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536 > Final Exam (wk 5-8) > Flashcards

Final Exam (wk 5-8) Flashcards

1
Q

What 4 conditions can an xray be used for?

A

-cardiomegaly
-CHF
-valve dysfxn
-differential dx of pulm conditions

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2
Q

What is echocardiography?

A

non-invasive procedure using high frequency US waves

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3
Q

What is doppler imaging used for?

A

to see BF direction and velocity

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4
Q

What do CTs show?

A

series of thin xrays to generate cross sectional images of heart and pulm vasculature

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5
Q

Does CT require that xray doesn’t in order to see specific structures?

A

IV contrast agent; distinguishes blood and tissue

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6
Q

What can a CT pulmonary angiography detect?

A

thrombus

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7
Q

What are 3 benefits of CT pulm angiography?

A

-rapid reporting
-high sensitivity/specificity
-widely available

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8
Q

What are 2 limitations of CT?

A

-artifact from pt moving/breathing
-radiation

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9
Q

Describe what an MRI does

A

-uses magnetic field to obtain images of internal structures
-requires no radiation

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10
Q

What is positron emission tomography?

A

nuclear technique that provides visualization and direct measurement of metabolic functioning

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11
Q

What is positron emission tomography the gold standard for?

A

BF measurement

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12
Q

Advantage and disadvantage of positron emission tomography

A

-advantage: can detect viable myocardium w/o ex

-disadvantage: costly

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13
Q

How does nuclear imaging work?

A

uses injected radioactive tracers to evaluate heart fxn

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14
Q

What does a duplex US do?

A

-records sound waves reflecting off objects to measure the qualities of flow
-determines if plaque is blocking artery flow

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15
Q

What does a carotid duplex do?

A

-evals neck arteries
-most accurate test to determine carotid artery disease

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16
Q

What is MRA? Purpose?

A

-magnetic resonance angiography
-detect PAD

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17
Q

2 advantages of MRA

A

-lack of radiation
-removal of background structures

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18
Q

What are the 4 ABI ranges?

A

> 1.1 - no symps
0.5-1.0 - claudication
0.2-0.5 - critical limb ischemia
< 0.2 - severe ischemia

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19
Q

What is arteriography? 3 SE?

A

-invasive dx test; contrast angiography; pic of blood vessels

SE: sensitive rxn, hemorrhage/hematoma
-thrombosis

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20
Q

What is contrast echocardiography? Purpose?

A

-uses IV contrast with echocardiogram
-assesses myocardial perfusion and ventricular chambers

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21
Q

What happens during trans-esophageal echogardiography?

A

-sedation, catheter into esophagus

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22
Q

Purpose of trans-esophageal echocardiography

A

-rule in/out bacterial endocarditis, aortic dissection, valve regurgitation, L atrial thrombus, septal defect

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23
Q

What is intravascular US?

A

tiny US on catheter inserted into artery to see interior artery walls

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24
Q

What is the purpose of R side cardiac catheterization?

A

evaluates R heart pressures

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25
Q

What is the purpose of L side catheterization? Where does catheter travel through?

A

-evaluates aorta
-common femoral artery or radial artery

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26
Q

6 indications for cardiac catheterization

A

-aortic dissection
-atypical angina
-cardiomyopathy
-congenital disease
-CAD
-s/p MI
-valve disease

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27
Q

Name 4 different angioplasty and briefly describe

A

-stent: supports arterial wall

-balloon angiography: tiny balloon pushes thrombus/thingy against arterial wall; percutaneous coronary intervention

-rotoblader: grinds up calcified blockage

-atherectomy: small vacuum that removes part/all blockage

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28
Q

What is percutaneous transluminal coronary angioplasty (PTCA)

A

-balloon and stent inserted into diseased artery
-balloon inflated, stent expands
-balloon taken out and stent left in to widen artery

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29
Q

What is an endarterectomy? Goal?

A

-surgical procedure to open/clear carotid artery
-goal: reducing stroke risk

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30
Q

What is ICU acquired weakness?

A

acute onset of NM and fxnal impairment in critically ill

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31
Q

3 dx criteria for ICU acquired weakness (ICUAW)

A

-generalized weakness developing after onset of critical illness
-diffuse weakness; spares CN nerves
-dependence on ventilation

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32
Q

2 S/S of critical illness polymyopathy

A

-loss of DTRs and diminished sensory and pinprick sensation
-loss of motor and sensory action potentials on

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33
Q

What are 3 factors of critical illness myopathy?

A

-proximal limb and respiratory mus weakness
-difficulty weaning off vent
-loss of motor action potentials but sensory ok

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34
Q

What are 4 main factors of post intensive care syndrome (PICS)?

A

-impaired cognition; similar to mild dementia
-psychiatric: depression, anxiety, PTSD
-physical fxn: ICUAW, vent > 7 days

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35
Q

3 big PT implications of ICUAW and PICS

A

-wean from vent
-reduce sedation
-EARLY rehab/mob

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36
Q

Target SaO2 range for norm adult

A

92-98%

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37
Q

Target SaO2 for COPD

A

88-92%

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38
Q

Oxygen delivery systems

A

-nasal cannula
-open face tents
-closed face mask
-trach collar
-non rebreather masks
-venturi masks/air entrainment masks
-CPAP/biPAP

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39
Q

What are 2 disadvantages of closed face mask for O2?

A

-interferes w/ coughing, eating, drinking
-not comfy so pt takes off often

40
Q

One big disadvantage of non-rebreather masks

A

risk of suffocation - bag must always be partially inflated, pt can’t be left alone

41
Q

What is the main purpose of CPAP/biPAP? 2 advantages

A

-“back pressure” keeps airways and alveoli open
-reduce work of breathing and demand on cardiac system

42
Q

What are things to be aware of with brachial, radial, and femoral artery a-lines?

A

-brachial and radial: arm board, length of line limits mobility, avoid wrist and elbow flex

-femoral: avoid hip flex >60-80 degrees

43
Q

What are 3 purposes of a-lines?

A

records mean arterial pressure (MAP), delivers meds, repeated blood samples

44
Q

Where should a transducer be kept?

A

phlebostatic axis: intersection of midaxillary line and 4th intercostal space

45
Q

What happens if transducer is too high or low?

A

-too low, BP reads high
-too high, BP reads low

46
Q

Where is a central venous catheter placed? Another name?

A

-internal jugular, femoral, subclavian veins into R atrium via vena cava
-Hickman catheter

47
Q

What are 3 important things to keep in mind with central venous catheter?

A

-no BP on arm with catheter in
-keep transducer at phlebostatic line
-ensure tape over insertion intact

48
Q

What does a pulmonary artery catheter do? Who are they for?

A

-gold standard
-extensive cardiac monitoring; pulm arterial pressure, R atrial pressure
-very sick pts

49
Q

Important thing to keep in mind if pt has pulm artery catheter

A

cautious with mob; don’t dislodge or kink catheter

50
Q

What is a peripherally inserted central catheter (PICC line)?

A

long catheter inserted into peripheral vein and to vena cava

51
Q

Two things to look out for with PICC line

A

-no BP monitoring on arm with PICC line
-ensure tape is secure over PICC line

52
Q

What does an interaortic balloon pump do?

A

-inflates during diastole
-deflates during systole

53
Q

Where are chest tubes most commonly placed?

A

4-6 intercostal space

54
Q

What is one important thing to keep in mind with chest tube?

A

keep drainage reservoir below the lvl of insertion site and below the suction system

55
Q

Wound VAC purpose

A

-promotes healing by preparing wound bed closure

56
Q

Jackson Pruitt drain (JP drain) purpose

A

removes excess fluid from beneath post-surg incision

57
Q

3 important factors for PTs to know with JP drains

A

-secure tubing to pt’s clothing/gown or abdominal binder
-ensure tubing doesn’t dislodge
-bulb stays compressed to create gentle suction

58
Q

3 important things to be aware of with intercranial pressure monitoring/external ventricular drain

A

-do not adjust stopcock
-head of bed no lower than 30 degrees
-must have drain “clamped” before changing the pt position

59
Q

What are two important things to keep in mind for PEG or NG tubes

A

-when tube feedings are running, maintain head of bed at >30 degrees if in supine
-do not dislodge tube

60
Q

5 wire EKG leads

A

-white (under R clavicle)
-brown (R chest)
-green (lower R abdomen)
-black (L under clavicle)
-red (L lower abdomen)

61
Q

How many phases are in the cycle for action potential in an EKG?

A

5; phase 0-4

62
Q

Describe the phases of the action potential in cardiac cells (EKG)

A

Phase 0 - depolarization and rapid entry of Na
Phase 1 - early depolarization, K+ slowly enters
Phase 2 - plateau continues and slower entry of Ca2+
Phase 3 - K+ moves out of the cell
Phase 4 - resting phase

63
Q

How many small squares makes 6 seconds for EKG strip

A

30

64
Q

How many seconds does a sm and lg square represent

A

Small square: 0.04 sec
Lg square: 0.2 sec

5 sm squares = 1 lg

65
Q

Where are leads VI-II placed for EKG?

A

Near sternal border

66
Q

Where is lead V3 placed for EKG?

A

Midway between V2 and V4

67
Q

Where is lead V4 placed for EKG?

A

5th intercostal space, L midclavicular line

68
Q

Where is lead V5 placed for EKG?

A

L anterior axillary line at V4 level

69
Q

Where is lead V6 for EKG placed?

A

L mid axillary line at V4/5 level

70
Q

How to quantify 6 sec tracing (1 min HR) for EKG

A

Count QRS complexes in 6 sec interval and multiply by 10

71
Q

What is the normal PR-interval for EKG?

A

3-5 sm squares or 0.12-0.2 seconds

72
Q

What is the normal QRS complex interval for EKG?

A

0.06-0.1 seconds (1.5-3 sm boxes)

73
Q

What is an abnormal QRS complex interval in EKG?

A

> 0.12 seconds

74
Q

Causes of premature atrial contractions (PACs)

A

-HTN, caffeine
-pregnancy
-COPD, asthma
-metabolic
-stress, extreme fatigue
-

75
Q

Next step if pt has a premature atrial contraction (PAC)

A

Reduce intensity, monitor vitals, report to team

76
Q

Symptoms of premature atrial contraction (PAC)

A

-skipped beat
-fatigue or SOB
-ex intolerance
-chest pain

77
Q

Causes of atrial tachycardia

A

-HTN and cardiomyopathy
-previous MI
-excessive alc/drug use
-“irritable focus”
-sometimes idiopathic

78
Q

Symps of atrial tachycardia

A

-palpitations
-fainting
-chest pain
-SOB
-fatigue
-ex intolerance

79
Q

Next steps if pt has atrial tachycardia

A

Reduce intensity, monitor vitals, alert team

80
Q

Symps of a fib and a flutter

A

-tachycardia
-SOB
-dizziness
-syncope
-fatigue
-ex intolerance
-chest pain/anxiety
-night sweats or waking w/ palpitations

81
Q

Next step if pt has a-fib or a-flutter

A

new onset or worsening, stop activity, call team, monitor pt

82
Q

What is the difference between a-flutter and a-fib

A

A-flutter — regular tachycardia
A-fib — quivers, irregular tachycardia and reduced atrial kick

83
Q

Causes of premature ventricular complex (PVC)

A

-excessive caffeine
-hyperthyroidism
-excessive alc/tobacco
-STIMULANTS (rx and non-rx)
-anemia
-most have no etiology

84
Q

Symps of PVCs

A

-asymptomatic
-lightheaded, chest pain/discomfort
-syncope rare
-dyspnea

85
Q

Next steps if pt has PVC

A

-1 or 2, monitor and keep going
-increasing in frequency, reduce intensity

-RUNS IN 3, LET THEM BE

86
Q

V-tach causes

A

-low CO, systemic hypoperfusion, syncope and potential death

87
Q

V-tach symps

A

-syncope
-SOB d/t pulm edema
-cardiac arrest

88
Q

Next steps if pt has v-tach

A

RAPID RESPONSE or possible CODE

89
Q

Causes of v-fib

A

-MI
-electrolyte imbalance
-syncope, significant SOB

90
Q

Next steps if pt has v-fib

A

Call a code and start CPR

91
Q

What would show ischemia on an EKG

A

Inverted T wave

92
Q

What is the normal range for pH (ABG)?

A

7.35-7.45

93
Q

What are the abnormal pH values for ABGs?

A

< 7.35 indicates ACIDOSIS

> 7.45 indicates ALKALOSIS

94
Q

What is the normal range for PaCO2 (respiratory system) ABGs

A

35-45

95
Q

What are the abnormal PaCO2 values for ABGs

A

< 35 indicates ALKALOSIS

> 45 indicates ACIDOSIS

96
Q

Normal range for HCO3 (metabolic system) ABGs

A

22-26

97
Q

Abnormal HCO3 values for ABGs

A

< 22 indicates ACIDOSIS

> 26 indicates ALKALOSIS

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