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Final for Critical Care > Final review > Flashcards

Final review Flashcards

1
Q

what does Etc02 measure?

A

measures exhaled carbon dioxide

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2
Q

what color indicates normal Etc02 on capnography?

A

yellow

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3
Q

what color indicates abnormal Etc02 on capnography?

A

purple

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4
Q

Potential causes of low C02? (4)

A

PE
DKA
anxiety
pain

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5
Q

potential causes of high C02? (2)

A

respiratory distress

respiratory failure from fatigue

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6
Q

what drugs can be given through an ETT?

A 
N-Narcan
A-Atropine
V-Vasopressin
E-Epinephrine
L-Lidocaine
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7
Q

what meds for intubation?

A

paralytics (roc, sux, etomidate)

sedatives (midazolam)

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8
Q

when would we not give paralytics in an RSI?

A

if the patient is postcode, unconscious…

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9
Q

how do we tell if paralytics are at the appropriate level?

A

train of four
2/4 is normal
3 or 4/4 is too low a dose
0 or 1/4 is too high a dose

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10
Q

when do we suction a patient?

A
  • only as needed
  • if secretions are visible in the ET tube
  • coughing
  • dropped 02 sat
  • visible secretions in mouth
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11
Q

what is the open suction technique?

A

requires sterile gloves

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12
Q

what is the closed suction technique?

A

does not require sterile gloves because it is enclosed in a sterile catheter

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13
Q

proper care of an intubated patient? (6)

A
  • q2h oral care and PRN
  • DVT prophylaxis
  • Prilosec
  • Gut feeds
  • HOB >30 degrees
  • handwashing
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14
Q

why do we do oral care for intubated patients?

A

to prevent breakdown and VAP

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15
Q

why do we do DVT prophylaxis on intubated patients?

A

because the intubated patients will not be moving

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16
Q

why do we give Prilosec to patients that are intubated?

A

to prevent ulcers

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17
Q

why do we do gut feeds for patients that are intubated?

A

patients that are intubated require protein to heal and recover to eventually get off of the vent

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18
Q

why do we elevate an intubated patient’s HOB to 30 degrees?

A

to prevent aspiration

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19
Q

what are the 4 modes of ventilation?

A
  • CPAP
  • BiPAP
  • BiLevel
  • ACVC
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20
Q

what is PEEP?

A

positive end-expiratory pressure: helps to keep alveoli open and improve oxygenation

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21
Q

what is a normal PEEP?

A

3-10 with 8 being the average

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22
Q

What are the signs of deterioration during ventilation? (7)

A
  • color change
  • apnea
  • Pa02 <50 and PaC02 >60
  • diminished breath sounds
  • increased rales and rhonchi
  • dysrhythmias
  • change in LOC
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23
Q

what do we do if the ventilator has problems?

A

call RT and bag the patient

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24
Q

what is the rate for sinus bradycardia?

A

40-60bpm

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25
Q

tx for sinus brady?

A

-atropine, epi, transcutaneous pacing

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26
Q

when do we treat sinus brady?

A

if you are symptomatic

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27
Q

what is the rate of sinus tach?

A

over 100bpm

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28
Q

tx of sinus tach?

A
  • fluids
  • NSAIDS
  • anxiolytics
  • beta-blockers
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29
Q

how do we find the rhythm on a strip?

A

on a 6 second strip, take 1500/small boxes

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30
Q

what is the rate of SVT?

A

> 180bpm

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31
Q

tx of SVT?

A

vagal stimulation
adenosine (6mg rapid push, followed by flush)
can double dose and repeat in 1-2 minutes if no response

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32
Q

tx of a PAC?

A

usually benign, but can be treated with beta blockers

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33
Q

what is a PAC?

A

early contraction

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34
Q

what is Atrial Flutter?

A

-presence of sawtooth patterns with an atrial rate of 250-350 and a normal QRS.

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35
Q

tx of Atrial Flutter?

A
  • slow the HR, antidysrhythmic drugs (amiodarone or lidocaine)
  • cardioversion
  • blood thinner due to blood stasis
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36
Q

what is atrial fibrillation?

A

disorganized atrial kicks with a normal QRS

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37
Q

tx of atrial fibrillation?

A 
amidarone
lidocaine
cardioversion
blood thinner
MAZE procedure
catheter ablation
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38
Q

what is a MAZE procedure?

A

uses cat scratches to form scar tissue and prevent fibrillation of the atrium

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39
Q

what is a PVC?

A

premature ventricular contraction

-causes a distorted QRS complex

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40
Q

when do you tx a PVC?

A

if they happen all the time

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41
Q

what is the tx of PVCs?

A

treat cause

  • electrolyte replacement
  • oxygen
  • beta-blockers
  • amiodarone
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42
Q

what is ventricular tachycardia?

A

a run of 3 or more PVCs with a rate of 150-250bpm

is a life-threatening rhythm!!!!

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43
Q

tx of pulsatile ventricular tachycardia?

A

underlying cause

  • amiodarone
  • cardioversion
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44
Q

tx of pulseless ventricular tachycardia?

A

ACLS protocol for cardiac arrest with a shockable rhythm

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45
Q

what are the 3 types of ventricular tachycardia?

A
  • monomorphic
  • polymorphic
  • torsades de pointes
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46
Q

what is ventricular fibrillation?

A

deadly rhythm
no QRS noted
no effective CO

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47
Q

tx of vfib?

A

begin ACLS protocol for unshockable rhythm

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48
Q

what is asystole?

A

absence of ventricular electrical activity

flatline

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49
Q

tx of asystole?

A

ACLS protocol for unshockable rhythm

CPR and meds only

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50
Q

what is PEA?

A

pulseless electrical activity

rhythm shows on EKG, but no mechanical activity or pulse.

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51
Q

tx of PEA?

A

compressions, ventilation and meds

no shocking

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52
Q

what is a 1st-degree block?

A

long PR interval

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53
Q

who is a first-degree heart block normal in?

A

athletes

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54
Q

what does a 1st-degree block look like?

A

extended but stable PR interval

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55
Q

what is a 2nd-degree type 1 block?

A

a wenkebach, longer and longer PR interval, and then a QRS is dropped

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56
Q

what is the treatment for a wenkebach?

A

pacemaker or transcutaneous pacing

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57
Q

what is 2nd-degree type 2 heart block?

A

equal PR lengths blocked QRS

also known as mirror strip

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58
Q

tx of 2nd-degree type 2 heart block?

A

pacer, transcutaneous pacing

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59
Q

what is a 3rd-degree heart block?

A

no association between atria and ventricles
atrial and ventricular rhythm is regular
there is no association between the p wave and QRS

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60
Q

how serious is a 3rd-degree heart block?

A

very serious!!!!!

this is a deadly rhythm and can progress very quickly to a deadly rhythm

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61
Q

what disease is atrial flutter a precursor to?

A

CHF

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62
Q

tx for 3rd-degree heart block?

A

pacemaker or transcutaneous pacing

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63
Q

what is the intervention for NSR?

A

nothing: continue to monitor

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64
Q

tx for sinus Brady?

A

wake up pt, atropine, epi, pacing

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65
Q

tx of sinus tach?

A

treat the cause: pain, anxiety, fever, decrease caffeine

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66
Q

tx for SVT?

A

vagal stimulation, adenosine

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67
Q

tx of PAC?

A

betablockers

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68
Q

tx of a flutter?

A

amiodarone and beta blockers

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69
Q

tx of a fib?

A

amiodarone, cardioversion MAZE procedure, blood thinner

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70
Q

tx of PVC?

A

treat cause: electrolytes, oxygen, beta blockers

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71
Q

tx of vtach?

A

amiodarone, lidocaine for pulsatile

CPR and epi for pulseless

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72
Q

tx of vfib?

A

CPR, ACLS, epi, defibrillation

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73
Q

tx of asystole?

A

CPR, ACLS

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74
Q

tx of PEA?

A

CPR and ACLS

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75
Q

tx of junctional rhythm?

A

atropine, verapamil, pacemaker

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76
Q

tx of the 1st-degree block?

A

continue to monitor

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77
Q

tx of wenckebach?

A

atropine

temp pacer

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78
Q

tx of 2nd-degree type 2 block?

A

permanent pacer

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79
Q

tx of a 3rd-degree block?

A

transcutaneous pacing per ACLS protocol

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80
Q

normal range of CO?

A

4-6L/min

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81
Q

normal range of CI?

A

2.4-4.0L/min

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82
Q

normal CVP?

A

0-8

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83
Q

normal stroke volume?

A

60-100

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84
Q

normal SVR?

A

800-1200dynes

85
Q

normal PVR?

A

30-100 dynes

86
Q

what is shock?

A

tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function
inadequate 02 delivery to meet cellular demands

87
Q

causes of hypovolemic shock?

A

third spacing or blood loss

88
Q

causes of cardiogenic shock?

A

left or right ventricular failure, MI

89
Q

3 types of distributive shock?

A
  • anaphylactic
  • septic
  • neurogenic
90
Q

what is hypovolemic shock?

A

from fluid shifts (hemorrhage, burn, ascites, dehydration)
or fluid loss (trauma, surgery, vomiting, diuresis, diarrhea, DI)
not enough fluid or blood to meet bodies demands

91
Q

what is cardiogenic shock?

A

impaired 02 delivery due to cardiac dysfunction

92
Q

tx of cardiogenic shock?

A

milrinone

93
Q

causes of obstructive shock?

A

PE, tension pneumo, cardiac tamponade

94
Q

what is normal lactate?

A

below 2

95
Q

what does elevated lactate indicate?

A

cellular hypoxemia, not enough oxygen o meet the bodies demands/

96
Q

what is septic shock?

A

widespread infection-causing elevated WBC, fever and hyperglycemia

97
Q

what is neurogenic shock?

A

loss of balance between sympathetic and parasympathetic nervous system

98
Q

causes of neurogenic shock?

A

SCI, spinal anesthesia, CNS damage

99
Q

causes of anaphylactic shock?

A

allergic reaction with systemic response causing widespread vasodilation

100
Q

what happens in the initial stage of shock?

A

first cellular changes, include decrease aerobic and increase anaerobic
no s/s yet

101
Q

what happens in the compensatory stage of shock?

A

attempt to compensate for decreased CO and decreased adequate 02 and nutrients. neural, hormonal and chemical responses

102
Q

what happens in the progressive stage of shock?

A

end-organ failure due to cellular damage. usually GI and renal first, then cardiac, with loss liver and cerebral function

103
Q

what happens in the refractory stage of shock?

A

irreversible damage

104
Q

tx of shock?

A
  • optimize 02 delivery

- decrease 02 consumption

105
Q

ways to optimize 02 delivery?

A
  • supplemental 02
  • IV fluids
  • inotropic drugs
  • vasoactive drugs
  • vasodilators
106
Q

ways to reduce oxygen consumption?

A
  • decrease total body work
  • mechanical intubation
  • paralytics
  • sedation
  • minimize pain and anxiety
  • maintain body temperature
107
Q

examples of inotropic drugs?

A

dopamine
dobutamine
milrinone

108
Q

examples of vasoactive drugs?

A

epinephrine
levophed
dopamine
vasopressin

109
Q

examples of vasodilators?

A

nitroprusside

nitroglycerin

110
Q

examples of paralytics?

A

rocuronium
succinylcholine
etomidate

111
Q

examples of sedation?

A

propofol

midazolam

112
Q

examples of pain/anxiety medication?

A

fentanyl, morphine, tylenol, ativan

113
Q

how to maintain body temperature?

A

Tylenol and fluids

114
Q

what is SIRS?

A

systemic Inflammatory response syndrome

115
Q

what is the criteria for dx of SIRS?

A

2 or more of the following

  • temp (>100.4 or <96.8)
  • HR >90
  • respiratory rate >20
  • WBC >12,000 or <4,000 or 10% immature neutrophil
116
Q

what are the complications of SIRS?

A
  • ARDS
  • AKI
  • shock
  • MODS
117
Q

what is SIRS a precursor to?

A

MODS

118
Q

Criteria for dx of MODS?

A

altered fx of 2 or more organs
acutely ill pt
hemostasis cannot be maintained without intervention

119
Q

what happens in stage 1 of MODS?

A
  • increase volume requirements
  • mild resp alkalosis
  • oliguria, hyperglycemia, increased insulin requirements
120
Q

what happens in stage 2 of MODS?

A

tachypnea, hypocapnia, hypoxemia, moderate liver dysfunction

121
Q

what happens in stage 3 of MODS?

A

azotemia, increased acid-base disturbance

122
Q

what happens in stage 4 of MODS?

A

vasopressor dependent
oliguria or anuria
ischemic colitis
lactic acidosis

123
Q

how is the heart affected in stage 4 of MODS?

A

systolic BP <90
MAP <70
requires pressor support

124
Q

how is the respiratory system affected in stage 4 of MODS?

A

Pa02 <250
PEEP >7.5
require mechanical ventilation

125
Q

how is the renal system affected in stage 4 of MODS?

A

UOP <0.5mL/kg/hr despite fluid resuscitation

126
Q

how is the hematologic system affected in stage 4 of MODS?

A

platelets <100,000

Pt/PTT high

127
Q

how is the metabolic system affected in stage 4 of MODS?

A

low pH

high plasma lactate

128
Q

how is the Hepatic system affected in stage 4 of MODS?

A

liver enzymes 2x normal level

129
Q

how is the CNS affected in stage 4 of MODS?

A

altered LOC

low GCS

130
Q

what is the basis for palliative care?

A

psychosocial and spiritual support

131
Q

what is the difference between dopamine and dobutamine?

A

dopamine is a pressor and dobutamine is an inotrope

132
Q

tx for CSF leak from LP?

A

blood patch

133
Q

steps of a neuro assessment?

A
  • LOC
  • Motor response and strength
  • pupillary response
  • reflexes
  • VS
  • NIH
  • GCS
134
Q

what are the brain death tests?

A
  • dolls eyes
  • cold caloric
  • corneal reflex
  • EEG
  • apnea test
135
Q

s/s of increased ICP?

A
  • decreased LOC
  • HA, N/V
  • seizure
  • ICP monitor at foramen of monroe
136
Q

how to manipulate CPP?

A
  • pressors
  • fluids
  • CSF drain
  • sedation
  • osmotic agents
  • positioning and paralytics
137
Q

what is a normal pbt02?

A

20-40mmHg

138
Q

seizure precautions?

A 
standby or blow by 02
padded rails
low bed
loose clothing
privacy
139
Q

what happens in a partial simple seizure?

A

no impairment in consciousness

alterations in motor and sensory

140
Q

what happens in partial complex seizures?

A

impaired consciousness and repetitive activities during a seizure
has a postictal state

141
Q

what can a partial complex seizure evolve into?

A

tonic-clonic seizure

142
Q

what is an absence seizure?

A

blank stare with impaired consciousness

most common in children

143
Q

what is a tonic seizure

A

sudden onset with stiffness and extension of extremities

144
Q

what is a clonic seizure?

A

rhythmic jerking motions that are either unilateral or bilateral

145
Q

what is an atonic seizure?

A

body suddenly goes limp

146
Q

what is a tonic clonic seizure?

A

also known as a Grande Mal seizure

stiffening and jerking motions

147
Q

what is a postictal state?

A

sleepy, confusion, and amnesia

148
Q

what meds can be used for seizures?

A
  • Ativan
  • Dilantin
  • phenobarbital
  • klonopin
  • lamictal
  • Depakene
  • Tegretol
149
Q

which med can cause gingival hyperplasia?

A

Dilantin

150
Q

what is the main way to test for meningitis?

A

lumbar puncture

151
Q

clinical presentation of meningitis?

A

nuchal rigidity
fever, positive kernig/brudzinski sign
petechial rash, HA

152
Q

what medication for family members exposed to meningitis?

A

ciprofloxacin

153
Q

what medication for inflammation r/t meningitis?

A

solumedrol (dexamethasone)

154
Q

tx of encephalitis?

A

admit with HA and fever

cultures are almost always negative

155
Q

what is Reyes syndrome?

A

caused by overuse of aspirin

-encephalopathy with hepatic, metabolic and neurologic failure

156
Q

what is guillan barre?

A

follows respiratory infection
ascending paralysis with a breakdown of the myelin sheath
requires longterm PT
concern in loss of respiratory drive

157
Q

what is an ischemic stroke?

A

clot form heart condition or DVT

158
Q

tx of ischemic stroke?

A

within 3 hours TPA

after 3 hours requires mechanical extraction

159
Q

how to determine if the stroke is ischemic or hemorrhagic?

A

CT w/o contrast

160
Q

what is a hemorrhagic stroke?

A

bleeding into brain tissue, ventricles, or subarachnoid space

161
Q

what is Parkinson’s?

A

progressive movement disorder from loss of cells in substantia nigra

162
Q

what are the cardinal signs of Parkinson’s?

A

requires 2/4 for dx

  • tremor
  • rigidity
  • bradykinesia
  • postural instability
163
Q

tx of Parkinson’s?

A

Levodopa

164
Q

what is bells palsy?

A

unilateral inflammation of 7th CN causing facial paralysis or weakness and ptosis with recovery in 3-5 weeks

165
Q

what is myasthenia gravis?

A

autoimmune disorder affecting the myoneural junction; causing weakness in face, throat, or body, with no effect on sensation

166
Q

how is MG diagnosed?

A

tensilon test

edrophonium is injected and if the pt has an increase in muscle strength, they have MG

167
Q

meds for MG?

A
  • mestinon
  • prostigmine
  • immunosuppressants
  • IVIG
168
Q

what is MS?

A

progressive demyelination with plaque development in the brain

169
Q

tx of MS?

A

delay the progression of the disease, and prevent acute exacerbations- tx is symptom relief

170
Q

what is trigeminal neuralgia?

A

5th cranial nerve inflammation-causing involuntary contraction of facial muscles which is triggered by stimulation

171
Q

what is a primary injury?

A

the injury at the time of impact

172
Q

what is a secondary injury?

A

complications from the primary injury caused by inflammation

173
Q

how can we prevent secondary injury?

A

steroids and anti-inflammatories

174
Q

what are the 3 types of skull fractures?

A

linear, basilar, and depressed

175
Q

what are the types of spinal cord injuries?

A

concussion, contusion, laceration, transection, and hemorrhage

176
Q

what is a complete spinal cord injury?

A

total loss of sensation and motor function

177
Q

what is the marker for a basilar skull fracture?

A

battle sign, bruising behind the ears

178
Q

what is an incomplete spinal cord injury?

A

varying degrees of sensory and motor function disruption

179
Q

what is autonomic dysreflexia?

A

life-threatening condition after a spinal cord injury caused by either a full bladder, rectum…. causing a hypertensive crisis with HA, sweating, tachycardia and HTN

180
Q

identifying features of AML?

A

blast cells >30% and is usually after a previous cancer tx; especially Hodgkins lymphoma

181
Q

identifying features of CML?

A

Philadelphia chromosome; tx is Gleevec

182
Q

identifying features of ALL?

A

Blast cells >30%, and seen in young children and the elderly

183
Q

Identifying features of CLL?

A

enlarged lymph nodes, hepatomegaly and splenomegaly with B symptoms

184
Q

Identifying features of Hodgkin Lymphoma?

A
  • Reed Sternberg cells, originate in a single node then spread to other lymph nodes.
  • Agent Orange and Epstein Barr virus are some causes
  • Highly curable but can have new cancers after, like AML.
185
Q

identifying features of Non-Hodgkin Lymphoma?

A
  • usually multiple sites
  • late diagnosis
  • can involve CNS
  • monoclonal antibodies are tx
186
Q

what is DIC?

A

dysfunction in clotting and bleeding. platelets and fibrinogen decreased. PT/PTT/d-dimer is increased

187
Q

what two illnesses makeup COPD?

A

chronic bronchitis and Emphysema

188
Q

what is chronic bronchitis?

A

-cough and sputum production at least 3 months in 2 consecutive years; associated with obesity, frequent cough, and accessory muscle use

189
Q

what is emphysema?

A

overdistended alveoli, barrel chest, and pursed-lip breathing are present. hyper resonant percussion of the chest

190
Q

what percent of URIs are viral?

A

90%

191
Q

what is OSA?

A

obstructive sleep apnea

192
Q

what is the tx for pneumonia?

A

zithromax, steroids, no cough suppressants, and encourage fluids

193
Q

What are the s/s of TB?

A

cough more than 3 weeks, weight loss, night sweats

194
Q

tx of TB?

A

long term antibiotics >6 months

195
Q

S/s of a PE?

A

dyspnea, tachycardia, chest pain, anxiety

196
Q

how fast can death occur with a PE?

A

within one hour of onset of symptoms

197
Q

tx of PE?

A

lyse clot and prevent the formation of a new clot

198
Q

what do chest tubes do?

A

promote lung expansion

199
Q

what sex has HIV and AIDS more often?

A

males; 5:1 ratio

200
Q

tx of HIV/AIDS?

A

outpatient tx generally

201
Q

how is HIV/AIDS transmitted?

A
  • blood
  • seminal fluid
  • vaginal secretions
  • breastmilk
202
Q

tx of HIV/AIDS?

A

anti-retroviral medications

203
Q

who more often has RA?

A

females 4:1 and males 2:1

204
Q

what is RA?

A

autoimmune reaction in synovial tissue causing destruction of bone and cartilage. results in joint pain, swelling, and deformity.

205
Q

what is SLE?

A

systemic lupus erythematosus

206
Q

what is the main symptom of SLE?

A

butterfly rash

207
Q

what is the goal of tx of lupus?

A

reduce acute episodes

208
Q

what is scleroderma?

A

excessive accumulation of collagen in tissues

209
Q

what is Reynaud’s syndrome?

A

decreased perfusion to tips of fingers

Final for Critical Care (3 decks)

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