acidic
if CO2 increases what happens to pH
it goes down
if HCO3 increases what happens to pH
it goes up
is resp acid/alk a quick fix or long term fix?
quick
what do your lungs do if your pH is too low?
increased RR to blow off the acidic CO2
what do your lungs do if your pH is too high?
decreased RR to retain CO2
how long does metabolic acid/alk take to correct?
24 to 48 hours
how do your kidney control pH?
excreting or retaining hydrogen and bicarb
what do your kidneys do in metabolic acidosis?
excrete hydrogen and retain bicarb
what do your kidneys do in metabolic alkalosis?
retain hydrogen and excrete bicarb
on the test if ABG comes back odd what do you never do?
REDRAW
what can cause resp acidosis?
hypoventilation, COPD, Pneumonia, Obstruction, OD, Pulmonary edema,
what are symptoms of metabolic acidosis
headache, confusion, tired, tachypnea, N/v, decreased bp, and cold/clammy skin
what can cause metabolic acidosis?
ketoacidosis and lactic acidosis
what can cause lactic acidosis?
shock, kidney failure, aspirin, hypotension, diarrhea
what can cause metabolic alkalosis?
stomach acid loss, vomit, abusing diuretics, antacids
what can cause resp alkalosis?
hyperventilation, fever, hypoxia, aspirin tox,
what is the range for pH?
7.35 - 7.45
what is the range for Co2?
35-45
what is the range for HCO3?
22-26
what is the range for PaO2?
80-100
what is a uncomped abg?
abnormal ABG that
what is a partially comped abg?
abnormal abg where the body is attempting to return balance by adjusting other values
what is a comped abg?
pH is normal range but other values are not normal
what does the SA node do?
the natural pace maker of the heart that send electrical signals to the atria of the heart
what is the natural HR for the SA node?
60 -100
where is the SA node found?
near the right atrium
where does the AV node get electrical signal from?
the SA node
what does the AV node do?
slows down the electrical impulse to allow the ventricles time to fill before contraction
what is the intrinsic rate of the AV node?
40=60
what is the intrinsic rate of atrial tissue?
60-100
what is the intrinsic rate of ventricular tissue?
20-40 HR
what is depolarization?
the contraction of the heart muscle
what is repolarization?
recharging of the heart muscle
what are P waves?
this is when the atria are depolarizing/contracting
when a good P wave is present what node is firing appropriately?
SA
what is the PR interval?
the time it takes to go from the SA node to AV node
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
what is the QRS complex?
ventricular depolarization/contraction
what is the ST segment?
the time between depolarization and repolarization
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
what is the QT interval?
the times it takes for the ventricles to depolarize and repolarize
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
what meds can cause a prolonged QT?
zofran, levoflaxacin, fluoxetine, sertraline, haloperidol, H2s, BETA Blocker?????
what can pronlonged QT lead to?
torsades V tach
how long is each ekg strip on the exam?
6 seconds
what are the characteristics of a sinus rhythm?
xxx
what are the characteristics of normal sinus rhythm?
P wave, QRS, T wave, 60-100 HR, and regular
what are characteristics of sinus bradycardia?
P wave, QRS, T wave, HR less than 60 , and regular
what are characteristics of sinus tachycardia?
P wave, QRS, T wave, HR greater than 100 , and regular
what are the symptoms of sinus brady?
sob, dyspnea, hypotension, LOC change
what can cause sinus brady?
athlete, old age, SA node issues, Meds, increased ICP, MI
what are non pharm interventions for sinus brady?
stimulation
when should you do interventions for sinus brady?
only do interventions if the patient is symptomatic
what interventions should you do for sinus brady?
First atropine, Epi, Dopamine
what should be done with the sinus brady patient if they cant be treated with meds
External pacer
what prevents atropine from working?
av blocks
what causes sinus tach?
fever, dehydration, hypoxia, hypotension, caffeine, drugs,
what are then treatments for sinus tach?
fever you give antipyretics, anxiety calm them down, dehydration fluids, BB or CCB
what are symptoms of sinus tach?
xx
what is atrial fibrillation?
this occurs when the atria of the heart are contracting randomly
what does atrial fibrillation look like on ekg?
no P wave, no t wave, QRS present, irregular
what is controlled a fib?
less than 100bpm
what is uncontrolled a fib?
over 100 bpm
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
what causes a fib?
hypertension, stress, sleep apnea, stimulant use, smokers, alcohol
what are symptoms of a fib?
tachycardia, palpitations, dizzy, fatigue, SOB, weak, decreased CO
what are a fib patients at risk for developing?
stroke from blood clots
what are the medications that help with the dysrhythmias for afib?
amiodarone, CCB/Diltiazem, Digoxin
what meds to afib patients take to prevent clots
Heparin, warfarin, enoxaparin
what long term anticoag do afib patients take?
warfarin
what labs are monitored with heparin?
PTT
what labs are monitored for patients taking Warfarin?
PT and INR
where do you administer enoxaparin?
within one inch of the umbilicus
what type of shock therapy may a afib patient get?
cardioversion
what must you know med wise about cardioversion?
must be off anticaogs for 24-48 hours due to the risk of dislodging clot
what operation might be performed on a afib patient?
ablation to remove heart muscle causing a fib
what happens in the body during V tach?
the ventricles are constantly contracting without time to fill
what does v tach look like on the EKG?
No p wave, no t wave, QRS present, regular
what is the HR like in v tach?
over 100 typically above 160
what is the criteria for v tach?
3 or more pvc and HR greater than 100
what is sustained v tach?
lasting longer than 30 seconds
what is unsustained v tach?
less than 30 seconds
what can cause V tach?
MI, K levels being high or low, Blunt chest trauma, Ischemia
when your patient is in v tach what is the first thing that you check?
pulse
what are the symptoms of v tach?
tachycardia
Palpitations
Dizzy
Fatigue
Sob
weakness
what is the pharm and non pharm treatment for v tach in a patient with a pulse?
Medication and getting the stim vagus nerve
what medications do v tach patients get?
amiodarone and lidocaine
how do you get a patient to stimulate vagus nerve?
bear down like a bm, blow into straw, scare them
what is the treatment for v tach without a pulse?
meds, cpr, defib
when doing cpr how mang compressions per minute?
100-120
when doing cpr how often do you deliver a breath?
6 seconds
what is v fib?
this happens when the ventricles are getting unsynchronized electricity causing there to be no contraction
what does V fib look like on ekg?
No p wave, no t wave, no
what is the treatment for v fib?
cpr and defibrillate
what does asystole look like on ekg?
a flat line
what is the treatment for asystole?
cpr
do you shock asystole right away?
no
when do you shock aystole?
the moment there is electrical signal on ekg
what type of beat do you shock in asystole?
agonal beat
what is the treatment for aystole?
CPR
what causes aystole?
Hypovolemia, hypoxia, hydrogen from acidosis, hypothermia, Hypokalemia, hyperkalemia, Toxins like drugs/poisons, Cardiac tamponade, tension pneumo, thrombosis
what is cardiac tamponade?
occurs when there is bleeding the pericardium
what is tension pneumo?
this occurs when air is trapped inside the pleural space causing deviated trachea
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
f
what is the treatment for aystole?
epi and cpr
are pvc always bad?
no but can be sign of v tach
what rhythms are indicating MI?
xx
what is coronary artery disease?
this occurs when plaque builds up in the arteries of the heart
what are risk factors for CAD?
obese, smoking, alcohol, hyperlipidemia, hypertension, genetics, metabolic syndrome
how do you prevent CAD?
quit smoking, lower fat diet, monitor cholesterol, exercise, manage BP, manage diabetes
what are symptoms of metabolic syndrome?
elevated fasting glucose, enlarged waist, high triglycerides, low HDL, hypertension
what can chronic angina lead to?
necrosis of the heart and MI
what is stable angina?
predictable chest pain usually caused by exertion that is relieved by rest
how long does stable angina last?
less than 15 minutes
what is the treatment for stable angina?
nitroglycerin
at what point do you get help for angna
after you take your 3rd nitro
what is unstable angina?
chest pain that is unpredictable
what are interventions when angina patient comes to the ER?
ekg, nitroglycerin, IV, obtain cardiac labs
will angina cause elevated cardiac labs?
no
what is myocardial infarction
blockage of the coronary artery
what is the bloods reaction to an MI?
the inflammatory response is triggered causing platelets to attract at the blockage site
if patients chest pain is releived by nitro are they good to go?
not always because nitro can relax GI
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
where can you feel pain in MI?
Left arm, neck, jaw, back
what are possible rhythms when having an MI?
PVC, ST elevated, Upside down t, normal sinus rhythm
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
what happens to wbc during MI?
elevated wbc
what happens to K during MI?
usually elevated due to it being released from dead tissue
why is PT,PTT and INR checked during MI?
need to know base line before giving medications
what happens to Creatine kinase during MI?
elevated
what can cause elevated creatine kinase?
MI or rhabdo
what happens to troponin during MI?
elevated
what happens to Creatine kinase myocardial bands during MI?
elevated
what can cause elevated creatine kinase myocardial bands?
MI and fast HR
what happens to urinary out put during MI?
decreases because of low perfusion
what do you give patient if their BUN/creatine levels are high before heart cath?
acetylcysteine to protect their kidney
what is are non pharmecutical interventions for MI?
Assessment, history, previous stroke/mi, IV bilateraly, 12 lead ekg, 5 lead ekg, q15 vitals
what meds are given to MI patients?
Clopidorgrel, Heparin, Enoxaparin, Ace inhibitors, Oxygen, Morphine, Beta blockers, Nitroglycerin, Aspirin, Statins, Alteplase, Tenecteplase, abciximab, tirofiban, epitfibatide
what are the thienopyridine meds?
clopidogrel
what do thienopyridine meds do?
prevent clotting
what are the RASS medications?
ace inhibitors
what is the ending for ace inhibitors?
pril
why are ace inhibitors given to MI patients?
prevents ventricular remodeling from forming scar tissue on the heart
why is morphine given to MI patietn?
vasodilator, pain reducer, and anxiety
why are betablockers given to MI patients?
to decrease workload of the heart and decrease oxygen demand
what patietns take statin meds?
CAD with high cholesterol
why do MI patients take aspirin?
to thin blood
what meds are salicylates?
aspirin
what are the thrombolytics used during MI?
alteplase, Tenecteplase
what should you watch out for when giving thrombolytics?
Another MI and arrythmias due to muscle being perfused again
what do 2b/3a inhibitors do?
they coat platelets and prevent them from clotting together
what are the 2b/3a inhibitors?
abciximab, tirofiban, eptifibatide
do patients take aspirin if they are taking heparin?
yes
what meds should you reconcile with patient before cabg?
blood thinners, metformin, and garlic
what is cabg?
a procedure where they bypass a clogged artery of the heart
how quick should patient be ambulating after cabg?
3-4 hours
what are the interventions for MI?
percutaneous cardiac intervention or CABG
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
what posistion should patient be in post pic
flat for 4-6 hours
when will you pull sheath from PIC?
when dr says its good and when clotting labs are in a good range
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
what should you watch for after pulling sheath?
pain, bleeding, hematoma, absent pedal pulses, chest pain, stroke,
what med is given after stent?
diuretics
what meds are given post CABG
pain meds, stool softener, protonix, heparin,
what labs are monitored post CABG
K, Mag, wbc
what diet to post CABG patients need?
high cal high protein
what are complications post CABG?
bleeding, BP issues, tamponade, excessive drainage, dysrhythmias
what is considered excessive drainage?
more than 150ml per hour
what are symptoms of left sided HF?
nocturnal dyspnea, crackles, wheezes, orthopnea, dyspnea, fatigue, weak, palpitations, oliguria, decreased peripheral pulses
what are symptoms of right sided HF?
JVD distention, edema, weight gain, anorexic, ascites, hepatomegaly, splenomegaly
what are surgical interventions for HF?
impella, lvad, transplant
what are nursing interventions for HF?
posistioning, rest, daily weights, oxygen, education on lifestyle changes
what nutritional ed for HF?
low sodium, limit fluids, avoid large meals
what meds are used to treat HF?
Digoxin, Nitroglycerin, morphine, diuretics, ace inhibitors, dobutamine, betablockers, entresto
what should be done before giving a patient nitroglycerin?
iv needs to be in place incase you drop BP too much
what do diuretics do for HF patient?
reduce pre and afterload
what does dobutamine do for HF?
improves CO without raising heart effort
what does entresto do?
increases the loss of sodium
what is in entresto?
Sacubitril/valsartan
what should be monitored when taking entresto?
Hypotension, dizzy, K level, kidney function
what should be monitored in digoxin patients?
K level and digoxin levels
what are symptoms of digoxin toxicity?
confusion, irregular pulse, N/v, diarrhea, fast heartbeat, vision changes with lights
what is a therapeutic range for digoxin?
0.8 to 2.0
what is done for digoxin toxicity?
charcoal or gastric lavage
what is pulmonary edema?
fluid around the lung that impairs gas exchange
what are symptoms of pulmonary edema?
pink frothy sputum, crackles, dyspnea, confusion, tachycardia, hypertension, hypotension, PVC, anxiety, restless
what are non pharm intervention for pulmonary edema
elevated HOB, tripod, rest, high flow o2,
what are pharm intervention for pulmonary edema?
diuretics, nitro, morphine, dobutamine
what meds should avoid dark leafy greens?
Warfarin
what is the antidote for warfarin?
vitamin k
what is the antidote for heparin?
protamine sulfate
what is the antidote for enoxaparin?
protamine sulfate
what are side effects of diuretics?
ototoxic, hypokalemia, and hypotension
what are some major side effects of ace inhibitors?
dry cough, confusion and angioedema, trouble swallowing
what are symptoms of respiratory acidosis?
hypoventilation, hypotension, headache, cyanotic, drowsiness, hyperkalemia, dysrhythmias
what are symptoms of respiratory alkalosis?
hypotension, hypokalemia, hyperventilation, tachycardia, confusion, seizures
what are symptoms of metabolic alkalosis?
hypoventilation, dysrhythmias, restless, confusion, N/v
