MAIN Flashcards
For the test, brutha!
1
Q
♥ Flow and Anatomy
A
Superior/Inferior Vena Cava → R Atrium → Tricuspid Valve → R Ventricle → Pulmonary Valve → Pulmonary Artery → Lungs → Pulmonary Vein → L Atrium → Mitral Valve → L Ventricle → Aortic Valve → Aorta
2
Q
5 Chest Pain (Coronary Artery Disease) Syndromes
A
Angina
Extertional Angina
Prinzmetal’s Angina or Variant Angina
Stable Angina
Unstable Angina
3
Q
Angina 📃
A
chest pain r/t
myocardial anoxia
4
Q
Extertional Angina 📃
& indicative of…?
A
d/t ↑ myocardial O2 demands (4Es: exertion, eating, emotions, exposure [to cold temps]), indicative of atherosclerosis
5
Q
Prinzmetal’s Angina or Variant Angina 📃
A
at rest, sleep, or w/o evidence provocation, indicative of coronary vasospasm
6
Q
Stable Angina 📃
A
exertional angina but relieved w/ rest
7
Q
Unstable Angina 📃
A
within 2 months recent onset that severely limits activity and newly occurs at rest
8
Q
Risk Factors CAD (7)
A
Smoking
Diabetes
HTN
↑ Cholesterol
Obesity
Sedentary Lifestyle
↓ Serum Folate
9
Q
Chest Pain Determinant Algorhythm
A
Non-Cardiac = Panic, anxiety, drug use, GI
Cardiac= Ischemic [angina] v. Non-Ischemic [pericarditis, tamponade, etc.]
Ischemic = Unstable [partial occulsion V. completely blocked = MI] v. Stable
10
Q
Acute Coronary Syndrome 📃
A
↓ blood supply to ♥ d/t CAD
11
Q
3 Keys to Dx Unstable Angina
A
S/S
12 Lead EKG
Blood Work (Cardiac Markers)
12
Q
Fat buildup & Acute Coronary Syndrome Pathophys.
A
Clinically silent until obstructive r/in exertional angina. When plaque fissues r/in thrombus, MI
13
Q
5 key S/S: ♥ Attack
A
Pain: back neck jaw, LUE
Chest discomfort
SOB, dyspnea → weakness
N/V + indigestion
14
Q
♥ Attack Chemical Marker: (CK) 📃, onset high, WDL for ♀/♂
Type 1, 2, 3 purpose
A
Creatine Kinase (2-MB specifically), ↑ w/ ♥ muscle damage
↑ 3-6 hrs after MI, peak 12-24hrs, resets in 2-3 days
♂ 60 -170 U/L
♀ 40 - 140 U/L
CK-1 BB is for brain
CK-3 MM is for muscle tissue
15
Q
♥ Attack Chemical Marker: Troponin 📃, onset high, WDL
A
cTnT and cTnI regulate ♥ force/speed contraction
leak from ♥ during ischemia
↑ 3-5 hrs after MI
cTn T peaks 4-6hrs, cTn I peaks 14-18hrs,
cTn T reset 21 days, cTn I reset 5-7 days
cTn T WDL < 0.1 mcg/L / cTn I WDL <3.1 mcg/L
16
Q
MI Immediate 3 Tx (Time is Muscle!)
A
ASA 325 mg PO qD
P2Y12 (Plavix, Brilinta, Effient)
Hep gtt or Lovenox
16
Q
Effects of Ischemia, Injury, Infarction on EKG
A
Ischemia = ST ↓ or inversion
Injury = ST ↑ (w/ 2 cont. leads, > 1mm)
Infarction = ▲ Q waves
17
Q
ST Elevation in Leads, Artery Determinant
A
II, III, aVF = R Inferior Coronary Artery
I, aVL, V5 = Lateral Circumflex
(V1, V2, Anterior Septal), V3, V4 = L Anterior Descending
aVR= L main
Memorize the worksheet(?)
18
Q
3 Long-Term TX for MI
A
Anti-thrombin/platelet
Nitroglycerin for pain
Reperfusion (for ↑ ST) - Thrombolytics, Percutaneous Coronary Intervention, and/or Coronary Artery Bypass (CABG)
19
Q
Thrombolytic Contraindications (6)
A
Active Bleeding
Aortic Dissection
Cerebral Neoplasm
Cerebral Vascular Disease
HX intracranial hemorrhage
Intracranial/spinal sx or trauma w/in 2 months
20
Q
Pre(7)/Post(7) MI Stent RN Care
A
Pre: ✔️ BUN, Creatinine, Anticoags, Lytes, Dye Allergy, Hydration, Limb Circulation
Post: ✔️ Groin site bleed, Distal circulation, Dysrhythmias, Coronary Artery Spasm, Ischemia, Stroke, Discharge edu
21
Q
♥ PCI Complications (4)
A
Bleeding r/t hematoma
Retroperitoneal bleed
ST ▲ r/t in-stent thrombosis
Pseudoaneursyms
22
Q
🥬(CABG)📃 and 🎯
A
Coronary Artery Bypass
Revascularlize ♥ w/ transplanted vessels
23
Q
🥬 Post-Op RN 👀 (7)
A
Pain
Infection
Volume Overload
Stroke Dysrhythmias
MI
Impaired gas exchange
Impaired work of breathing
24
S/S ♥ Attack (MI) (10)
DARTH VADER
**D**eath
**A**rrythmia
**R**upture (ventricular wall, muscles)
**T**amponade
**♥** Failure
**V**alve Disease
**A**neurysm of Ventricle
**D**ressler's Syndrome - inflammation pericardium
**E**mbolism (Mural Thrombus)
**R**ecurrence/Mitral Regurg
25
Pericarditis 📃and Key S/S (3)
📃 Swelling of sac around heart
🔍 **diffuse** ↑ST, ↑CP w/ supine, +friction rub
26
Myocarditis 📃, 🔍, & C/B
📃Inflammation of ♥ muscle (myocaridum)
🔍 ↓ pump & dysrhythmias
C/B: viral infections
27
Endocarditis 📃, C/B, r/in, & TX
📃infection of inner lining chambers, valves
C/B: bacteria in blood
r/in: valve damage
💊: ABX or SX
28
Cardiac Tamponade 📃
↑%C/B
r/in
S/S (3 + 2)
fluid in pericardial space
Pericarditis
↓ cardiac output
muffled ♥ , ↓BP, +JVD (Becks Triad) + Bibasilar rales, **fever**
29
Cardiac Tamponade ▲ to EKG (2) + BP
Diffuse ↑ST
▲ QRS (electrical alternans)
[unresolved by MI tx]
↓ 10mmHg SBP w/ inspiration
30
Cardiac Tamponade 2 Diagnostics and TX
Enlarged ♥ w/ CXR, TransEsophag/Thoraco Echo (TEE/TTE)
Cardiocentesis
31
♥ Failure (HF) 📃 & r/in
inability of ♥ to pump/meet metabolic demands
↓ cardiac function and output
r/in activation neurohormonal systems to ↑ pump
32
Neurohormonal System activation 3 players and r/in (4)
Adrenergic (Sympathetic Nervous System)
Renin-Angiotensin
Hypothyalmic Neurohypophyseal
↑ HR, ↑ Contractility, ↑ Vasoconstriction ↑ Na/H2O Retention
33
Adrenergic (SNS) role in HF
in reaction to ↓ BP/CO
**Nore/epinephrine** release
**Alpha1** ↑ Vasoconstriction
**Beta1** release for ↑ HR/Contraction
34
Renin-Angiotensin (Kidney) role in HF
in reaction to ↓ BP/CO
↓ **GFR w/ Renin, Angiotensin I & II, Aldosterone** r/in vasoconscriction & **Aldosterone** r/in Na/H2O retention
35
Chronic results of HF (3)
Release of Natriuretic Peptides (AtrialNP/BrainNP) r/in diuresis & vasodilation (not enough to counter Neurohormonal System
Release of Cytokines
♥ Hypertrophy/remodeling
36
Hypothalmic - Neurohypophyseal role in HF
in reaction to ↓ BP
**Vasopressin** Release from posterior pituitary r/in vasoconstriction & Na/H2O retention
37
HF Left vs Right
L = pulmonary congestion, S3, frothy-pink sputum
R = JVD, Hepatojugular reflex, Edema
38
7 Goals of HF Treatment
**Prevent/Reverse Cause**,
↑ perfusion
🛑 Spiral of Compensatory Mechanisms
↓ ♥ demands
↓ ectopy,
↑ electrical stability
↑ quality of life
39
HF: Meds to 🛑Neurohormornal Spiral (10)
▶️**Loop Diuretics** (Lasix, Bumex) ↓ volume
▶️**Thiazides** (Metalozone [Zaroxylyn]) ↓ Na output in Kidney
▶️**Aldostrone Antagonist** (Spironalactone [Aldactone], Eplerenone [Inspira]) 👀 ↑ K+ (must have Creatinine < 2.5 & K+ < 5)
▶️**Beta Blockers** (**olols** Metopro, Bisorpo, & Carvedil) 👀 ↓BP, **bronchospams w/ asthma/COPD**, ↓ sex drive in ♂
▶️**ACE Inhibitors** (**prils**) 🌟 👀 ↓BP, edema, **dry hacking cough**
▶️**Angiotensin 2 Receptor Blockers** (ARBs) (**sartans**) if can't tolerate ACE inhibs 👀 ▲ taste
▶️**Hydralazine + Nitrates** if can't tol ACE/ARBs
▶️**Digitalis** (Digo**xin**, Lano**xin**) ↑ contraction, 👀 Dig level >2.5 = toxic, WDL = 0.8 - 2.0 mg/dL. Amio/Diltia = ↑ digi, Reglan, Rifampicin = ↓ digi
▶️**Inotropes** (Dobutamine, Milrinone), ↑ contractility/HR **only for shock/poor perfusion**
▶️**B-Type Natriuretic Peptide** (Nesiritide/Natrecor) ↑ CO/GFR 👀 ↓BP, skews BNP results in labs (artificially ↑)
40
HF: Meds to 🛑Neurohormornal Spiral (Honorable 3)
▶️**Angiotensin Receptor/Neprilysin Inhib** (ARNI) (Sacubitril + Valsartan together)
▶️**Sodium-glucose-co-transporter 2 inhibs** (SGLT2-I)
▶️**Ivabradine** (Corlanor) ↓ HR
41
HF: Surgical Interventions (2)
Intra-Aortic Balloon Pump (IABP)
Ventricular Assist Device (VAD)
42
HF: 50% deaths, 2 key interventions
**50% deaths r/t HF are c/b dysrhythmia**
Antidysrhythmics (Amio, Bblockers, Digi) and Pacing
43
Cardiogenic Shock 📃and 3 RN expectations
**↓ ability of ♥ to pump effectively r/in ↓ perfusion**
-Prepare for ICU Xfer (vent, vasoactive meds, monitor hemodynamics, IABP?)
-Correct Acidosis (NaHCO3, lyte placement)
-VAD
44
Cardio**myopathy** 3 Types
Dilated (Congestive)
Hypertrophic
Restrictive
45
Dilated Cardiomyopathy 📃 & C/B (3)
**Damage r/in thinning of walls & enlarged atria/ventricles**
↑ Renin-Angiotensin response ↓ pre/after-load/CO
C/B: Ischemic, Non-ischemic, Stress-Induced (Takotsubo Octopus Trap)
46
Hypertrophic Cardiomyopathy 📃 & C/B (2)
♥ hypertrophy → ↑ difficulty ventricle size/pump → ↓pre-load ↓CO
C/B: Idiopathic & Hereditary (60% cases)
47
Restrictive Cardiomyopathy 📃 & S/S (2)
**least common form cardiomyopathy**
↑ Vent fibroses → Stiff ventricles → ↓ preload ↓ CO
+S3/S4, ↑ Venous pressure
48
HTNsive Crisis vs. Urgency vs. Emergency 📃📃TX📃TX
Crisis: DBP > 120
Urgency: Crisis **W/O** organ damage
(TX: BP w/in 24-48hrs)
Emergency: Crisis **+**acute/ongoing organ damage
(TX: MAP ↓ 25% ASAP/w/in 2 hrs)
49
Aortic Aneurysms: Ruptured 📃(#1/#2 C/B) vs. Dissecting 📃 (acute vs. chronic)
**Ruptured:** dilation of arterial wall (C/B #1 aging, #2 HTN)
**Dissecting:** aortic wall separation (acute if dx w/in 14 days, chronic if dx >2 weeks)
50
Dissecting Aortic Aneurysm: **Standford Classification** Type A (% cases) vs. Type B (% cases)
A: ascending + descending aorta (↑% younger pt, 2/3 of dissections)
B: only descending (↑% older pts)
51
Dissecting Aortic Aneurysm: **DeBakey Classification** Type I, II, III
Type I: Ascending + Descending
Type II: Ascending
Type III: Descending
52
Cardiac Conduction System Order
SA Node → AV Node → Bundle of His → Bundle Branches → Purkinje Network
53
A Flutter: Key Appearance
**consistent sawtoothed** in between QRS
54
A Fib: Key Appearance
Controlled vs. Uncontrolled
**irregular wavy deflections** in between QRS
Controlled < 100 BPM < Uncontrolled
55
♥ Block 1st vs. 2nd (Type I & II) vs. 3rd
**1st:** P > 0.28 (R is far from P, 1st degree!)
**2nd Type 1:** Longer Longer Longer drop, Wenkebach (P-R ++ until no QRS)
**2nd Type 2:** If P doesn't get through, Type 2 (P=R, still drop QRS)
**3rd:** P & Q's don't agree (no correlation)
56
Supraventricular Tachycardia TX (6)
Vagal Maneuvers
IV Adenosine
Verapamil
Beta-Blockers
Synchronize Cardioversion
Radio-Frequency Catheter Ablation
57
V Tach (pulse (3) v no pulse)) TX
**Stable w/ Pulse:**
if monomorphic: Procainamide, Sotalol, Amiodarone, Lidocane
if polymorphic:
[normal QT] BBlockers, Lidocaine, Amiodarone
[long QT] Mg, Pacing, Isoproterenol, Phenytoin, Lidocaine
**Unstable w/ or w/o pulse:** immediate ⚡
58
Bradycardia 2 TX
**Atropine 0.5mg IV** (↑ HR by ↑ conduction, ineffective against 3rd degree b/c AV no comms w/ V)
**Pacing** (external, temp tranvenous/epicardial, or permanent)
59
Long QT 📃 and C/B (3[3, 6, 1])
**Lyte Imba:** ↓ Mg, K, Ca
**Antiarrhythmic Drugs:**
Procainamide
Sotalol
Amiodarone
Dofetilide
Ibutilide
Disopyramide
**New Onset Brady**
60
Torsades de Pointes 7 Med Inducers and Key TX
Tricyclic Antidepressants
Erythromycin
Clarithromycin
Inapsine
Thorazine
Cocaine
Haldol
**Mag replacement**
61
Brady/Tachy effect on QT Interval
Lengthens/Shortens
62
QTc Interval Formula
QT
____
RR interval
63
Normal ECG Intervals
PR, QRS, ST, QT, & RR
PR= 0.12-0.2 ms
QRS= 0.08-0.1 ms
ST= 0.08-0.12 ms
QT= <.42 ms
RR = 0.6-1.2 second
64
Acute Respiratory Failure 📃 & 3(+3 ea) Physiologies
**failure to ventilate & oxygenate**
Alveloar Hypoventilation: drugs, head injury, muscle weakness
Ventilation-Perfusion Mismatch: COPD, interstitial lung dz, PE
Diffusion Impairment: cardiac output, H/H, ↓ O2 consumption r/t sepsis or toxins
65
Restrictive vs. Obstructive Lung Dz
Restrictive: fill air (ie: PNA, scarred alveloi)
Obstructive: expell air (ie. tightened trachea)
66
Restrictive 6 Lung Dz
Acute Injury
Inflammatory
Bacterial infx
Occupational
Sarcoidosis
Atelectasi
67
Obstructive 3 Lung Dz
Chronic Bronchitis
Emphysema
Asthma
68
Chronic Bronchitis 4 S/S & Key HX
Blue Bloater (hypoxic, edematous)
Recurrent Cough
↑ Hgb
♥ Enlargement
Smoking
69
Emphysema 5 S/S
Pink Puffer
Barrel Chested
Thin appearance
Exertional Dyspnea
Hyperresonance w/ chest percussion
70
COPD 5 TX
O2
Bronchodilators
Inhaled Corticosteroids
Sx
Education, 🛑 smoking
71
Asthma 3 TX, 5 Med TX
Remove irritant
O2
Hydration, Humidification
Pharm: bronchodilators, corticosteroids, anticholinergics, sedatives, muscle relaxants
72
73
Obstructive Sleep Apnea 📃 and 6 TX
Apnea > 15 seconds w/ sleep
Wt loss
HOB > 30 degrees
🛑 EtOH/sedatives before bed
Oral/Dental appliance
CPAP/BiPAP
Sx
74
Pulmonary Emboli 4 Causes & Virchow's Triad
Fat, Air, Amniotic Fluid, Thomboembolic (90% events)
Venous Stasis, Hypercoagulability, Vascular Wall Damage
75
Pneumo/Hemo Thoraxes 📃 (4)
1 Key DX
Tension Pneumo = air in pleural space can't escape r/in tension
Simple Pneumo = air in pleural space on inspiration
Hemo thorax = blood in pleural space
Hemo Pneumothorax both
Tracheal deviation
76
Hemo/Pneumothorax 4 TX
O2 deliver/intubation
Lay Trendelenberg L side (if air embolism)
Needle decompress
CT placement (low for blood, high for air) **for test purposes NEVER milk tube**
77
Pleural Effusion 📃, 5 C/B, TX Plan
**↑ fluid around lung**
Infections
Autoimmune Conditions
PE
leakage other organs (↑% CHF)
Cancer
Same as pnemo/thorax
78
Pulmonary HTN 📃 and r/in...
↑ pressure in pulmonary arteries/veins r/t block, narrow, or destruction.
r/in pressure on ♥ r/in cardiac issues
79
Pulmonary Fibrosis 📃 and TX
Scarring/thickening of alveoli
No treatment :(
80
Hypoventilation 5 meds + key TX
Alcohol, Bartituates, Sedatives, Opiods, Benzos
Narcan
81
**Acid/Base WDL Values**
pH, PaO2, PaCO2, HCO3, SaO2, Base Excess
(+ diff ABG/VBG)
ABG / VBG
pH 7.35-7.45 / 7.31-7.41
PaO2 80-100 mmHg / 30-40
PaCO2 35-45 mmHg / 41-51
HCO3 22-26 mEq / 23 - 29
SaO2 >95% / 75%
Base Excess -2 to +2 / ←same
82
Acidosis/Alkalosis Compensation chart
Compensated: pH WDL, PaCO2 **AND** HCO3 = *NOT WDL*
Partially Compensated: *NOTHING WDL*
Uncompensated: pH *!WDL*, PaCO2 **OR** HCO3 = WDL
83
pH, PaCO2, HCO2 direction and correlating acid/alkalosis
Acidosis ← pH 7.35 - 7.45 → Alkalosis
Alkalosis ← PaCO2 35 – 45 mmHg → Acidosis
Acidosis ← HCO3 22 – 26 mEq/L → Alkalosis
84
4 Steps to determine ABG Dx
1. if pH WDL/!WDL = compensated/uncompensated
2. if pH ↓/↑ = acidosis/alkalosis
3. if CO2 ↓/↑ - alkalosis/acidosis (respiratory)
4. HCO3 ↓/↑ acidosis/alkalosis (metabolic)
Whoever matches pH (resp/metab) determines name (can be BOTH)
85
Respiratory acidosis ABGs & 3 S/S
↓ pH ↑ CO2
respiratory depression
↓ ventilation
↓ diffusion
86
Respiratory Alkalosis ABGs & S/S
↑ pH ↓ CO2
↑ ventilation
87
Metabolic Acidosis ABGs & 4 S/S
↓ pH ↓ HCO3
HypoTN
▲ LoC
Muscle twitching (r/t Lyte imba)
Kussmaul Respirations (rapid, deep breathing in attempt to ↓ CO2 to balance)
88
Metabolic Alkalosis ABGs & 4 S/S
↑ pH ↑ HCO3
▲ LoC
Muscle twitching (Lyte imba)
Dysrhythmias
Severe vomitting
89
Hematopoeitic WDLs
WBC
RBC
Hgb/Hct
Platelets
WBC: 5,000-10,000/mcL
RBC: 4.5 - 5.5 million/mcL
Hgb 12-18 g/dL
Hct 37-50%
150K-400K/mcL
90
Anemia 📃
↓ RBCs r/in ↓ O2 Delivery
91
Hemostasis Cascade
Injury → RBCs/Platelets form a clot → fibrin stabilizes
92
Coagulation Cascade
Intrinsic v. Extrinsic
**Intrinsic:** Injury r/in Sub-Endothelial Collagen Release→ XII → XI → IX (+ VIII) → X (which + V converts Prothrombin to Thrombin)
**Extrinsic:** Injury r/in Tissue Factor Release → VII (+ X r/in Prothrombin to Thrombin)
Thrombin converts Fibrinogen to Fibrin which clots shiet (w/ XIII)
93
Disseminated Intravascular Coag (DIC) 📃 and 5 TX
**↑ clotting → ↑ platelet consumption → uncontrollable bleeding**
Transfusions: Platelets, FFP, Cryoprecepitate, Fibrinogen
Heparin to ↓ clotting
94
Heparin Induced Thrombocytopenia (HIT) 📃 and 3 TX
Allergy to heparin r/in 50% drop platelets
🛑all Heparin, admin non-Heparin anti-coag, admin platelets IF CRITICALLY LOW
95
4 **VENOUS** Anti-Coag Options, Labs, and Reversal Agents.
+PT/INR & aPTT WDLs
**Heparin** / aPTT, AntiXa / Protamine Sulfate
**Vitamin K Antagonist (Warfarin)** / INR / Vit K, FFP
**Factor Xa Inhib (Xarelto/Eliquis)** / AntiXa / Andexxa, PCC
**Direct Thrombin Inhibitor (Pradaxa/Lepirudin)** / PT, aPTT / Praxbind, PCC
PT/INR = 11-13 sec
aPTT = 25-26 sec
96
4 **ARTERIAL** Anti-Coags
Aspirin
Non-Aspirin NSAIDS
Adenosine Diphosphate Receptor Antagonists (Plavix [Clopidogrel] and Prasugel [Efficent])
97
4 Autoimmune Disorders and attack targets
Lupus = attacks tissue/organs
Guillian Barre = attacks peripheral nerves
Amyotrophic lateral sclerosis (ALS) = attacks brain spinal cord
Multiple Sclerosis = attacks myelin sheath of spinal cord
98
Autoimmune Dz 4 TX + 3 RN considerations
Steroids
Monoclonal Antibodies
Chemo
Antirejection Meds
↑ handwashing ↓ tubes/lines ↑ education
99
2 Oncologic Emergencies w/ Autoimmune Dz
**Tumor Lysis Syndrome:** destroyed tumor cells ↑ lytes r/in AKI, TX with hydration, allopurinol, poss HD
**Pericardial Effusion**
100
Cirrhosis 📃 r/in 4 effects & 3 Types
**fibrotic bands distort liver architecture & functional ability**
↓ fluid regulation, ↓ waste metabolization, ↓ coag control, ↓ nutrition control
Alcohol: Laennec's, Fatty
Post Necrotic: Toxic, Nodular, Post Hepatic
Biliary: Cholangitic, Obstructive
101
Hepatitis 📃, Primary and Secondary C/B & Route Transmissions (ABC) and 3 (1 key) S/S
inflammation of liver cells
Primarily Viral
Secondary Hepatotoxins (Herbs, Vit supplements, Green Tea Extract)
Hep A - Fecal/Oral
Hep B - Blood/Sex
Hep C - Blood
fever, fatigue, **dark tea urine** (**regardless of hydration**)
101
4 S/S and 7 TX Common Liver Dysfunction: (Hepatic 📃 and Malnutrition 📃)
HEPATIC: **b/c liver unable to detox, ↑ ammonia**
▲ LoC
Agitation
Asterixis: flap like tremor of hands
Apraxia: unable to perform acts w/ purpose
MALNUTRITION **b/c liver unable to manage carbs, protein, fat metab (nutrition) → ↓ energy / weight**
Parenteral Nutrition
↓ Protein Intake ↓ Hepatotoxins ↓ Fluids
Lactulose and Neomycin
Safe Environment
102
Portal HTN 📃, 3 S/S, 4 TX, NEVER...?
↑ Liver Portal Vein pressure r/in varicies to esophagus, stomach, & rectal vault
Shunting, Clipping, Ligation
BP meds to ↓ HTN
**NEVER suction as may hemmorage esoPHAGus ykwis**
103
Hepatorenal Syndrome 📃
4 TX
pre-RENAL failure r/t liver failure.
↓ fluids ↓ nephrotoxins
↑ renal perfusion ↑ replacement therapies
104
Ascites 📃 4 C/B and 4 TX
Fluid accumulation in peritoneal space r/t...
↓ albumin production ↓ oncotic pressure ↑ hepatic lymph production ↑ capillary permeability
↓ fluids and Na +diuretics +Paracentesis
105
Liver Kuppfer Cells Purpose
Type of problem bacteria
clean bacteria from blood
Gram negative
105
Pancreas 2 Functions and what regulates it?
**Endocrine:** synthesis of Glycogen, Insulin, Gastrin
**Exocrine:** secretes (which digest) Trypsin [protein], Amylase [carbohydrates], Lipase [fat]
Regulated by Parasympathetic Nervous System, Gastrin, & Hormones
106
Causes of Acute Pancreatitis (GET SMASHED!!!)
**G**allstones
**E**thanol
**T**rauma
**S**teroids
**M**umps
**A**utoimmune
**S**corpion Bite
**H**yperLipidemia
**E**RCP
**D**rugs
107
Pancreatitis 4 Key S/S + 2 S/S if Necrotizing
**Steatorrhea:** bulky, pale, foul-smelling stools
Low grade **fever**
hypoactive bowel sounds
hypovolemic shock
**Cullens Sign**: blue discoloration to umbilical
**Grey Turner's Sign**: bluish discoloration to flanks
108
Anticipated 5 labs w/ Pancreatitis
↑ WBC
↑ Amylase (WDL = 27-131)
↑ Lipase (WDL = 20-180)
↑ Glycemia
HypoCalcemia (WDL = 8.5-10.5) b/c auto-digestion of fats binds to Ca+
109
Pancreatitis 4 Key TX
Pain ctrl
Rest pancreas w/ NPO
Fluid, nutrition support
Possible Sx
110
Upper GIB vs. Lower GIB Threat level and 4/6 C/B
**Life threatening vs. Typically Not**
**UGIB** = ulcers (50%), gastr/esophagitis, varices, Mallory-Weiss Syndrome (tear in lower esophagus)
**LGIB**= Hemmorhoids, Inflammatory Bowel Dz (Ulceratis colitis/Crohn's), Diverticulitis, Angiodysplasia, CA, Bowel Infarction
111
112
Upper GIB 6 S/S
Hematemesis
Melena
Peptic Ulcer Disease
Distended/tender abd
↑ bowel sounds
↓ volemia
113
Upper GIB 5 TX
Fluid replacement
Blood replacement
Somatostatin/Octreodide (PPI)
NG Decompression/Lavage
Endoscopic therapy / Sx
114
Upper GIB Anticipated Labs 4
↓ HH
↑ Hemoconcentration
↑ LFTs = trying to produce coags
↑ or ↓ Coags/Platelets r/in stage of bleeding
115
Bowel Infarction 📃 and 4 Key TX
death of part of intestine r/t blood supply cut off
Anticoags to ↑ perfusion
Embolic Lysis for Thrombosis
Angiography to visualize
Sx to remove
116
4 S/S Diffs between Small and Large Bowel Obstruction
**Small v. Large**
Acute sudden pain / slow progression to severe
↑ N/V / ↓ N/V
↑ Bowel sounds & output / ↓ Bowel Sounds & output
↓ Distention / ↑ Distention
117
Bowel Obstruction TX (same as... +2)
Same as Pancreatitis+
Decompress w/ NGT
Sx
118
Bowel Sx poss complication 4 S/S & 4 TX
**Anastomotic Leak** = when connection fails and contents leak
Abd pain, fever, n/v, diarrhea **OR** constipation
Monitor nutrition, weight, labs + low fiber diet
119
Bowel Perforation/Peritonitis 📃
S/S are similar to... +3
3 TX
Gastric contents leak into peritoneal cavity
sepsis + sudden severe pain, rigid abd/rebound tenderness, ↓ bowel sounds
Sx to repair/ clean, ABX, Fluids
120
Diabetic Gastroparesis 📃
Irritable Bowel Syndrome 📃
Ileus 📃
- (in DM1/2 which damages VAGUS nerve) stomach takes too long to empty r/in blockages
- Common to colon r/in cramps, abd pain, bloating, tx with long term ROIDS
- ↓ intestinal movement r/in blockages
121
Glasgow Coma Scale: Eye Responses 1 - 4
4 - Spontaneous, blinking @ baseline
3 - to verbal command
2 - to pain
1 - none
122
Glasgow Coma Scale: Verbal Responses 1 - 5
5 - oriented
4 - answers questions but confused
3 - words discernible but innapropriate responses
2 - incomprehensible
1 - none
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Glasgow Coma Scale: Motor Responses 1 - 6
6 - obeys movement commands
5 - purposeful movement to pain
4 - withdraws from pain
3 - flexion, decorticate postgure
2 - extensor, decerebrate posture
1 - none
124
Stroke: 🕒 is 🧠
Purpose of goals are to...
Stroke 📃vs. TIA 📃
**Save penumbra** (area around attack) which can recover
**Stroke** - ↓ cerebrovascular function r/in permanently impaired CNS
**Transient Ischemic Attack** (mini-Stroke) - lasts for minutes/hrs but no detectable dysfunction afterwards
125
Ischemic Strokes 2 Stats + 5 Origins
**87% of ALL strokes, 5th cause of death/disability**
Thrombotic - clot starts in **brain**
Atherosclerosis - **plaque**
Cardioembolic - clot from **♥**
Embolic - clot from **elsewhere in body**
Athero-thrombotic - clot **from** plaque
126
S/S Stroke BEFAST
**B**alance ▲
**E**yes - ▲ vision
**F**ace - weakness/asymmetry
**A**rms - weakness/asymmetry
**S**peech - difficulty, slurred
**T**ime - last time normal?
w/ transient ischemic - rarely loss of consciousness
126
127
Stroke 2 TX and Timings/Limits
**Activase** (Alteplase or t-PA) to breakdown clot
if < 4.5 hrs can give
> 24 hrs go embo/thrombectomy
NO thinners 24 hrs post t-PA
**Permissive HTN** to perfuse/break clots (keep SBP < 180) lest risk conversion aneurysm
128
LEFT sided ischemic stroke 8 S/S
R Hemiparesis
R Sided Sensory Loss
R Honomyous Hemianopsia (R visual field of BOTH eyes impaired)
Aphasia - !speak
Alexia - !read
Acaculia - !math
Agraphia - !write
▲ mood/behaviors
129
RIGHT sided ischemic stroke 7 S/S
L Hemiparesis
L Sided Sensory loss
L Honomyous Hemianopsia (L visual field of BOTH eyes impaired)
L Sided Neglect - !perceive L side of body
Dysarthria - diffculty speaking r/t ↓ muscle control
Anosognosia - ↓ insight own condition
↓ Awareness
130
Hemorrhagic Stroke 3 Types, #1 Cause
Epidural, Subdural, Intracerebral
HTN
131
Aneurysm 📃
weak bulging spot of cerbral atery prone to rupturing r/in intracerebral stroke
131
Hemorrhagic Stroke 3 Key S/S (in addition to normal stroke s/s)?
**worst HA in my LIFE**
**total loss of consciousness** r/t ↑ICP
**↓ Natremia** r/t blood in brain
132
Arteriovenous Malformation Stroke 📃
congential abnormal linkage of artery/vein in brain r/in blood passing too quickly, ↓ perfusion and can burst
133
Hemorrhagic Stroke 4 TX
Unlike reg stroke, **concern for active bleed**
↓ BP ↑ Coags, poss Sx, Anti-seizure Meds
134
Encephalopathy 📃 + Direct v. Indirect C/B (3ea) + 3 S/S + 3 TX
**Generalized mental status dysfunction**
**Direct:** injury, ↓ blood flow, electrical ▲
**Indirect:** Toxins (hepato/renal), EtoH (Wernickes, ↓ VitB1), metabolic ▲
S/S: ▲ LoC, Renal, Liver s/s
ABC, Seizure Precautions, Tx underlying cause
135
Seizures 📃 + 2 Type + 2 Subtype + unique C/B (3)
**Uncontrolled discharge of neurons**
Provoked / Unprovoked
**Focal** (simple partial) w/ retained awareness
**Generalized Tonic-Clonic** (grand mal, major motor, convulsions) are most common
**C/B anything**, but ↑% w/ Theophylline, Tricyclic Antidepressants, high fever in children
136
Epilepsy 📃
2+ unprovoked seizures > 24 hrs apart (after 1, 60% another w/in 10 yrs)
137
Status Epilepticus 📃
Seizure > 5 minutes OR 2+ seizures w/in 5 minutes without return to normalcy
138
Seizure 4 TXs
ABCs
**Ativan** and/or Anticonvulsants
Safe environment
139
Delirium vs. Dementia 📃
Delirium / Dementia
Rapid Acute ▲ / Gradual onset (no TX)
140
Delirium % Incidences Hospitalized
2 Types
% ICU
% Ventilated
20-50% hospitalized pts
Hyper/Hypoactive
20-80% ICU
87% Ventilated
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