Lecture Week 1 Flashcards
Which insulin can not be mixed
Lantus
Vecuronium (Vico-ronium)
paralytic
what drug are most patients at a hospital on regardless of diagnosis and why
A PPI (The Prazole family) because of the large amount of drugs they recieve and the increased stress levels put them at risk for developing a peptic ulcer.
BP values :normal/abnormal
120-129/ 80-84 =normal
130-139/85-89 = high normal
140-159/90-99 = HTN stage 1
What is normal Cardiac output and how do you calculate it?
4-8L …. HR X SV
3-6L (for ATI proctored)
what is the normal SV
50-100 mL
what is cardiac index and what is the normal range
CO adjusted for BSA. 2.5-4.5L
what factors influence SV
contractility
preload
afterload
theraputic range for digoxin. What can make digoxin toxcitiy worse
0.8-2.0
low potassium levels increase chance of toxcity
what is another name for preload and afterload
central venous pressure (CVP) and systemic venous resistance (SVR)
what is normal CVP
2-6
what is normal SVR
800-1200
what is preload a clinical indicator of
fluid VOLUME
One of the most common vasopressors
Levophed (norepinephrine)
What is ejection fraction and what is the normal range and how would you measure it
the proportion of blood that left the left ventricle (55-70%)
measured with ecko
what is clinically important to know about the frank starling law
it has an upper limit. You normally give more fluid which leads to higher preload -> more stretching -> increased contractility -> increased CO. But this eventually peaks and you start getting decreased CO as you add more fluids because your heart can no longer handle the load.
Pulmonary Artery Pressure (PAP) range
normally 9-18 calculated by taking PAS/PAD(15-30)/(10-15)
what is the best indicator of perfusion
MAP
what is your first action if PAP is high then what?
rule out pulmonary hypertension then give sildenafiil
what does high PAP indicate
alot of volume on the left side of the heart. which means we have high left ventricular end diastolic volume (LVEDV)
what does Pulmonary Artery oculsive pressure (PAOP) or pulmonary artery wedge pressure (PAWP) tell us
the volume (aka pressure) in the left ventricle. esstenially it tells us how the left ventricle is functioning.
what is the normal PAWP and how is it measured
8-12. measured by a swan guanz the tip goes into the PA.
what are positive inotropic agents
drugs that increase contractility
what are positive chronotropic agents
drugs increase HR
what is SvO2 and whats the normal range
its the amount of oxygenated blood in the venous system.It tells us the balance between oxygen delivery vs consumption. It can be compared to SaO2 to see how much oxygen is being used. Normal = 60-75%
what can you do with a swan guanz
everything expect draw ABGs because it goes into the PA which means it is venous blood.
CVP line
a line that goes into the right atrium and tells us how much fluid is in the right side of the heart.
what is a A-Line and nursing considerations
goes into the radial artery allows for continous arterial access. Must perform Allens tests prior to insertion and make sure there are absolutely no air bubbles.
overwedge pressure
shows up on the monitor like a small hill and indicates there is to much air or the end of the catheter (in a PAWP) is kinked. Must call doctor.
why do some IV bags have pressurized bags
pressure inside the bag must be over 300 in order to flow into the heart (overcome the pressure inside the heart)
phlebostatic point
ideally patient should be flat
- find the 4th intercostal space mid axillary line.
- the phlebostatic point should be at the same level as the transducer. this is called leveling.
Which electrolyte can increase contractility
Hypercalcemia
what happens if transducer is above the phleobostatic point? below?
above you get a low reading and below you get a high reading
what factors increase afterload
- high SVR
- aortic stenosis
- MI/Cardiomyopathy
- polycythemia(b/c increased blood viscosity)
what are the factors that decrease afterload
- decreased volume
- septic shock (warm phase)
- end stage cirrhosis
- vasodilators
what does the right ventriclular afterload measure and whats the normal range
indirectly assess pulmonary vascular resistance(PVR)
120-200
what drugs can be used to treat increased afterload
1.vasodilators
-nitroprusside,nitroglycerin,
hydralazine
2.ace inhibitors
-captopril,enalapril
3.Calcium channel blockers
-diltiazem, nifedipine
nicardipine
