Interpretation of Monitoring

Question 1

Hypernatremia value

Answer 1

> 145

usually hypovolemic

Question 2

CNS changes, mental status changes,
irritability, hyperreflexia, ataxia, seizures, hypotension
after induction.

Answer 2

signs and symptoms hypernatremia

Question 3

Treatments for hypernatremia

Answer 3

volume
diuretics if hypervolemic
vasopressors, inotropes

Question 4

Hyponatremia [more commom] value

Answer 4

Na <135, usually hypervolemic

Question 5

CNS,lethargy, cramps, decreased reflexes, seizures.

Answer 5

hyponatremia s&s

Question 6

Na+ <120 associated with

Answer 6

50% mortality rate

Question 7

treatment hyponatremia

Answer 7

• CHF inotropes
• lasix
• replete Na with 3% saline

Question 8

Too rapid a correction with 3% saline (hypertonic saline) may lead to

Answer 8

demyelination of pontine neurons and a condition known as central pontine myelinolysis

Question 9

Hyperkalemia value

Answer 9

> 5.5

Question 10

f K+ > 6.0, what rhythm changes will you see?

Answer 10

prolonged PR, peaked T waves

Question 11

significant S&S of high K?

Answer 11

conduction disturbances of the heart

[ESRD, HD, DKA, meds]

Question 12

treatments of >K?

Answer 12

avoid acidosis, hypoventilation, >ETCO2
Calcium
lasix
glucose/insulin/D10

Question 13

for every 10 mmHg change in EtCO2 the K+ changes

Answer 13

0.5 mEq

Question 14

what med should you avoid with >K and why?

Answer 14

avoid succinylcholine, intubating dose ↑’s K+ 0.5 mEq

Question 15

Hypokalemia value

Answer 15

<3.5

Question 16

typical causes of

Answer 16

diuretics, N/V, GI losses

Question 17

muscle weakness, cramps, PVCs, high U waves,
flattened low or even inverted T waves, low ST
segment, worsens digoxin toxicity

Answer 17

S&S

Question 18

treatment

Answer 18

avoid hypoventilation, alkalosis
glucose
k replacement

Question 19

what does

Answer 19

prolongs

Question 20

causes of hypercalcemia

Answer 20

hyperparathyroid, cancer,

*breast cancer alone causes 25-50% of hypercalcemia.

Question 21

N/V, ↓ deep tendon reflexes, hypotonia,

confusion, lethargy

Answer 21

hypercalcemia S&S

Question 22

treatment hypercalcemia

Answer 22

Maintain hydration and UOP.
• Loop diuretics (avoid thiazide diuretics, they ↑Ca++
reabsorption)
• Monitor muscle relaxation using nerve stimulator.

Question 23

Hypocalcemia causes

Answer 23

↓’d PTH, ↓’d Mg+ (causes ↑’d end-organ resistance to PTH)
alkalosis (↑’d pH causes iCa++ bind to protein),
massive blood tx, (citrate binds Ca++),
pancreatitis,
hypoparathyroidism
removal of parathyroid

Question 24

tetany, twitching, laryngospasm, tingling lips &

fingers. Spontaneous action potentials are generated.

Answer 24

Hypocalcemia

Question 25

treatment hypocalcemia

Answer 25

Avoid hyperventilation • Avoid alkalotic conditions, maintain normal to hypercarbic state (↑EtCO2) • IV replacement if severe symptomatology.

Question 26

Hypomagnesemia causes

Answer 26

Poor GI absorption, Dialysis, ETOH

Question 27

S&S hypomagnesemia

Answer 27

Dysrhythmias, Ventricular –Muscle weakness/twitching/tetany –Tetany

Question 28

Treatment

Answer 28

Supplemental Mg++ –Avoid diuretics Mg++ follows Na+ –Cautious with muscle relaxants –Mg++ helps treat and correct refractory hypocalcemia and hypokalemia

Question 29

Hypermagnesemia causes

Answer 29

Rare, infusions for preeclampsia and pheo

Question 30

S&S hypermagnesemia?

Answer 30

–Lethargy, Loss of deep tendon reflexes, paralysis, hypotension, heart block –Acidosis worsens effects

Question 31

treatments hypermagnesemia?

Answer 31

temporary dialysis –Loop diuretics –Reduce muscle relaxants –Adequate ventilation to prevent acidosis

Question 32

Measures the degree of systolic dysfunction

Answer 32

Ejection Fraction, normal 55 or greater

Question 33

Graded Systolic Dysfunction

Answer 33

* Mild 45-54% * Moderate 30-44% * Severe less than 30%

Question 34

Indicator of balance between oxygen delivery & consumption. Normal range 68-80%. Normal extraction around 25%

Answer 34

``` Mixed Venous (SvO2) and Central Venous (ScvO2) ```

Question 35

Four primary factors impact SVO2

Answer 35

–Oxygen consumption (VO2) –Hemoglobin level (hgb) –Cardiac Output (CO) –Arterial oxygen saturation (SaO2)

Question 36

Decreased svo2 causes

Answer 36

* Increased VO2 (Fever, hyperthermia) * Decreased hgb (anemia, hemolysis) * Decreased SaO2 * Decreased CO (ex: MI, CHF, hypovolemic states)

Question 37

increased svo2

Answer 37

• Decreased VO2 (cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis) Increased hgb (volume depleted) • Increased SaO2 •Increased CO (burns, inotropic drugs)