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Acute care > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What are the different ways in which a patient can enter the acute care setting?

A
  • Emergency care
  • Urgent care
  • Short-term stabilization
  • Pre-hospital care
  • Critical care
  • Trauma care and acute care surgery
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2
Q

What is acute care?

A

• “include all promotive, preventive, curative, rehabilitative or palliative actions, whether oriented
towards individuals or populations, whose primary
purpose is to improve health and whose effectiveness largely depends on time-sensitive and, frequently, rapid intervention.”
• “includes the health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and
illness that can lead to death or disability without rapid intervention.”

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3
Q

What are the units found in acute care?

A
  • General medical
  • Specialty inpatient services
  • Surgical: may be general surgery or individual units determined by type of surgery (ortho, cardiopulmonary, general)
  • Combined “med/surg”
  • Obstetrics/gynecology (ob/gyn)
  • Post-anesthesia care unit (PACU)
  • Pre-operative unit
  • Emergency department (ED): usually the point of entry to the system by most patients
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4
Q

What are the characteristics of general care, acute care?

A

Highest patient to nurse ratio

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5
Q

What are the characteristics of intensive care, acute care?

A
  • May be general ICU or divided into specialties (i.e., trauma, cardio, neuro, pediatric, neonatal)
  • Lowest patient to nurse ratio
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6
Q

What are the characteristics of transitional units, acute care?

A
  • “Step down” units that bridge between ICU & general medical care
  • Patient to nurse ratios between ICU and general care
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7
Q

What are the acute care team members?

A

• Hospitalist
• Specialty physician (ortho, neuro, cardio, pulmo, nephro, etc)
• Nurse (usually RN, but sometimes LVN/LPN): primary, charge, managers/directors,
house supervisor
• Rehab team: PT/OT/ST
• Case Managers (usually an RN, but includes social workers)
• Respiratory therapy (RT)
• Pharmacist (RPh)
• Patient care technician/certified nursing assistant (PCT/CNA)
• Chaplain
• Others as needed (hospice care, dialysis nurse, ostomy nurse, etc)

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8
Q

What is SBAR?

A

Situational briefing guide for staff & provider communication re changes in pt status or needs for non-emergent events, related issues, events in unit, the lab, or within health team.

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9
Q

What are the components of SBAR?

A
  • Situation: What’s going on with the patient?
  • Background: What’s the clinical background or context
  • Assessment: What do I think the problem is?
  • Recommendations: What do I think needs to be done for the patient?

• Does not become part of the medical record

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10
Q

What are the characteristics of the written form of communication used in the acute care setting?

A 
• Medical record: “If you don’t
document, it didn’t happen!”
  - Reading them can be a different story (see example in readings of a physician history
and physical)
• SBAR
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11
Q

What are the characteristics of the verbal form of communication used in the acute care setting?

A
  • Multi-disciplinary rounds
  • Professional-to-professional
  • Team huddles
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12
Q

What are the characteristics of communication in the acute care setting?

A

• Critical for patient safety and medical error prevention!
- Poor communication also contributes to increased length of stay, excessive resource
utilization, poor patient/family satisfaction, and employee turnover
• Necessary for discharge planning: “discharge
planning begins on hospital day one!”
• Facilitates efficient and effective transitions of care
between hospital providers
• Patient privacy of utmost importance! HIPAA!

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13
Q

What do Multidisciplinary Rounds consist of?

A

Consists of entire healthcare team and/or representatives

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14
Q

What are the characteristics of Multidisciplinary Rounds?

A
  • Meet on daily basis

* Patient-centered

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15
Q

What do Multidisciplinary Rounds focus on?

A
  • Open and collaborative communication
  • Decision making
  • Information sharing
  • Care planning
  • Patient safety issues
  • Cost and quality of care issues
  • Setting daily goals of care
  • Communicating with patients and/or family members
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16
Q

What are the components of safety in acute care?

A
  • Imperative to create and maintain a safe environment and plan of care
  • Establish appropriateness of care
  • Assemble required assistance and items (equipment, AD, PPE, other personnel)
  • Two patient identifiers (name, DOB verification– look at wrist band)
  • COMMUNICATION!!
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17
Q

What are the components of establishing appropriateness of care in the safety of an acute care setting?

A
  • Verify orders and other precautions (WB, surgical, etc)
  • Chart review to determine preliminary precaution list and plan (look at lab values, nursing notes, H&P/MD progress notes)
  • VITALS!!!!!
  • Key discussions with other providers– esp. nursing and MD
  • Anticipate difficulties or challenges in patient mobility or status, and plan accordingly
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18
Q

What are some common safety situations common in acute care (but also present in skilled nursing and inpatient rehab?

A
  • Various mattress types (can change bed mob. strategies)
  • Bed and chair alarms
  • Call lights/bells
  • Presence of various lines, tubes, & monitors
  • No undergarments or presence of a brief/adult diaper
  • Need for specialized lifting equipment (Hoyer lift, sit-to-stand lift, overhead lift)
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19
Q

What are the precautions to take with patients in an acute care setting?

A 
• Infection control (see other lecture)
• Eating/drinking precautions
  - NPO (can't have anything by mouth)
  - Swallow precautions
  - Fluid restrictions
  - Fluid monitoring (input output)
• Falls precautions
• 1-on-1 supervision (may be for safety, suicide prec., swallow prec.)
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20
Q

What is the 1st thing to do before any thing begin in the acute care setting?

A

Before anything begins, ALWAYS check with the nurse about any new developments or information on the patient that may not have been in your
chart review!

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21
Q

What are the subjective information to get in an acute care exam?

A
  • PLOF and work/school/activities— FALL HX!!!
  • Caregiver support and availability
  • Home situation and barriers– esp. stairs to enter home and whether home 1-2 stories; where is the main bedroom & is there a full bath on 1st floor?
  • Availability of assistive devices
  • Patient/caregiver’s d/c plans (may not match up with your assessment, though)
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22
Q

When should the vitals of an acute care patient be assessed?

A

Before, multiple times during if needed, after activity. Remember pain is another
important part of vitals assessment!

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23
Q

What is a key to remember when doing test and measures?

A

Recognize that you may not need to do ALL, and some may require adjustments to normal exam technique or may need a more functional assessment

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24
Q

What are the tests and measures that can be done in an acute care setting?

A 
• Cognition
• Speech/language ability
• General appearance
• CVP
• MSK– may not be able to perform traditional positions for ROM/strength; look at functional
mobility
• Neuro– as appropriate for the patient condition: screen vs full exam
• Integumentary
• Pain
• Functional mobility
• Standardized measures
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25
Q

How do we choose functional measures appropriate for acute

care use?

A
  • Applicable to the patient
  • Practical for use in acute care (time, cost, feasibility)
  • Assistance with d/c planning and pt. safety
  • Acceptability of test to the individual (tolerance for test, positioning)
  • Appropriateness of test for application to the pathology or health condition, body function or status, activity, or participation
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26
Q

What are the general functional mobility and endurance functional measures that are appropriate for acute care use?

A
  • Functional tests (AMPAC 6-Clicks)
  • Cardiovascular endurance (6MWT, 2MWT, 400m walk test, 2 min step test)
  • Walking Speed
  • RPE during functional activities
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27
Q

What are the balance & falls functional measures that are appropriate for acute care use?

A
  • TUG
  • Berg
  • Forward Reach
  • Single limb support
  • ABC
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28
Q

What are the functional strength functional measures that are appropriate for acute care use?

A 
• Chair rise test (quad strength)
   - 30 sec, timed 5 reps
• Arm curl
• Supine hip extension
• Heel rise
• Toe tap
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29
Q

What is the role of n acute care PT?

A

• Not to necessarily completely resolve the patient’s issues but rather to determine what is needed to d/c safely to the next level of care, whether that is home or to another post-acute facility
• To assist in preventing further functional decline, discourage bed rest as much as is
possible
• To prepare the patient for further care and progressions needed after hospitalization,
whether that is a HEP, family education and training, info re the role of subsequent therapy settings, or other recommendations
• To initiate new movement patterns and/or use of assistive devices needed as a result of
the patient’s surgery, medical condition, or recent functional losses
• To EDUCATE, EDUCATE, EDUCATE
- You are often the “translator” between the MD and pt/family!
- Multiple opportunities to educate other healthcare providers on many issues
(safety, transfers, body mechanics, role of PT, etc)

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30
Q

What are the characteristics of discharge planning?

A

• Begins on DAY ONE!!
• Communicate to the hospital team (likely the case manager or hospitalist) immediately
• It’s okay to be a little unsure– better to overestimate care and be prepared than project a lower level of care & have to scramble last minute for d/c disposition
• Consider pt/family resources and projected level of assistance: do these match?
• Use functional measures to help you in justifying d/c recommendations
• Recommend equipment needs– what needs to be arranged by hospital? What
must pt/family secure? How many of these needs are essential for d/c?
• Remember, insurance, finances, and care arrangements can be MESSY!

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31
Q

What are the characteristics of discharge disposition: Home w/no further therapy needed?

A

Pt. may not even need therapy in the hospital or have no other needs after initial treatments

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32
Q

What are the characteristics of discharge disposition: Home w/home health PT?

A
  • “Homebound” status
  • Does the patient need supervision or assistance?
  • Pt’s own home/apartment, family or caregiver home, assisted-living facility?
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33
Q

What are the characteristics of discharge disposition: Home w/referral to outpatient therapy?

A
  • Can the pt drive?
  • What kind of assistance still needed?
  • Oftentimes, a significant gap exists between hospital d/c & start of care in OP–HEP/education critical!
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34
Q

What are the characteristics of discharge disposition: Post-acute facility placement?

A
  • Inpatient rehab (IRF)
  • Skilled nursing (SNF)
  • Long-term acute care (LTAC)
  • Long-term care facility/nursing home
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35
Q

What is the criteria 1 for a patient to be Home health homebound upon discharge?

A

• Criterion 1: The patient must either:
• Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence.
OR
• Have a condition such that leaving his or her home is medically contraindicated.

If the patient meets one of the Criteria 1 conditions, then the patient must ALSO meet
both additional requirements defined in Criteria 2.

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36
Q

What is the criteria 2 for a patient to be Home health homebound upon discharge?

A
  • There must exist a normal inability to leave home; and

* Leaving home must require a considerable and taxing effort

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37
Q

What are the patients that go to an Assisted Living Facility upon discharge?

A

Patients who need housing, support services, and health care

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38
Q

What are the Services/Amenities (Facility dependent) provided at an Assisted Living Facility?

A
  • 3 Meals/day in common dining area
  • Housekeeping
  • Transportation
  • Laundry services
  • Exercise/Wellness programs
  • Social/Recreational activities
  • Social/recreational activities
  • Assistance w/ADLs
  • Medication assistance
  • Rehabilitation services (HH vs OP)
  • Emergency call systems
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39
Q

What are the patients that go to an Inpatient Rehabilitation Facility upon discharge?

A

Patient who needs intensive rehabilitation services
• Must be able to tolerate 3 hours of therapy services 5-7 days/wk
- Includes PT, OT, ST (must have AT LEAST two disciplines on board)

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40
Q

What are the characteristics of an Inpatient Rehabilitation Facility?

A
  • Length of stay determined by diagnosis: typically 10-12 days
  • Rehabilitation is the main focus, medically stable
  • No qualifying length of stay required in acute care hospital
  • Patients can even be referred from and admitted straight from home or ED
  • “60% rule” for Medicare patients
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41
Q

What are the patients that go to a Skilled Nursing Facility upon discharge?

A

Patient who needs daily skilled care under the direction of skilled nursing or rehabilitation staff for a hospital related medical condition
• Rehabilitation services
• Nursing services (IV injections etc.)
• Activities

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42
Q

What are the characteristics of a Skilled Nursing Facility

A
  • Billed under Part A Medicare for those 65+, otherwise private insurance
  • Requires 3 midnight stay in acute care hospital (for Medicare)
  • Length of stay up to 100 days
  • Can be within a long-term care facility or a free-standing facility (often combined with inpatient rehabilitation services)
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43
Q

What are the patients that go to a Long-term Acute Care Hospital upon discharge?

A

Patients with multiple co-morbidities who need a long stay of hospital care
• Still need daily medical management by a physician

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44
Q

What are the characteristics of a Long-term Acute Care Hospital?

A 
• Average LOS >25 days
• Provide: (These are facility dependent)
  - Ventilator Weaning
  - IV Antibiotics
  - Dialysis
  - Rehabilitation services
  - Wound Care services
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45
Q

What is theexternal ventricular drain(EVD)?

A

A small tube surgically inserted into theventriclesof the brain, which drainscerebrospinal fluid(CSF) The tube is connected to a device that measures the amount of this fluid

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46
Q

When is an external ventricular drain(EVD) used?

A

When the ICP is elevated, and the drain may be clamped for short periods of time and should only be done by nursing unless your facility regulations allow other providers after significant training.

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47
Q

What must be position of the bed be when using an external ventricular drain(EVD)?

A

The head of the bed must be elevated to a specific level the bed should be locked out to prevent accidental movement of head of bed. Head must be at 30 deg when the drain is open

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48
Q

Why must the bed be in a certain position when using an external ventricular drain(EVD)?

A

Because of the specific calibration, function of the drain, and accuracy in measurement. Unless the drain is clamped, the head of the bed may not be changed, and patients should not be mobilized.

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49
Q

Why should you alway check with the nurse prior to working with a patient that has an external ventricular drain(EVD)?

A

They will need to close drain prior to mobilization.

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50
Q

What is the function of the external ventricular drain(EVD)?

A

Monitors and alleviates swelling and increased pressures in the ventricles of the brain

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51
Q

Where are the locations that a “central” central line can be?

A
  • Subclavian
  • Internal jugular
  • External jugular
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52
Q

Where are the locations that a “peripheral” central line can be?

A
  • Basilic
  • Cephalic
  • Femoral
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53
Q

What are the functions of a central line?

A

Used to deliver meds, nutrition, dialysis, blood draws

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54
Q

What are the characteristics of a central line?

A
  • Usually patients can be disconnected from any tubing connected to IV pole (other than during dialysis) to allow easier mobilization with less lines to manage.
  • Usually the port is covered with a thin clear dressing, always use gloves when handling these patients to prevent infection.
  • You should never disconnect any of these lines as nursing will need to flush and clamp to prevent claudication in the line. - Commonly known as a hep lock
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55
Q

Where are IVs inserted and what are they used for?

A

IV’s are inserted into veins and are used to deliver medications and fluids.

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56
Q

What are the characteristics of an arterial line IV?

A
  • Arterial line are placed in the artery they are quite painful for the patient during insertion and any wiggling of the line is painful.
  • Arterial lines are place to limit arterial punctures for blood gas draws and can be used to directly measure pressure.
  • Ask nurses which lines can be disconnected (Hep lock) prior to mobilization sometimes, they can which make ambulating patient easier
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57
Q

What should you do if you pull out an IV line?

A
  • Cover site with clean linen, gauze ect ASAP, calmly apply pressure
  • Don’t walk away from patient calmly have them sit down.
  • Notify Nurse
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58
Q

Where is a Pulmonary Artery Pressure Monitors also called swan-ganz catheters inserted?

A

Directly into pulmonary artery at the right side of the heart

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59
Q

What is the function of the Pulmonary Artery Pressure Monitor?

A

Measures heart function pressure

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60
Q

What is a major component of managing a patient with a Pulmonary Artery Pressure Monitor?

A

ALWAYS CHECK WITH NURSING PRIOR TO MOBILIZATION

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61
Q

What is pulmonary hypertension?

A

When thepressurein the pulmonary arteryis greater than 25 mm Hg at rest or 30 mmHg during physical activity

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62
Q

When will a patient be placed on an oxygen max or rebreather?

A

If the patient is on more than 4 L

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63
Q

When will a patient be placed on a nasal cannula and what are the characteristics?

A

For up to 6L. Is extremely drying to nose tissues and it is common to have nose bleeds.

  • This is especially concerning when the patient is on a blood thinner like heprin, coumadin, or a low molecular weight heprin such as levenox.
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64
Q

What is a saline reservoir used for in the administration of oxygen?

A

To assist with moistening environment, increased comfort for patient O2

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65
Q

What are the characteristics of a saline reservoir?

A
  • Many home health patients will be d/c home without the sterile saline reservoir, never add tap water to the reservoir. - If you are working with a patient who is a mouth breather use mask or if you are working with mouth breather who has nasal cannula, OK to put it in their mouth after wiping with an alcohol wipe.
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66
Q

What is a CPAP and BIPAP usually prescribed for?

A
  • Usually prescribed for sleep apnea but it can also assist with pts with COPD, high level spinal cord, or patients with ALS for respiratory support.
  • Also used to decrease work of respiratory muscles so you might find them in ICU after a patient has been extubated from the ventilator.
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67
Q

What does a BIPAP allow for?

A

Bipap allows for 2 levels for inhalation and exhalation good for pts with COPD as they might need more help getting the air out, and less inspiratory pressures.

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68
Q

What is telemetry and how is it achieved?

A

The monitoring of the heart EKG without being directly tethered to the EKG machine. Achieved through a 5 lead device

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69
Q

What should be done before working with a patient with a telemetry (tele patient) and why?

A

Be sure you notify tech prior to working with patients to avoid perceived emergency situation

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70
Q

What is an impella?

A

A device inserted into the left side of the heart to temporarily assist the heart to pump.

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71
Q

What are the medical devices used to help the heart pump during a Percutaneous coronary intervention(PCI)?

A

TheImpella heart pump and IABP

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72
Q

What is a Percutaneous coronary intervention(PCI)?

A

A non-surgical procedure used to treat narrowing (stenosis) of thecoronaryarteries of the heart found in coronary artery disease

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73
Q

What does an impella heart pump and IABP do?

A
  • Bothdevicespush blood from the left ventricle to the aorta with each heartbeat.
  • Bothdevicesincrease blood flow to your coronary arteries and the rest of your body during the PCI procedure

Intra aortic pump is timed with the beating of the heart deflating in systole and inflates in diastole to increase blood flow to coronary arteries.

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74
Q

What does a ventricular assist device do?

A
  • Increases cardiac circulation in heart failure patients, it can support either right, left, or both sided heart failure and can be worn as an outpatient
  • Assists with increasing pressure for circulating blood
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75
Q

What are the characteristics of a ventricular assist device?

A

It can be use temporary or full time long term awaiting heart transplant.

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76
Q

What does a Pt controlled analgesic, or PCA pump allow for?

A

Allows the patient to control the delivery of pain medication through IV.

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77
Q

What are the characteristics of a Pt controlled analgesic, or PCA pump?

A
  • The nurse sets the maximal medication units and Dosing controlled by the device so the patient cannot overdose.
  • There is Conflicting evidence for use in literature
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78
Q

What is the function of a nasogastric or NG tube?

A
  • Can be used as a drain through connection with wall suction or it can be used for short term delivery of nutrition
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79
Q

What are the characteristics of a nasogastric or NG tube?

A
  • When working patients who have an NG tube you must keep the head of the bed at 45 degrees or greater to prevent aspiration.
  • Do Check with nursing to see if the patient can be d/c prior to working with them.
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80
Q

What are the ways to administer of TPN- total parenteral nutrition?

A
  • Central line: vena cava
  • Bypass GI tract
  • Glucose, protein, vitamin, minerals, lipids
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81
Q

What are the ways to administer PPN- partial parenteral nutrition?

A
  • Peripheral vein lines

- Amino acids, dextrose, lipids

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82
Q

What are the characteristics of the ways to administer total/partial parenteral nutrition?

A
  • These interventions are used for longer term nutrition delivery for very sick or burn pts, as they bypasses GI tract.
  • This can be for GI rest, decrease the work of the GI system, or quicker delivery of nutrients directly into the blood stream.
  • TPN provides minerals, glucose and lipids and is delivered via central line while PPN is inserted into peripheral veins
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83
Q

What is a hemovac drain used for after surgery?

A

Used to drain excessive fluid, blood from a surgical sight.

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84
Q

What are the characteristics of a hemovac drain?

A

Do not open collection device; if opens in advertally let nursing know so they can reestablish suction.

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85
Q

What type of patients have a G- tubes/J tubes?

A

When working with patient who have swallowing problems, as long term solution for delivery of nutrition with patients that cant swallow: such as GB, CVA, TBI

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86
Q

What are the characteristics of a G- tubes/J tubes?

A
  • These lines do not have the restrictions of an NG and patient can be supine on a flat surface.
  • These lines can be surgically removed if the patient regains the ability to swallow.
  • The G tube on the top looks infected and I would notify the nurse of this redness
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87
Q

What is the function of a chest tube?

A
  • To re-inflate a collapsed lung through the creation of negative pressure in the chest cavity
  • Also used to remove blood during pleural effusion, or pus from empyema.
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88
Q

What are the characteristics of the setup of a chest tube?

A
  • These devices are usually attached to the wall with suction.
  • The middle chamber of the collection device of a traditionalchestdrainage system is thewater seal.
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89
Q

What is the main purpose of the water seal found in a chest pump?

A

The main purpose of the water sealis to allow air to exit from the pleural space on exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation to assist in the re-inflation of the lung.

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90
Q

What does bubbling in the water seal chamber of a chest pump mean?

A

Air Leak.

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91
Q

What are the characteristics of a chest tube?

A
  • You should always check with nursing to be sure but usually these patients can be disconnected from wall suction for mobilization.
  • NEVER roll the patient onto the side with the chest tube it can kink the line and be very painful for the patient. If they cant be disconnected from the wall suction you can work with them sitting as the edge of the bed, standing, marching in place, transfers are all very appropriate interventions.
  • Be aware of where the line is, how taunt is is and be sure to keep reservoir below the level of tube entry as raising it may allow the collected fluid to re-enter the chest wall causing infection.
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92
Q

What are the characteristics of a balloon?

A
  • Balloon holds device in bladder
  • Be sure and take catheter bag with you so it does not get pulled out
  • You can empty the bag prior to mobilization as long as you let nursing know the amount empty
  • Keep collection bag lower than bladder to prevent re-entry of urine into bladder
  • Can cause bladder infection
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93
Q

What are the characteristics of fecal tubes?

A
  • The patients diet is adjust to allow the feces to be a nectar thick consistency.
  • This device is a great help to nursing but more importantly it keeps the patients skin dry and clean as urine and fecal matter will quickly break down the integrity of skin.
  • They are also used to keep sacral wounds clean and dry to allow for healing.
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94
Q

What are wound vacs used for?

A

Used to assist in wound or surgical incision healing.

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95
Q

What are the characteristics of a wound vac?

A
  • Foam and clear drapes are used with suction allowing for any drainage to be pulled away from healing wound.
  • Use unit has a battery pack allowing the patient to move and walk with this portable pack.
  • An alarm if suction is broken, movement may break suction.
  • Usually using a gloved hand to smooth around the dressing will recreate the suction. Or you may need to apply more drapes (they have an adhesive backing) to secure the dressing to allow for appropriate suction. If the unit continues to alarm Let nursing know if they are responsible.
  • Always Use gloves when working with these patients as the drainage may be infectious.
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96
Q

What is a Peripheral Compression pump used for?

A

Used as a prophylactic to prevent DVT and are common after surgery

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97
Q

What are the characteristics of a Peripheral Compression pump?

A
  • Always take the time to remove and check the skin underneath.

**Lazy therapists just disconnect but leave on

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98
Q

What are the characteristics of a general anesthesia?

A
  • Propofol is one of the most commonly used intravenous drugs employed to induce and maintain general anesthesia.
  • The patient is unconscious with no awareness and no sensation.
  • Generally a majority of the effects are gone within 24 hours however, complete resolution of these medications can take week(s).
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99
Q

What are the characteristics of a regional anesthesia?

A
  • The patient is awake, usually the patient is given additional drugs to decrease awareness examples are spinal or epidurals.
  • Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, orlidocaine.
  • They are often delivered in combination withopioids ornarcoticssuch asfental in order to decrease the required dose of local anesthetic.
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100
Q

What are the characteristics of a local/peripheral anesthesia?

A
  • Injected into tissue to temporally numb the area like in dental procedures using the same medications used for epidurals.
  • The physician may add epinephrine, clonidine, dexamethasone, tramadol, or sodium bicarbonate to increase effectiveness
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101
Q

What are the characteristics of a conscious sedation?

A

– midazolamandpropofolare the most commonly used sedatives, whereasfentanylis the most frequently administered analgesic to help relax and block pain while the patient remains awake but not able to speak and wont remember much about procedure: colonoscopy, breast biopsy, minor surgical procedures

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102
Q

What are the side effects of general anesthesia?

A
  • Nausea (most common)
  • Vomitting (most common)
  • Sore throat
  • Confusion
  • Muscles aches
  • Itching
  • Hypothermia
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103
Q

What are some tips a PT should employ when working with a patient that has received a general anesthesia?

A
  • Moving the patient slowly, cueing for deep breathing helps but one should always be ready have a emesis basin or trash can close by.
  • Another helpful tip is having a cold damp wash cloth to place on the patients face.
  • Another tip is to carry a packaged alcohol wipe if the pt begins to get nauseous open the package and place the pad under the patient nose and have them breath deeply
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104
Q

What causes a sore throat in patients after a general anesthesia?

A

From intubation

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105
Q

Why is confusion generally worse in older patients after general anesthesia?

A

Their decrease metabolism and any kidney/liver pathology makes it difficult to clear the medications.

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106
Q

What are some complaints that a patient might have and what should be done?

A
  • If the patient c/o being itchy notify nursing they often have standing order for Benadryl.
  • Pts may also complain about being cold refusing to get out of bed. You can use a warm bath blanket to drape over shoulders or promise then deliver lots of warm blankets once you are done with therapy.
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107
Q

What are some complications seen in patients after general anesthesia?

A
  • Delirium
  • Cognitive dysfunction
  • Malignant hyperthermia

There are some serious and long lasting serious complications of anesthesia. It’s more common in older people

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108
Q

What are the effects of anesthesia on the cardiovascular system?

A
  • Hypotension
  • Hypertension
  • Dysrhythmias
  • Increased risk for MI
  • DVT
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109
Q

What are the effects of anesthesia on the respiratory system?

A
  • Hypoventilation
  • Decreased ventilation drive
  • Aspiration
  • PE
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110
Q

What are the effects of anesthesia on the psychomotor function?

A
  • Time to regain consciousness
  • Delirium
  • Personality changes
  • Memory loss
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111
Q

What are the things to do before ambulation with a patient after anesthesia?

A
  • Take a set of vitals before beginning, just because a patient does not c/o dizziness does not mean that they may have orthostatic hypotension. Take vitals in every position after 1-2 min BEFORE you begin ambulation
  • On initial evaluation especially, take time to allow for transition of patients position.
  • Encourage deep breathing, if they have an incentive spirometer at bedside have the patient demonstrate its use (suck don’t blow) in supine before sitting bedside, in sitting EOB before ambulating
  • Remind pts to take deep breaths when ambulating many times they will hold their breath in anticipation or because of pain.
  • Risks of DVT, as the wells decision rules delineates an increase risk with surgery. ALWAYS take the time to look at the patients lower leg, pull ted hose down and inspect for warmth, redness, and swelling.
  • Report any unilateral symptoms immediately to the nurse.
  • If the patient is on prophylactics (for 7 days post op) Apixaban, dabigatran, rivaroxaban, edoxaban, and betrixaban are alternatives to warfarin ask the nurse when the first dose was given. It takes 3 days for warfarin to become therapeutic, however low weight molecular heparin becomes effective in 2 hours.
112
Q

What are some low molecular weight heparins?

A

Lovenox and Xeralto are brand names other meds with parin at the end of it (Bemiparin. Certoparin. Dalteparin. Enoxaparin. Nadroparin. Parnaparin. Reviparin. Tinzaparin.) are all low molecular weight heparins.

113
Q

What incision site has the highest rate of pulmonary complications?

A

Chest and abdominal surgery (thoracic and upper abdominal)

114
Q

Why do patients with chest/abdominal incisions have the highest rate of pulmonary complications?

A

Do not breath deeply because of perceived or actual pain leading to a wide range of pulmonary complications

115
Q

What should we always do with patient incision sites?

A

We should always include assessment of inspiration volumes (incentive spirometer) cough (be sure and use splinted cough techniques) and complete interventions that encourage deep breathing and movement.

116
Q

What are the other factors for a pulmonary complication?

A
  • Age > 60yrs
  • Decreased mobility
  • Malnourishment
  • Past respiratory disease
  • Prolonged procedure
  • Expected intubations
117
Q

What are the pulmonary complications seen in an abdominal/thoracic surgery?

A
  • Incision pain
  • Weakness secondary to fasting
  • Sedation
  • Poor pain control
  • Infrequent position change
  • Increased airway secretions
  • Decreased diaphragmatic excursion
  • Rib cage and lung expansion.
118
Q

What can cause diaphragmatic dysfunction in patients with an abdominal/thoracic surgery?

A

Occur from decreased phrenic nerve output which occurs secondary to pain especially in upright positions, from reflexes arising from the periphery (chest wall and/or peritoneum), which could inhibit the phrenic nerve output

119
Q

What does decreased volume in a patient with an abdominal/thoracic surgery mean?

A

Decrease volume means decreased pressure which means less pressure in alveoli which can cause atelectasis

120
Q

Diaphragmatic breathing can reduce ____ and should be instructed on every post op pt with and abdominal or thoracic incision.

A

Diaphragmatic breathing can reduce atelectasis and should be instructed on every post op pt with and abdominal or thoracic incision.

121
Q

What does the inability to eat after surgery do?

A

Effects surfactant levels which decreased ability to lower surface tension

122
Q

What can infrequent position change lead to?

A

Atelectasis. So educating our patients to move despite pain should be encouraged, as patients to always get out of bed for meals and to use the bathroom, nursing staff can bring a bedside commode rather than bedpan

Sometime nursing staff with just use a bedpan because it is easier and does not require the supervision of the patient. Educating patient on the importance of requesting to get OOB for toileting is always best as gravity can help with bowel and bladder elimination whereas the bedpan does not facilitate evacuation

123
Q

What are the things that a PT should do when working with a post op patient?

A
  • Assess cough
    • teach splinted coughing
    • teach airway clearance
  • Teach diaphragmatic breathing
  • Teach incentive spirometry
  • Teach infrequent position changes

*Education on the importance of the above and should be done with every post op patient on every visit

124
Q

What are the observation/assessment things to do for a post op patient?

A
  • Look for edema
  • Assess for DVT
  • Look at incision if possible or at least look for drainage
  • Assess for orientation and the ability to follow commands
  • Involve family if possible but if they are going to get in the way, give them permission to take a break
125
Q

When should an incision be looked at?

A

Before and AFTER mobilization

126
Q

What are the pain management techniques for post op patients?

A

• Communicate with nursing
- Pain med schedule
- Maximize scheduling of PT
• Use splinting
- Pillow
- Abdominal binder
• Educate patient about routine pain meds
- Don’t get behind
- Address fear of addiction
- Tell the patient your goal is to minimize their pain while completing needed task
• Use deep breathing as a tool to decrease pain

127
Q

What should be done if a patient is within 30 mins of pain med dose?

A

Come back 30 mins after, and communicate with the patient that they are close to receiving another dose of medications and you will return at the height of its effectiveness. This simple conversation reinforces with the patient that you are doing everything possible to decrease their pain

128
Q

What kind of activities should a PT start a post op patient with?

A

Start with activities that will:

  • Promote confidence in the PT
  • Don’t hurt
  • Give your patient some control
  • Promote upright posture
129
Q

How do you consider the incision in a post op patient?

A
  • Avoid stretching or stressing the incision

- Avoid unilateral stress especially with abdominal and thoracic incisions

130
Q

What are the normal values of white blood cells?

A

4,500-10,000/mcL

131
Q

What is Leukocytosis?

A

When the WBC is >11,000 as a result of a bacteria infection, stress/trauma, allergy, smoking, pneumonia, or a neoplasm

132
Q

What is Leukopenia?

A

A <5,000 due to bone marrow failure (aplastic anemia), radiation & chemo, HIV, viral diseases

133
Q

What are the guidelines for PT in regards to WBC?

A
  • <5,000 with fever hold PT

* >5,000 light exercise, progress as tolerated

134
Q

What is the most common cause of leukocytosis?

A

Most common cause of

leukocytosis, usually due to bacterial infection

135
Q

What is eosinophilia due to?

A

Allergic reaction or asthma.

136
Q

What is lymphocytosis due to?

A

Viral infections and chronic bacterial

137
Q

What is normal RBC?

A
  • 4.7-6.1x10^6/uL (Male)

* 4.2-5.4x10^6/uL (Female)

138
Q

What are the possible causes for a decrease in RBC?

A

Anemia, cancer, blood loss,

malnutrition

139
Q

What are the possible causes for an increase in RBC?

A

Dehydration, Right HF, COPD and smoking

140
Q

_____ is an indicator of severity of anemia or polycythemia

A

Hemoglobin (HgB) is an indicator of severity of anemia or polycythemia

141
Q

What is the normal range of Hemoglobin (HgB)?

A
  • Male: 14-17Gm/dL

* Female: 12-16Gm/dL

142
Q

What are the possible causes for a decrease in Hemoglobin (HgB)?

A

Anemia, surgery, iron and B12

deficiency

143
Q

What are the possible causes for an increase in Hemoglobin (HgB)?

A

COPD, altitude

144
Q

What kind of exercise should be done if a patient’s hemoglobin (HgB) is less than 8gm/dL?

A

Essential daily activities only, hold therapy

145
Q

What kind of exercise should be done if a patient’s hemoglobin (HgB) is greater than 8gm/dL?

A

Ambulation permitted.

146
Q

What kind of exercise should be done if a patient’s hemoglobin (HgB) is between 8-10gm/dL?

A 
Stairs, light aerobics,
light weights (1-2lbs).
147
Q

What kind of exercise should be done if a patient’s hemoglobin (HgB) is greater than 10gm/dL?

A

Resistive exercise permitted

148
Q

What is hematocrit (Hct)?

A

Percent by volume of RBC in a whole blood sample

149
Q

What is the normal range for hematocrit (Hct)?

A
  • Male: 43-49%

- Female 38-44%

150
Q

What are the possible causes for a decrease in hematocrit (Hct)?

A

Anemia, fluid overload, bleeding

151
Q

What are the possible causes for an increase in hematocrit (Hct)?

A

Heart defects, severe dehydration, hypoxia, smoking

152
Q

What kind of exercise should be done if a patient’s hematocrit (Hct) is below 25%?

A

Essential daily activities only, hold therapy

153
Q

What kind of exercise should be done if a patient’s hematocrit (Hct) is between 25-35%?

A

Therapy permitted, ambulation and stairs permitted, light

aerobics, light weights (1-2 lbs)

154
Q

What kind of exercise should be done if a patient’s hematocrit (Hct) is greater than 35%?

A

Resistance and moderate

aerobic exercises.

155
Q

What are platelets (PLT)?

A

Cells in blood who function to stop bleeding, produced in bone marrow.

156
Q

What is the normal range for platelets?

A

150-350,00/uL

157
Q

What is thrombocytosis and what causes it?

A

When the platelets is >450,00, caused by iron deficiency, cancer, infection and inflammation

158
Q

What is thrombocytopenia and what causes it?

A

When the platelets is <150,000 caused by liver disease, aplastic anemia, viral
infection (HIV/AIDS chicken pox), radiation and Chemo

159
Q

What kind of exercise should be done if a patient’s platelet is < 10,000 and /or temperature >
100.5 degrees?

A

No therapeutic

exercise/Hold therapy

160
Q

What kind of exercise should be done if a patient’s platelet is between 10,000-20,000?

A

Therapy permitted, Therapeutic exercise/bike without resistance

161
Q

What kind of exercise should be done if a patient’s platelet is > 20,000?

A

Therapeutic exercise/bike with or without resistance

162
Q

What are coagulability tests used for?

A

Used to monitor anticoagulation therapy

• Post orthopedic surgery, cardiac surgery/stenting, Afib, DVT

163
Q

What is coagulability test: Prothrombin Time (PT) used for?

A

Used to assess the function of the extrinsic pathway (fast system)

164
Q

What are the characteristics of the extrinsic pathway?

A

Activated by trauma to tissue, causing blood to escape from the vascular system, initiated by release of tissue factor

165
Q

What does the prothrombin time (PT) screen for?

A

Bleeding abnormalities, measures the time it takes for the liquid portion (plasma) of your blood to clot

166
Q

What are the normal ranges for a prothrombin time (PT)?

A

11-12.5sec
• Values 1-2 times normal range is “Therapeutic”
• Values 2-3 times normal range is “risk of bleeding”

Need to use judgment, facility guidelines and context

167
Q

What is the partial thromboplastin time (aPTT) used for?

A

Used to assess the function of the intrinsic pathway (slow system)

168
Q

What are the characteristics of the intrinsic pathway?

A

Activated factors in the blood (factor XII)

169
Q

What does the partial thromboplastin time (aPTT) test screen for?

A

Bleeding abnormalities, measures the time it takes for your blood to clot.
• aPTT “activated PTT”, addition of an activator which speeds up clotting time and results in a
narrower reference range, considered a more sensitive than PTT, essentially the same thing

170
Q

What is the normal range for a partial thromboplastin time (aPTT) test?

171
Q

Why may a person need to hold exercise in reference to the partial thromboplastin time (aPTT) test?

A

Values 1-2 times normal range is may need to hold exercise due to risk of spontaneous
bleeding.

172
Q

What is the standardized technique to correct variations in Prothrombin Time (PT) between labs?

A

International Normalized Ratio (INR)

173
Q

The International Normalized Ratio (INR) is used to monitor ___

A

Coumadin (Warfarin) therapy.

174
Q

How is the INR calculated?

A

(PTtest)/(PTnormal)

Ptnormal usually 12-13

175
Q

What is the normal range for the INR?

176
Q

What does it mean when the INR is greater than 3?

A

Risk for bleeding

177
Q

What are the therapeutic ranges of the INR?

A
  • Afib/DVT/PE: 2-3

* Valve replacement: 2.5-3.5

178
Q

What kind of exercise should be done when the INR is less than 4.0?

A

PT indicated, light exercise,
hold progressions until INR at
therapeutic levels

179
Q

What kind of exercise should be done when the INR is greater than 5.0?

A

Hold exercise, however can

perform PT evaluation in room

180
Q

What kind of exercise should be done when the INR is greater than 6.0?

A

PT contraindicated, 2 days

bed rest likely, possibly transfers OOB to chair only

181
Q

What is the interpretation of the wells score DVT?

A

• Score >2.0 — High (probability 53%])
• Score 1.0 to 2.0 — Moderate
(probability 17%)
• Score <2.0 — Low (probability 5%)

182
Q

____ may be used to rule in/out DVT

A

D-Dimer may be used to rule in/out DVT

183
Q

What is indicated in Moderate to High risk DVT?

A

A vascular ultrasound is indicated

184
Q

What are the components of the Wells Score PE (Pulmonary Embolism)?

A
  • Clinically suspected DVT — 3.0 points
  • Alternative diagnosis is less likely than PE — 3.0pts
  • Tachycardia (heart rate > 100) — 1.5 pts
  • Immobilization (≥ 3d)/surgery in previous four weeks — 1.5 pts
  • History of DVT or PE — 1.5 pts
  • Hemoptysis — 1.0 pts
  • Malignancy (with treatment within 6 months) or palliative — 1.0 pts
185
Q

What is the interpretation of the Wells Score PE?

A
  • Score >6.0 — High (probability 59%])
  • Score 2.0 to 6.0 — Moderate (probability 29%)
  • Score <2.0 — Low (probability 15%)
  • Score > 4 — PE likely. Consider diagnostic imaging.
  • Score 4 or less — PE unlikely. Consider Ddimer to rule out PE
186
Q

What is a Disseminated Intravascular Coagulopathy (DIC)?

A

Serious disorder in which the proteins/factors that control blood clotting become over active.

187
Q

What causes Disseminated Intravascular Coagulopathy (DIC)?

A

Severe trauma, liver failure, transfusion failure, sepsis, venom poisoning, cancer.

188
Q

What are the characteristics of Disseminated Intravascular Coagulopathy (DIC)?

A

• Small blood clots form in the blood vessels, can block vessels that supply organs
such as the liver, brain, or kidneys, leading to organ failure.
• Over time, the clotting factors in the blood are consumed or “used up.” resulting in a high risk of serious bleeding, even from a minor injury or without injury.

189
Q

When is a D-dimer test ordered?

A

When a DVT or PE is suspected and to confirm DIC

190
Q

What does the D-dimer test measure?

A

Measures levels of degradation of fibrin products in the body

191
Q

What is a positive D-dimer test?

A

Values >500ug/L

192
Q

What does the basic metabolic panel (BMP) include?

A
  • Sodium
  • Potassium
  • Glucose
  • Chloride
  • Bicarbonate
  • Blood Urea Nitrate (BUN)
  • Creatnine

Used to assess the function of the endocrine system

193
Q

What is the function of sodium?

A

Regulates fluid volume and important for nerve conduction

194
Q

What do increases in sodium result in?

A

Increases fluid retention, fluid volume and blood pressure

195
Q

What is the normal range of sodium?

A

135-145mEq/L

196
Q

What is hyponatremia and what are its possible causes?

A

Low Na+
- Causes: diuretics, chronic vomiting/diarrhea, dehydration (Hypovolemic) and over-hydration (hypervolemeic), HF and cirrhosis (euvolemic)

197
Q

What are the signs and symptoms of hyponatremia?

A

Confusion, weakness, cramps/spasms, HA, convulsions, irritability

198
Q

What happens when the amount of sodium in fluids outside cells drops?

A

Water moves into the cells to balance, brain cells especially sensitive to swelling, can be fatal.

199
Q

What type of patients mostly get hypernatremia?

A

Most often hypovolemic, common in elderly who don’t drink water

200
Q

What are the symptoms of hypernatremia?

A

Swelling, increased thirst, lack of urination, cramps/spasms, weakness

201
Q

What is the function of potassium?

A

Affects the excitability of the heart, muscle and nerves.

• Abnormal values either way can cause cardiac arrhythmias

202
Q

Potassium is normally excreted in ___

A

Potassium is normally excreted in urine

203
Q

What is the normal range of potassium?

A

3.5-5.0mEg/L

204
Q

What causes hypokalemia?

A

NG suctioning, diuretics, diarrhea, Cushing’s syndrome

205
Q

What causes hyperkalemia?

A

Severe cell destruction (ie trauma) redistributes K+ from intra to extracellular fluid.

206
Q

What are the signs and symptoms of hypokalemia?

A

Flattened Twave, arrhythmias, clammy skin, muscle tetany, weakness, abdominal distension (low ab tone) & respiratory failure (resp muscle weakness)

207
Q

What are the signs and symptoms of hyperkalemia?

A

Flaccid paralysis, Peaked Twaves, shortened Q-Twave interval

208
Q

What is the function of chloride?

A

Works with sodium, potassium and bicarbonate to regulate acid-base balance
• Typically mirrors values of sodium

209
Q

What are the normal ranges of chloride?

A

95-105mEg/L

210
Q

What are the causes of hyperchloremia?

A

Dehydration, kidney disease

211
Q

What are the signs and symptoms of hyperchloremia?

A

Does not often cause symptoms, can cause metabolic acidosis

212
Q

What are the causes of hypochloremia?

A

NG suction, diarrhea, cystic fibrosis vomiting, usually occurs with metabolic alkalosis,

213
Q

What are the signs and symptoms of hypochloremia?

A

There are no signs or symptoms specific for hypochloremia as it rarely occurs in isolation

214
Q

What are the normal values of Bicarbonate (HCO3-)?

A

22-26mEq/L

215
Q

What is the function of Bicarbonate (HCO3-)?

A

Critical in maintaining acid-base balance, mediated by kidneys

216
Q

What is respiratory acidosis?

A

Reduction in alveolar ventilation, results in increased CO2 in blood, body compensates by producing more HCO3- to balance

217
Q

What is respiratory alkalosis?

A

Elevation in the frequency of alveolar ventilation, results in less CO2 in blood, body compensates by producing less HCO3- to balance

218
Q

What are the characteristics of Blood Urea Nitrate (BUN)?

A
  • Urea is synthesized in the liver from ammonia derived from the metabolism of protein in the body and gut.
  • It is filtered and reabsorbed by the kidney; reabsorption is inversely related to the rate of urine flow.
219
Q

What is normal Blood Urea Nitrate (BUN)?

A

10 to 20 mg/dL

220
Q

What do increases in Blood Urea Nitrate (BUN) cause?

A

Kidney disease and dysfunction, Excessive protein intake, excessive tissue
destruction (burns, fever, corticosteroid therapy), heart failure, dehydration, shock,
GI bleeds

221
Q

What do decreases in Blood Urea Nitrate (BUN) cause?

A

Low-protein diets, muscle wasting, starvation, liver failure, cirrhosis, high urine flow.

222
Q

What is creatinine?

A

Waste product of muscle metabolism of creatine

223
Q

What are the characteristics of creatinine?

A
  • Creatinine production in most people is relatively constant and related to muscle mass, averaging 20-25 mg/kg in men and 15-20 mg/kg in women.
  • Creatinine is then filtered but not reabsorbed in the kidneys.
224
Q

What could elevations of creatinine indicate?

A

Kidney issues, dehydration and rhabdomyolysis

225
Q

What is the BUN: Creatinine ratio used for?

A

Used to determine the cause of acute kidney injury or dehydration

226
Q

What is the principle behind the BUN: Creatinine ratio?

A

The principle behind this ratio is the fact that both urea (BUN) and creatinine are freely filtered by the glomerulus
• Urea reabsorbed by the tubules can be regulated (increased or decreased)
• Creatinine reabsorption remains the same (minimal reabsorption)

227
Q

What is the normal BUN: Creatinine ratio?

228
Q

What does a BUN: Creatinine ratio of 10 to 20:1 mean?

A

Likely due to kidney dysfunction.

229
Q

What does a BUN: Creatinine ratio of greater than 20:1 mean?

A

Likely due to dehydration.

230
Q

What is the normal range of glucose?

A

70-100 mg/dL (non-diabetic)

231
Q

What can cause elevated levels of glucose?

A

Eating, post surgery, stress lack of insulin or insulin sensitivity

232
Q

What can cause reduced levels of glucose?

A

Exercise and fasting

233
Q

What is hypoglycemia?

A

Glucose <70mg/dL

234
Q

What are the signs and symptoms of hypoglycemia?

A

Clammy skin/sweating, shaking, delirium, vision changes, HA, tachycardia, weakness,
lightheadedness, LOC, seizures

235
Q

What is hyperglycemia?

A

Glucose >100mg/dL

236
Q

What are the signs and symptoms of hyperglycemia?

A

Frequent urination, Increased thirst, nausea, vomitting, abdominal pain, and severe fatigue

237
Q

What can the failure to correct hyperglycemia (>240md/L) result in?

A

Life threatening ketoacidosis

238
Q

What are the signs and symptoms of ketoacidosis?

A

Nausea, vomiting, dry mouth , fruity breath

239
Q

What should be done in terms of exercise and glucose?

A

<70mg/L consider giving patient a carbohydrate snack before exercise

240
Q

When is exercise typically contraindicated in terms of glucose?

A

> 250mg/L exercise typically contraindicated

241
Q

Why is glucose contraindicated when glucose is >250mg/L?

A

Initial minutes of exercise results glucose levels increase, due to suppression of insulin
production and release of glycogen to feed muscles, if patient is already in a severe
hyperglycemic state it’s indicative that glucose is not absorbing well.

• Thus exercise could make hyperglycemia worse!

242
Q

What are the characteristics of Glycated Hemoglobin (HbA1C)?

A
  • Based on the attachment of glucose to HgB contained within RBC
  • RBCs live for about 3 months, thus the A1C test reflects the average of a person’s blood glucose levels over the past 3 months
243
Q

What is the normal range for Glycated Hemoglobin (HbA1C)?

244
Q

What is the pre-diabetic range for Glycated Hemoglobin (HbA1C)?

245
Q

What is the diabetic range for Glycated Hemoglobin (HbA1C)?

A

> 6.5% (well controlled DM is considered at least <7%

246
Q

What is the function of Magnesium?

A

Mg2+ along with Ca2+ are crucial for normal neuromuscular activity.

247
Q

What are the normal value of Magnesium?

A

0.7–1 mmol/L

248
Q

What causes Hypomagnesemia?

A

Malabsorption; protracted vomiting, diarrhea, or intestinal drainage; defective renal tubular reabsorption, Cyclosporine

249
Q

What are the signs and symptoms of hypomagnesemia?

A
  • Generalized alterations in NM function (tetany, tremor, seizures, weakness, ataxia)
  • Depression
  • Irritability
  • Delirium
  • Sinus tachycardia
  • Supraventricular tachycardias, and ventricular arrhythmias
  • Prolonged PR or QT intervals - T-wave flattening or inversion.
250
Q

What causes hypermagnesemia?

A

Typically occurs due to renal insufficiency, normally kidneys excrete large amounts (250 mmol/d), soft tissue injury

251
Q

What are the signs and symptoms of hypermagnesemia?

A
  • > 2 mmol/L vasodilation and neuromuscular blockade,

* >4mmol/L nausea, lethargy, weakness, respiratory failure, paralysis, coma, hypoactive tendon reflexes

252
Q

What is the function of calcium?

A

Plays a critical role in regulating normal cellular function and signaling:
• Neuromuscular signaling, cardiac contractility, hormone secretion, and blood coagulation

253
Q

What are the normal ranges of calcium?

A

8.5-10.5 mg/dl

254
Q

What causes hypocalcemia?

A

Most often due to impaired Parathyroid hormone (PTH) or vitamin D production

255
Q

What are the signs and symptoms of hypocalcemia?

A

Often asymptomatic in mild & chronic cases, mod to severe: seizure, muscle spasm, bronchospasm, laryngospasm, paresthesia & prolonged QT interval.

256
Q

What causes hypercalcemia?

A

Excessive PTH production, Hyperthyroidism and malignancy

257
Q

What are the signs and symptoms of mild hypercalcemia?

A

(11–11.5 mg/dL) often asymptomatic

258
Q

What are the signs and symptoms of severe hypercalcemia?

A

(>12–13 mg/dL) especially acute: lethargy, stupor, coma, bradycardia, AV block, and short QT interval

259
Q

What are the levels of Cardiac Troponin (cTn)?

A

<0.1-0.4 ng/ml

260
Q

What are the characteristics of cardiac specific troponin isoforms?

A

• Cardiac Troponin I (cTnI): Inhibitory subunit,
• Cardiac Troponin T (cTnT): Tropomyosin-binding subunit
• Elevations detectable as early as 2 hrs after MI but not reliably
elevated in all patients until 6 to 12 hrs.

261
Q

What are the characteristics of CPK-MB: Cardiac specific isoenzyme of creatine kinase?

A

• Normal values 0-0.04 ng/ml
• Elevation within 4 to 8 hrs after coronary artery occlusion,
peak between 12 and 24 hours, and return to normal between 3 and 4 days

262
Q

What must be done in regrads to cardiac troponin and myocardial infarctions?

A
  • MUST RULE OUT OTHER CAUSES OF ELEVATION TO
    DIAGNOSE AS MI
  • IF MI DIAGNOSED MUST WAIT FOR 2 CONSECUTIVE
    DOWNTRENDING VALUES BEFORE INITIATING PT
263
Q

What does BNP indicate?

A

Cardiac ventricular stretch/over-stretch, termed as such

because it was initially discovered in the brains of animals.

264
Q

What is the primary physiological action of BNP?

A

Primary physiological action is to reduce arterial pressure by decreasing blood volume
(diuresis) and systemic vascular resistance.

265
Q

What do levels of BNP <100 pg/mL indicate?

A

No heart failure

266
Q

What do levels of BNP 100-300 pg/mL indicate?

A

Heart failure is present.

267
Q

What do levels of BNP 300-600 pg/mL indicate?

A

Mild heart failure

268
Q

What do levels of BNP >600 pg/mL indicate?

A

Moderate to severe heart failure.

269
Q

What is albumin a measurement of?

A

Measurement of circulating protein

270
Q

What is normal albumin?

A

3.5-4.8U/L

271
Q

What do high amounts of albumin indicate?

A

Dehydration

272
Q

What do low amounts of albumin indicate?

A

Poor liver or kidney function.

273
Q

What does Glomerular Filtration Rate (GFR) reflect?

A

Reflects kidney function

274
Q

What is normal Glomerular Filtration Rate (GFR)?

A

> 90 mL/min

275
Q

What is the expected decrease in GFR with age?

A

Approximately 1 mL/min/year after age 35

Acute care (9 decks)

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