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Blueprint #1 Flashcards

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1
Q

A patient had surgery and is being prescribed fentanyl, what would the nurse question about this order?

A

hx of heroin addiction

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2
Q

What causes a high CVP (above 8?)

A

-Right ventricular issues (ineffective pump)
-HYPERvolemia

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3
Q

What causes a low CVP (below 2)?

A

-poor return of blood to RA
-systemic vasodilation
-HYPOvolemia

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4
Q

What do you do when removing an arterial line?

A

hold firm pressure for 5 minutes

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5
Q

What do you need to watch for with any hemodynamic device? (a-line, central line, pulmonary artery catheter)

A

Thrombosis

All hemodynamic devices are at risk for thrombosis (blood clots)

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6
Q

What should you watch for when placing a pulmonary artery catheter (PAC)?

A

monitor for dysrhythmias

PAC’s cause risk for dysrhythmias

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7
Q

How do you confirm the placement of a pulmonary artery catheter (PAC) or central line?

A

Chest x-ray

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8
Q

What medication can be used for cardiogenic shock?

A

nitroglycerin

vasodilation –> treats angina and restores blood flow

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9
Q

What causes pulmonary capillary wedge pressure (PCWP) to be high?

A

-Left ventricular failure
-HYPERvolemia

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10
Q

What causes pulmonary capillary wedge pressure (PCWP) to be low?

A

hypovolemia and mass systemic vasodilation

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11
Q

What are ways to prevent delirium in the ICU?

A

-minimize use of benzos
-minimize use of sedatives
-have clocks set to the right time
-lights on during the day and off at night

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12
Q

Pt is nonverbal and anxious, writhing in bed, what assessment tool should you use?

A

CPOT

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13
Q

What is less likely to drop your blood pressure, CRRT or Hemodialysis?

A

CRRT is continuous renal replacement therapy, a slower continuous alternative to hemodialysis. Less aggressive and won’t tank your BP

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14
Q

Where does the transducer need to be placed for an a-line?

A

phlebostatic axis

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15
Q

If the transducer falls on the floor, what will it show?

A

a false HIGH bp

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16
Q

What do you do to help a 3rd degree AV block?

A

Transcutaneous pacing

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17
Q

Pt has an a-line, reports their hand is cool and tingly, what do you do?

A

remove the a-line

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18
Q

What should you tell your patient to report while taking fibrate (gemfibrozil)?

A

-report abd pain and bloating, rounded stomach, epigastric pain

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19
Q

What does fibrate (gemfibrozil) do?

A

its a fibrate, helps lower triglyceride levels and increase HDL (good cholesterol)

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20
Q

An older woman needs a colonoscopy, what medication should you recommend for sedation?

A

midazolam (Versed)

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21
Q

Drop down: Shock
1. Hypovolemic
2. Cardiogenic
3. Obstructive
4. Distributive

A
  1. Hypovolemic: hypoperfusion caused by low intravascular fluid volume
  2. Cardiogenic: Hypoperfusion caused by poor cardiac output
  3. Obstructive: Hypoperfusion caused by an obstruction in blood flow/reduced diastolic filling
  4. Distributive: hypoperfusion caused by massive vasodilation
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22
Q

Types of distributive shock

A

neurogenic, anaphylactic, septic

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23
Q

neurogenic shock

A

hypoperfusion caused by loss of SNS tone (massive dilation)

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24
Q

anaphylactic shock

A

hypoperfusion caused by exposure to a sensitizing substance –> allergic reaction –> massive vasodilation

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25
septic shock
hypoperfusion caused by systemic response to an infection (vasodilation, capillary permeability, myocardial suppression)
26
Case study of a woman experiencing a 3rd degree AV block with hypotension Categorize indicated & contraindicated
indicated: continuous BP monitoring, continuous EKG monitoring, transcutaneous pacing contraindicated: labetalol (beta blocker, rate is already slow), defibrillate, tell pt to bear down, adenosine/amnio
27
What should you monitor for propofol?
hypotension
28
What is one of the main issues with propofol?
use of propofol reduces quality of sleep
29
If your patient is agitated, what can you do to help them?
increase drip
30
What hemodynamic change is consistent with hypovolemic shock?
decreased central venous pressure (CVP)
31
Which is consistent with the progressive stage of shock?
oliguria and jaundice
32
Which is true regarding a-lines?
reposition arm if a-line is abnormal
33
Nurse is giving report about a pt and says they have bad deirium, how should you assess your patient?
CAM-ICU; altered mental status and distractability
34
What do you say to a pt who has ST depression and T wave inversion?
you cannot diagnose a heart attack until after you receive blood work for cardiac enzymes (troponins)
35
What does CVP tell you?
intravascular volume
36
If the patient is cool and clammy, what should you do?
call the provider
37
How do you measure preload?
-CVP/RAP (right atrial preload) -PAWP/PAOP/LAP (left atrial preload)
38
What does the a-line measure?
-arterial blood pressure -cardiac output (CO) -cardiac index (CI) -stroke volume (SV) -systemic vascular resistance (SVR)
39
Pt has a heart rate in their 30's, what should you do?
pacemaker
40
If pt has a STEMI, how fast do you need to get to cath lab?
within 90 minutes
41
What does the vigileo show?
contractility (how STRONG the heart is pumping)
42
A patient is experiencing anaphylaxis, what should you give?
epinephrine
43
What are the two rhythms you can defibrillate?
pulseless v-tach and vfib
44
What are non-shockable rhythms?
asystole and PEA
45
If you are hypovolemic, what can this cause?
high systemic vascular resistance (SVR) because vessels will contrict in response to low fluid volume = higher resistance
46
pt is having symptoms of a heart attack, what do you do first?
give O2
47
What do you do for V-tach with a pulse?
amniodarone, cardiovert, identify electrolyte replacement, O2 for hypoxia
48
What med can be used for neurogenic shock?
norepinephrine
49
What med do you give for this EKG rhythm (strip shows SVT)
adenosine
50
EKG strip with rhythm, pt has no pulse What is the immediate action that the nurse should take?
high quality cpr
51
Which of the following is true regarding unstable angina?
unstable angina symptoms may stop with nitroglycerin
52
Left ventricular failure causes what?
High PAWP/PAOP/LAP
53
Which of the following medications would be used to help this patient experiencing dizziness, weakness, etc EKG shows bradycardia
atropine
54
intervention for junctional rhythm
transcutaneous pacing
55
What do you do for ventricular tachycardia with a pulse?
-cardiovert -amiodarone -id electrolyte replacement -O2 for hypoxia
56
If you are hypovolemic, what can this cause?
High SVR (bc hypovolemia --> vasoconstriction to compensate)
57
What education would you tell a patient that is leaving home on atorvastatin?
that it might cause myopathy
58
Know the difference between gemfibrozil and atorvastatin. What are the causes and side effects for both individually and together?
gemfibrozil: can cause gallbladder problems, liver dysfunction, myopathy/muscle pain --> avoid fried foods (gallbladder risks) atorvastatin: can cause hepatotoxicity and myopathy, no grapefruit! stop if pregnant. Both: 1. monitor LDL, VLDL, HDL 2. instruct to report muscle pain 3. watch for bleeding if pt taking warfarin 4. report abd pain, jaundice, fatigue
59
So you get a 12 lead and it is a NSTEMI, what do you do next to see if the patient is having a heart attack?
troponin, CKMB, myoglobin
60
What would you tell a patient that has an LVAD
no contact with water
61
2 things that qualify someone for delirium
altered mental status and distractability
62
What devices measure hemodynamic parameters?
-central line -arterial line -pulmonary artery catheter
63
What are some risk factors of an arterial line being placed?
-Infection -6 p's (pain, pressure, pallor, paresthesia, paralysis, pulselessness) -hemmorhage -neurovascular compromise -thrombosis
64
What measures preload?
RAP/CVP and PAWP/PAOP/LAP
65
What measures afterload?
PVR (right ventricle) and SVR (left ventricle)
66
What measures contractility?
CI, CO, SV, EF
67
What is appropriate care for a pulmonary artery catheter? What would you monitor for?
dysrhythmias, pneumothorax, infection

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