Lecture Week 1

Question 1

Which insulin can not be mixed

Answer 1

Lantus

Question 2

Vecuronium (Vico-ronium)

Answer 2

paralytic

Question 3

what drug are most patients at a hospital on regardless of diagnosis and why

Answer 3

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.

Question 4

BP values :normal/abnormal

Answer 4

120-129/ 80-84 =normal
130-139/85-89 = high normal
140-159/90-99 = HTN stage 1

Question 5

What is normal Cardiac output and how do you calculate it?

Answer 5

4-8L …. HR X SV

3-6L (for ATI proctored)

Question 6

what is the normal SV

Answer 6

50-100 mL

Question 7

what is cardiac index and what is the normal range

Answer 7

CO adjusted for BSA. 2.5-4.5L

Question 8

what factors influence SV

Answer 8

contractility
preload
afterload

Question 9

theraputic range for digoxin. What can make digoxin toxcitiy worse

Answer 9

0.8-2.0

low potassium levels increase chance of toxcity

Question 10

what is another name for preload and afterload

Answer 10

central venous pressure (CVP) and systemic venous resistance (SVR)

Question 11

what is normal CVP

Answer 11

2-6

Question 12

what is normal SVR

Answer 12

800-1200

Question 13

what is preload a clinical indicator of

Answer 13

fluid VOLUME

Question 14

One of the most common vasopressors

Answer 14

Levophed (norepinephrine)

Question 15

What is ejection fraction and what is the normal range and how would you measure it

Answer 15

the proportion of blood that left the left ventricle (55-70%)
measured with ecko

Question 16

what is clinically important to know about the frank starling law

Answer 16

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.

Question 17

Pulmonary Artery Pressure (PAP) range

Answer 17

normally 9-18 calculated by taking PAS/PAD(15-30)/(10-15)

Question 18

what is the best indicator of perfusion

Answer 18

MAP

Question 19

what is your first action if PAP is high then what?

Answer 19

rule out pulmonary hypertension then give sildenafiil

Question 20

what does high PAP indicate

Answer 20

alot of volume on the left side of the heart. which means we have high left ventricular end diastolic volume (LVEDV)

Question 21

what does Pulmonary Artery oculsive pressure (PAOP) or pulmonary artery wedge pressure (PAWP) tell us

Answer 21

the volume (aka pressure) in the left ventricle. esstenially it tells us how the left ventricle is functioning.

Question 22

what is the normal PAWP and how is it measured

Answer 22

8-12. measured by a swan guanz the tip goes into the PA.

Question 23

what are positive inotropic agents

Answer 23

drugs that increase contractility

Question 24

what are positive chronotropic agents

Answer 24

drugs increase HR

Question 25

what is SvO2 and whats the normal range

Answer 25

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%

Question 26

what can you do with a swan guanz

Answer 26

everything expect draw ABGs because it goes into the PA which means it is venous blood.

Question 27

CVP line

Answer 27

a line that goes into the right atrium and tells us how much fluid is in the right side of the heart.

Question 28

what is a A-Line and nursing considerations

Answer 28

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.

Question 29

overwedge pressure

Answer 29

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.

Question 30

why do some IV bags have pressurized bags

Answer 30

pressure inside the bag must be over 300 in order to flow into the heart (overcome the pressure inside the heart)

Question 31

phlebostatic point

Answer 31

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.

Question 32

Which electrolyte can increase contractility

Answer 32

Hypercalcemia

Question 33

what happens if transducer is above the phleobostatic point? below?

Answer 33

above you get a low reading and below you get a high reading

Question 34

what factors increase afterload

Answer 34

1. high SVR 2. aortic stenosis 3. MI/Cardiomyopathy 4. polycythemia(b/c increased blood viscosity)

Question 35

what are the factors that decrease afterload

Answer 35

1. decreased volume 2. septic shock (warm phase) 3. end stage cirrhosis 4. vasodilators

Question 36

what does the right ventriclular afterload measure and whats the normal range

Answer 36

indirectly assess pulmonary vascular resistance(PVR) | 120-200

Question 37

what drugs can be used to treat increased afterload

Answer 37

1.vasodilators -nitroprusside,nitroglycerin, hydralazine 2.ace inhibitors -captopril,enalapril 3.Calcium channel blockers -diltiazem, nifedipine nicardipine