Final review Flashcards
(209 cards)
1
Q
what does Etc02 measure?
A
measures exhaled carbon dioxide
2
Q
what color indicates normal Etc02 on capnography?
A
yellow
3
Q
what color indicates abnormal Etc02 on capnography?
A
purple
4
Q
Potential causes of low C02? (4)
A
PE
DKA
anxiety
pain
5
Q
potential causes of high C02? (2)
A
respiratory distress
respiratory failure from fatigue
6
Q
what drugs can be given through an ETT?
A
N-Narcan A-Atropine V-Vasopressin E-Epinephrine L-Lidocaine
7
Q
what meds for intubation?
A
paralytics (roc, sux, etomidate)
sedatives (midazolam)
8
Q
when would we not give paralytics in an RSI?
A
if the patient is postcode, unconscious…
9
Q
how do we tell if paralytics are at the appropriate level?
A
train of four
2/4 is normal
3 or 4/4 is too low a dose
0 or 1/4 is too high a dose
10
Q
when do we suction a patient?
A
- only as needed
- if secretions are visible in the ET tube
- coughing
- dropped 02 sat
- visible secretions in mouth
11
Q
what is the open suction technique?
A
requires sterile gloves
12
Q
what is the closed suction technique?
A
does not require sterile gloves because it is enclosed in a sterile catheter
13
Q
proper care of an intubated patient? (6)
A
- q2h oral care and PRN
- DVT prophylaxis
- Prilosec
- Gut feeds
- HOB >30 degrees
- handwashing
14
Q
why do we do oral care for intubated patients?
A
to prevent breakdown and VAP
15
Q
why do we do DVT prophylaxis on intubated patients?
A
because the intubated patients will not be moving
16
Q
why do we give Prilosec to patients that are intubated?
A
to prevent ulcers
17
Q
why do we do gut feeds for patients that are intubated?
A
patients that are intubated require protein to heal and recover to eventually get off of the vent
18
Q
why do we elevate an intubated patient’s HOB to 30 degrees?
A
to prevent aspiration
19
Q
what are the 4 modes of ventilation?
A
- CPAP
- BiPAP
- BiLevel
- ACVC
20
Q
what is PEEP?
A
positive end-expiratory pressure: helps to keep alveoli open and improve oxygenation
21
Q
what is a normal PEEP?
A
3-10 with 8 being the average
22
Q
What are the signs of deterioration during ventilation? (7)
A
- color change
- apnea
- Pa02 <50 and PaC02 >60
- diminished breath sounds
- increased rales and rhonchi
- dysrhythmias
- change in LOC
23
Q
what do we do if the ventilator has problems?
A
call RT and bag the patient
24
Q
what is the rate for sinus bradycardia?
A
40-60bpm
25
tx for sinus brady?
-atropine, epi, transcutaneous pacing
26
when do we treat sinus brady?
if you are symptomatic
27
what is the rate of sinus tach?
over 100bpm
28
tx of sinus tach?
- fluids
- NSAIDS
- anxiolytics
- beta-blockers
29
how do we find the rhythm on a strip?
on a 6 second strip, take 1500/small boxes
30
what is the rate of SVT?
>180bpm
31
tx of SVT?
vagal stimulation
adenosine (6mg rapid push, followed by flush)
can double dose and repeat in 1-2 minutes if no response
32
tx of a PAC?
usually benign, but can be treated with beta blockers
33
what is a PAC?
early contraction
34
what is Atrial Flutter?
-presence of sawtooth patterns with an atrial rate of 250-350 and a normal QRS.
35
tx of Atrial Flutter?
- slow the HR, antidysrhythmic drugs (amiodarone or lidocaine)
- cardioversion
- blood thinner due to blood stasis
36
what is atrial fibrillation?
disorganized atrial kicks with a normal QRS
37
tx of atrial fibrillation?
```
amidarone
lidocaine
cardioversion
blood thinner
MAZE procedure
catheter ablation
```
38
what is a MAZE procedure?
uses cat scratches to form scar tissue and prevent fibrillation of the atrium
39
what is a PVC?
premature ventricular contraction
| -causes a distorted QRS complex
40
when do you tx a PVC?
if they happen all the time
41
what is the tx of PVCs?
treat cause
- electrolyte replacement
- oxygen
- beta-blockers
- amiodarone
42
what is ventricular tachycardia?
a run of 3 or more PVCs with a rate of 150-250bpm
| is a life-threatening rhythm!!!!
43
tx of pulsatile ventricular tachycardia?
underlying cause
- amiodarone
- cardioversion
44
tx of pulseless ventricular tachycardia?
ACLS protocol for cardiac arrest with a shockable rhythm
45
what are the 3 types of ventricular tachycardia?
- monomorphic
- polymorphic
- torsades de pointes
46
what is ventricular fibrillation?
deadly rhythm
no QRS noted
no effective CO
47
tx of vfib?
begin ACLS protocol for unshockable rhythm
48
what is asystole?
absence of ventricular electrical activity
| flatline
49
tx of asystole?
ACLS protocol for unshockable rhythm
| CPR and meds only
50
what is PEA?
pulseless electrical activity
| rhythm shows on EKG, but no mechanical activity or pulse.
51
tx of PEA?
compressions, ventilation and meds
| no shocking
52
what is a 1st-degree block?
long PR interval
53
who is a first-degree heart block normal in?
athletes
54
what does a 1st-degree block look like?
extended but stable PR interval
55
what is a 2nd-degree type 1 block?
a wenkebach, longer and longer PR interval, and then a QRS is dropped
56
what is the treatment for a wenkebach?
pacemaker or transcutaneous pacing
57
what is 2nd-degree type 2 heart block?
equal PR lengths blocked QRS
| also known as mirror strip
58
tx of 2nd-degree type 2 heart block?
pacer, transcutaneous pacing
59
what is a 3rd-degree heart block?
no association between atria and ventricles
atrial and ventricular rhythm is regular
there is no association between the p wave and QRS
60
how serious is a 3rd-degree heart block?
very serious!!!!!
| this is a deadly rhythm and can progress very quickly to a deadly rhythm
61
what disease is atrial flutter a precursor to?
CHF
62
tx for 3rd-degree heart block?
pacemaker or transcutaneous pacing
63
what is the intervention for NSR?
nothing: continue to monitor
64
tx for sinus Brady?
wake up pt, atropine, epi, pacing
65
tx of sinus tach?
treat the cause: pain, anxiety, fever, decrease caffeine
66
tx for SVT?
vagal stimulation, adenosine
67
tx of PAC?
betablockers
68
tx of a flutter?
amiodarone and beta blockers
69
tx of a fib?
amiodarone, cardioversion MAZE procedure, blood thinner
70
tx of PVC?
treat cause: electrolytes, oxygen, beta blockers
71
tx of vtach?
amiodarone, lidocaine for pulsatile
| CPR and epi for pulseless
72
tx of vfib?
CPR, ACLS, epi, defibrillation
73
tx of asystole?
CPR, ACLS
74
tx of PEA?
CPR and ACLS
75
tx of junctional rhythm?
atropine, verapamil, pacemaker
76
tx of the 1st-degree block?
continue to monitor
77
tx of wenckebach?
atropine
| temp pacer
78
tx of 2nd-degree type 2 block?
permanent pacer
79
tx of a 3rd-degree block?
transcutaneous pacing per ACLS protocol
80
normal range of CO?
4-6L/min
81
normal range of CI?
2.4-4.0L/min
82
normal CVP?
0-8
83
normal stroke volume?
60-100
84
normal SVR?
800-1200dynes
85
normal PVR?
30-100 dynes
86
what is shock?
tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function
inadequate 02 delivery to meet cellular demands
87
causes of hypovolemic shock?
third spacing or blood loss
88
causes of cardiogenic shock?
left or right ventricular failure, MI
89
3 types of distributive shock?
- anaphylactic
- septic
- neurogenic
90
what is hypovolemic shock?
from fluid shifts (hemorrhage, burn, ascites, dehydration)
or fluid loss (trauma, surgery, vomiting, diuresis, diarrhea, DI)
not enough fluid or blood to meet bodies demands
91
what is cardiogenic shock?
impaired 02 delivery due to cardiac dysfunction
92
tx of cardiogenic shock?
milrinone
93
causes of obstructive shock?
PE, tension pneumo, cardiac tamponade
94
what is normal lactate?
below 2
95
what does elevated lactate indicate?
cellular hypoxemia, not enough oxygen o meet the bodies demands/
96
what is septic shock?
widespread infection-causing elevated WBC, fever and hyperglycemia
97
what is neurogenic shock?
loss of balance between sympathetic and parasympathetic nervous system
98
causes of neurogenic shock?
SCI, spinal anesthesia, CNS damage
99
causes of anaphylactic shock?
allergic reaction with systemic response causing widespread vasodilation
100
what happens in the initial stage of shock?
first cellular changes, include decrease aerobic and increase anaerobic
no s/s yet
101
what happens in the compensatory stage of shock?
attempt to compensate for decreased CO and decreased adequate 02 and nutrients. neural, hormonal and chemical responses
102
what happens in the progressive stage of shock?
end-organ failure due to cellular damage. usually GI and renal first, then cardiac, with loss liver and cerebral function
103
what happens in the refractory stage of shock?
irreversible damage
104
tx of shock?
- optimize 02 delivery
| - decrease 02 consumption
105
ways to optimize 02 delivery?
- supplemental 02
- IV fluids
- inotropic drugs
- vasoactive drugs
- vasodilators
106
ways to reduce oxygen consumption?
- decrease total body work
- mechanical intubation
- paralytics
- sedation
- minimize pain and anxiety
- maintain body temperature
107
examples of inotropic drugs?
dopamine
dobutamine
milrinone
108
examples of vasoactive drugs?
epinephrine
levophed
dopamine
vasopressin
109
examples of vasodilators?
nitroprusside
| nitroglycerin
110
examples of paralytics?
rocuronium
succinylcholine
etomidate
111
examples of sedation?
propofol
| midazolam
112
examples of pain/anxiety medication?
fentanyl, morphine, tylenol, ativan
113
how to maintain body temperature?
Tylenol and fluids
114
what is SIRS?
systemic Inflammatory response syndrome
115
what is the criteria for dx of SIRS?
2 or more of the following
- temp (>100.4 or <96.8)
- HR >90
- respiratory rate >20
- WBC >12,000 or <4,000 or 10% immature neutrophil
116
what are the complications of SIRS?
- ARDS
- AKI
- shock
- MODS
117
what is SIRS a precursor to?
MODS
118
Criteria for dx of MODS?
altered fx of 2 or more organs
acutely ill pt
hemostasis cannot be maintained without intervention
119
what happens in stage 1 of MODS?
- increase volume requirements
- mild resp alkalosis
- oliguria, hyperglycemia, increased insulin requirements
120
what happens in stage 2 of MODS?
tachypnea, hypocapnia, hypoxemia, moderate liver dysfunction
121
what happens in stage 3 of MODS?
azotemia, increased acid-base disturbance
122
what happens in stage 4 of MODS?
vasopressor dependent
oliguria or anuria
ischemic colitis
lactic acidosis
123
how is the heart affected in stage 4 of MODS?
systolic BP <90
MAP <70
requires pressor support
124
how is the respiratory system affected in stage 4 of MODS?
Pa02 <250
PEEP >7.5
require mechanical ventilation
125
how is the renal system affected in stage 4 of MODS?
UOP <0.5mL/kg/hr despite fluid resuscitation
126
how is the hematologic system affected in stage 4 of MODS?
platelets <100,000
| Pt/PTT high
127
how is the metabolic system affected in stage 4 of MODS?
low pH
| high plasma lactate
128
how is the Hepatic system affected in stage 4 of MODS?
liver enzymes 2x normal level
129
how is the CNS affected in stage 4 of MODS?
altered LOC
| low GCS
130
what is the basis for palliative care?
psychosocial and spiritual support
131
what is the difference between dopamine and dobutamine?
dopamine is a pressor and dobutamine is an inotrope
132
tx for CSF leak from LP?
blood patch
133
steps of a neuro assessment?
- LOC
- Motor response and strength
- pupillary response
- reflexes
- VS
- NIH
- GCS
134
what are the brain death tests?
- dolls eyes
- cold caloric
- corneal reflex
- EEG
- apnea test
135
s/s of increased ICP?
- decreased LOC
- HA, N/V
- seizure
- ICP monitor at foramen of monroe
136
how to manipulate CPP?
- pressors
- fluids
- CSF drain
- sedation
- osmotic agents
- positioning and paralytics
137
what is a normal pbt02?
20-40mmHg
138
seizure precautions?
```
standby or blow by 02
padded rails
low bed
loose clothing
privacy
```
139
what happens in a partial simple seizure?
no impairment in consciousness
| alterations in motor and sensory
140
what happens in partial complex seizures?
impaired consciousness and repetitive activities during a seizure
has a postictal state
141
what can a partial complex seizure evolve into?
tonic-clonic seizure
142
what is an absence seizure?
blank stare with impaired consciousness
| most common in children
143
what is a tonic seizure
sudden onset with stiffness and extension of extremities
144
what is a clonic seizure?
rhythmic jerking motions that are either unilateral or bilateral
145
what is an atonic seizure?
body suddenly goes limp
146
what is a tonic clonic seizure?
also known as a Grande Mal seizure
| stiffening and jerking motions
147
what is a postictal state?
sleepy, confusion, and amnesia
148
what meds can be used for seizures?
- Ativan
- Dilantin
- phenobarbital
- klonopin
- lamictal
- Depakene
- Tegretol
149
which med can cause gingival hyperplasia?
Dilantin
150
what is the main way to test for meningitis?
lumbar puncture
151
clinical presentation of meningitis?
nuchal rigidity
fever, positive kernig/brudzinski sign
petechial rash, HA
152
what medication for family members exposed to meningitis?
ciprofloxacin
153
what medication for inflammation r/t meningitis?
solumedrol (dexamethasone)
154
tx of encephalitis?
admit with HA and fever
| cultures are almost always negative
155
what is Reyes syndrome?
caused by overuse of aspirin
| -encephalopathy with hepatic, metabolic and neurologic failure
156
what is guillan barre?
follows respiratory infection
ascending paralysis with a breakdown of the myelin sheath
requires longterm PT
concern in loss of respiratory drive
157
what is an ischemic stroke?
clot form heart condition or DVT
158
tx of ischemic stroke?
within 3 hours TPA
| after 3 hours requires mechanical extraction
159
how to determine if the stroke is ischemic or hemorrhagic?
CT w/o contrast
160
what is a hemorrhagic stroke?
bleeding into brain tissue, ventricles, or subarachnoid space
161
what is Parkinson's?
progressive movement disorder from loss of cells in substantia nigra
162
what are the cardinal signs of Parkinson's?
requires 2/4 for dx
- tremor
- rigidity
- bradykinesia
- postural instability
163
tx of Parkinson's?
Levodopa
164
what is bells palsy?
unilateral inflammation of 7th CN causing facial paralysis or weakness and ptosis with recovery in 3-5 weeks
165
what is myasthenia gravis?
autoimmune disorder affecting the myoneural junction; causing weakness in face, throat, or body, with no effect on sensation
166
how is MG diagnosed?
tensilon test
| edrophonium is injected and if the pt has an increase in muscle strength, they have MG
167
meds for MG?
- mestinon
- prostigmine
- immunosuppressants
- IVIG
168
what is MS?
progressive demyelination with plaque development in the brain
169
tx of MS?
delay the progression of the disease, and prevent acute exacerbations- tx is symptom relief
170
what is trigeminal neuralgia?
5th cranial nerve inflammation-causing involuntary contraction of facial muscles which is triggered by stimulation
171
what is a primary injury?
the injury at the time of impact
172
what is a secondary injury?
complications from the primary injury caused by inflammation
173
how can we prevent secondary injury?
steroids and anti-inflammatories
174
what are the 3 types of skull fractures?
linear, basilar, and depressed
175
what are the types of spinal cord injuries?
concussion, contusion, laceration, transection, and hemorrhage
176
what is a complete spinal cord injury?
total loss of sensation and motor function
177
what is the marker for a basilar skull fracture?
battle sign, bruising behind the ears
178
what is an incomplete spinal cord injury?
varying degrees of sensory and motor function disruption
179
what is autonomic dysreflexia?
life-threatening condition after a spinal cord injury caused by either a full bladder, rectum.... causing a hypertensive crisis with HA, sweating, tachycardia and HTN
180
identifying features of AML?
blast cells >30% and is usually after a previous cancer tx; especially Hodgkins lymphoma
181
identifying features of CML?
Philadelphia chromosome; tx is Gleevec
182
identifying features of ALL?
Blast cells >30%, and seen in young children and the elderly
183
Identifying features of CLL?
enlarged lymph nodes, hepatomegaly and splenomegaly with B symptoms
184
Identifying features of Hodgkin Lymphoma?
- Reed Sternberg cells, originate in a single node then spread to other lymph nodes.
- Agent Orange and Epstein Barr virus are some causes
- Highly curable but can have new cancers after, like AML.
185
identifying features of Non-Hodgkin Lymphoma?
- usually multiple sites
- late diagnosis
- can involve CNS
- monoclonal antibodies are tx
186
what is DIC?
dysfunction in clotting and bleeding. platelets and fibrinogen decreased. PT/PTT/d-dimer is increased
187
what two illnesses makeup COPD?
chronic bronchitis and Emphysema
188
what is chronic bronchitis?
-cough and sputum production at least 3 months in 2 consecutive years; associated with obesity, frequent cough, and accessory muscle use
189
what is emphysema?
overdistended alveoli, barrel chest, and pursed-lip breathing are present. hyper resonant percussion of the chest
190
what percent of URIs are viral?
90%
191
what is OSA?
obstructive sleep apnea
192
what is the tx for pneumonia?
zithromax, steroids, no cough suppressants, and encourage fluids
193
What are the s/s of TB?
cough more than 3 weeks, weight loss, night sweats
194
tx of TB?
long term antibiotics >6 months
195
S/s of a PE?
dyspnea, tachycardia, chest pain, anxiety
196
how fast can death occur with a PE?
within one hour of onset of symptoms
197
tx of PE?
lyse clot and prevent the formation of a new clot
198
what do chest tubes do?
promote lung expansion
199
what sex has HIV and AIDS more often?
males; 5:1 ratio
200
tx of HIV/AIDS?
outpatient tx generally
201
how is HIV/AIDS transmitted?
- blood
- seminal fluid
- vaginal secretions
- breastmilk
202
tx of HIV/AIDS?
anti-retroviral medications
203
who more often has RA?
females 4:1 and males 2:1
204
what is RA?
autoimmune reaction in synovial tissue causing destruction of bone and cartilage. results in joint pain, swelling, and deformity.
205
what is SLE?
systemic lupus erythematosus
206
what is the main symptom of SLE?
butterfly rash
207
what is the goal of tx of lupus?
reduce acute episodes
208
what is scleroderma?
excessive accumulation of collagen in tissues
209
what is Reynaud's syndrome?
decreased perfusion to tips of fingers
