test 2

Question 1

Assist control

Answer 1

resting mode. must set rate, Vt (tidal vol- amount of air inhaled and exhaled), inspiratory time, and PEEP. ventilator sensitivity is also set, and when the pt initiates a spontaneous breath, a full volume breath is delivered. All breaths are of the same preset vol (ACV)

Question 2

Synchronized Intermittent Mandatory Ventilation SIMV or IMV

Answer 2

Must set rate, Vt (Tidal vol), inspiratory time, sensitivity and PEEP. In between “mandatory breaths”h pts spontaneously breath at their own rates and Vt. with SIMV, the ventilator synchronizes the mandatory breaths with the pt’s own respirations. during spontaneous breaths receives pre set FiO2, but self regulates rate and vol. prevents muscle atrophy as the pt takes on more of the WOB.

Question 3

continuous positive airway pressure (CPAP)

Answer 3

delivers continuous positive pressure during spontaneous breathing and restores functional residual capacity (FRC)

Question 4

guidelines on ventilator associated pneumonia (VAP) prevention

Answer 4

VAP prevention: HOB min 30-45
uno routine changes of circuit tubing
dorsal lumen above the cuff to allow continuous suctioning of subglottic secretions
gloves and HH
always drain water that collects in tubing away from pt

Question 5

hemoglobin levels and anemia

Answer 5

hemoglobin:
female: 12-16 (+ 1 for males)
mild anemia: 10-12
moderate anemia: 6-12
severe less than 6

Question 6

sxs of anemia

Answer 6

mild- moderate: fatigue, palpitations, dyspnea, roaring in ears

Question 7

cobalamine

Answer 7

vit b 12, rbc maturation, red meat, liver, dairy, fish, enriched grain, eggs. deficiency usually in vegetarian diet, or dairy elimination, chronic alcoholics

Question 8

folic acid

Answer 8

rbc maturation, green leafy vegetable, liver, meat fish legumes whole grains orange juice peanuts

Question 9

iron

Answer 9

liver, muscle meats, eggs, dried fruit, legumes, dark green leaf veg, whole grain and enriched bread and cereal, potato. 2-6grams. 2/3 in hemoglobin and muscles, 1/3 in bone marrow, spleen, liver. if have iron def anemia need to eat 10-15mg/day

Question 10

ascorbic acid

Answer 10

vit c, conversion of folic acid to its active form, aids in iron absorption- citrus, green leafy vegetables, strawberries, cantalope

Question 11

iron deficient anemia sxs

Answer 11

iron def anemia sxs
mild- weak, pallor, TONGUE INFLAMMATION
other- fatigue, FISSURES in corners of mount, NAILS- thin, brittle, rigid, SPOON SHAPED

Question 12

Iron administration

Answer 12

diet high in iron- 10-15mg/day
PO-coated, take with vit C, one hr before meal
IM/IV (only for severe) watch for allergic rxn!
IM (Iron dextran)- z track to reduce skin staining
IV (sodium ferrous gluconate) less chance allergy

Question 13

troponin I (cTnl)

Answer 13

bedside assay, serial sampling X3, with CKMB and serial ECG, contractile protein released after MI, both I and T highly specific to cardiac tissue. neg <0.5, suspicious 0.5-2.3, positive >2.3

Question 14

CK-MB

Answer 14

> 4-6% of total CK are indicative of MI, increase within 4-6 hrs, serial sampling with troponin

Question 15

normal pr interval

Answer 15

0.12-.20

Question 16

normal qrs time

Answer 16

0.04-0.12, prolonged- bundle branch prob

Question 17

pvc

Answer 17

caused stimulant, infection trauma or hypo
fix prob, if symptoms give O2 and lidocaine. then amiodarone, eliminate stress and stimulants
PVCs have wider irreg QRS with a reg underlying rythm

Question 18

A Fib

Answer 18

irreg R to R. reduced CO and BP. amiodarone to fix- anticoagulant. TEE to verify no clots then cardioversion

Question 19

amidodarone

Answer 19

1dose- loading dose, slow ivp always D5W, always filter

Question 20

V tach with pulse

Answer 20

O2 and Epi, 12 lead EKG, amiodarone, prepare for cardioversion. long term- place an ICD
torsades de pointes- low mg

Question 21

atropine

Answer 21

for both second degree blocks- then transcutaneous pacemaker

Question 22

duration of qt interval

Answer 22

.34-.44

Question 23

ST seg

Answer 23

.12 second- myocardial ischemia or infarct aka acute coronary syndrome

Question 24

ACE inhibitor

Answer 24

prils- greatly reduces incidence of adverse outcomes in pt with CAD, reduces blood pressure, reduce after load after MI, used in HF (DOC) and protect kidney, for after stem of anterior wall with HF or EF <40. baseline BP, WBC with diff. first dose hypotension- d/c diuretics 2-3 days before, start low dose, monitor BP closely for 2 hours- if necessary, give fluids. persistent dry cough, taste diminished, hyperkalemia (no sparing diuretic), angioedema, neutropenia and birth defects

Question 25

ACE inhibitor

Answer 25

prils- prevents vasoconstriction. greatly reduces incidence of adverse outcomes in pt with CAD, reduces blood pressure, reduce after load after MI, used in HF (DOC) and protect kidney, for after stem of anterior wall with HF or EF <40. baseline BP, WBC with diff. first dose hypotension- d/c diuretics 2-3 days before, start low dose, monitor BP closely for 2 hours- if necessary, give fluids. persistent dry cough, taste diminished, hyperkalemia (no sparing diuretic), angioedema, neutropenia and birth defects

Question 26

Ca channel blocker

Answer 26

same effect on heart as beta blocker. reduce force of contraction, slow heart rate, and suppress conduction through the AV node- lower bp and increase o2 to the heart. used to prevent angina. Very Nice Drugs Dis(pines)- more vasodilation of coronary arteries. verapamil for dysrhythmia, diltiazem for both.s/e HA, hypertension, dizzy, peripheral edema, renal/hepatic dysfncn, no beta blockers- cause HF *caution with HF, LV impairment, AV block; call dr if HR irreg. SOB, swelling, n/v, dizzy

Question 27

Ca channel blocker

Answer 27

same effect on heart as beta blocker. reduce force of contraction, slow heart rate, and suppress conduction through the AV node- lower bp and increase o2 to the heart. used to prevent angina. Very Nice Drugs Dis(pines)- more vasodilation of coronary arteries. verapamil for dysrhythmia, diltiazem for both.s/e HA, hypertension, dizzy, peripheral edema, renal/hepatic dysfunctional, no beta blockers- cause HF * taper off or risk of rebound HTN * caution with HF, LV impairment, AV block; call dr if HR irreg. SOB, swelling, n/v, dizzy

Question 28

sympathomimetic drugs

Answer 28

dopamine and dobutamine- both- increase contractility and HR, dilates renal blood flow (more pp). both short term HF treatment, both continuous infusion, continuous monitor UO, ECG, and BP. Only dopamine increase after load, decrease CO, so dobutamine preferred. Dig only one can take PO/ long term. Both risk for tachycardia. dopamine for neurogenic shock. also NE (levophed), increase HR and BP and decrease UO

Question 29

beta blocker

Answer 29

prevent SNS stimulation, decrease atrial ectopic stimulation, for HTN, angina, Afib, a flutter take apical pulse before and call dr <60, if asthma want B1 selective, non selective also affects lungs≥ can mess up hypoglycemic response, don't take with verapamil

Question 30

amiodarone

Answer 30

K channel block- prolong the action potential and refractory period of the cardiac cycle, decreases rate of depolarization, decrease contractility, PO- conversion of A fib, recurrent Vfib or Vtach. loading dose, filter, d5w A/E pulm tox -baseline cxr and pulm fan test, baseline liver and thyroid, call with vision changes (blind), highly toxic, A/E may last for a while after d/c. no grapefruit= tox, sig increase risk of dig tox. first for AFIB, most widely used antidysrythmia drug. combo with ACEI or BB can cause bradycardia, risk of severe dysrhythmia increases with diuretic use- because of decrease in k and mg

Question 31

heparin

Answer 31

effective aPPT 60-80 seconds (normal 30-50)

Question 32

warfarin

Answer 32

effective PT 1.5-2 times control (normal 12-13) | INR 2-3

Question 33

atropine

Answer 33

given for symptomatic sinus brady, and for both 2nd degree heart blocks, with o2. may do transcutaneous pacing. reverses parasympathetic slowing of the heart and increases HR

Question 34

norepinephren

Answer 34

sympathomimetic, used for shock to increase HR and BP, long term will injure kidneys. vasoconstriction, shunts blood away from extremities. decrease kidney perfusion- decrease UO, dilate pupils, glycogenesis, bronchioles open norepinephrine-NE-levophed epinephrine- give when pulseless, CPR, defibrillator

Question 35

lidocaine for

Answer 35

PVC, Vtach (with amiodarone),maybe with epi during asystole. without Vtach will convert to Vfib

Question 36

tetralogy of fallot

Answer 36

have a ventricle septal defect, an overriding aorta, pulmonic stenosis with resulting right ventricle hypertrophy. Severity depends on severity of stenosis

Question 37

coarctation of the aorta

Answer 37

narrowed at one point, hypertrophy of left ventricle, heart damage. HTN in upper extremities, hypotension in lower extremities. TX- balloon angioplasty, a little at a time to stretch out

Question 38

PVC

Answer 38

ectopic beat from ventricle, QRS usually >.12 sec, unifocal- same place, multifocal- different origins (PVCs look different) give lidocaine and o2 if symptomatic. sustained- more than 30 second run. 3+ in a row= Vtach. lower stress and stop stimulants

Question 39

LDH1 and 2

Answer 39

LDH 1 is heart and LDH 2 is serum, 2 should be larger, if 1 is larger- heart had issue

Question 40

risk factors for sudden cardiac death

Answer 40

usually caused by acute ventricular dysrhythmias (Vtach, Vfib). strongest predictors: left ventricular dysfunctional (EF < 30%) and Vent. dysrhythmias after MI. others: hx of syncope, left ventricular outflow tract obstruction/ aortic stenosis, male gender- especially african american, and family hx of left ventricular dysrhythmias. if witnessed- therapeutic cooling. use implantable cardioverter-defibrillator to prevent reoccurrence.

Question 41

post heart sx exercise

Answer 41

start slow- listen to body, limit isometric bc HR and BP rise quickly. do isoTONIC exercises- with movement. assess HR and keep in target limits- 80% of max or < 20 more than resting rate. If HR exceeds limit, or have chest pain or SOB, take a break. always warm up and cool down (5 min), aim for most days of week for at least 30 minutes.

Question 42

Before cardiac cath/pci

Answer 42

assess allergies (contrast), v/s, heart and breath sounds, pulses, skin temp, color, sensation of extremities, teach procedure, kidney fxn (mucomyst/acetylcysteine protects, you will have palpitations, hot and flushed all over

Question 43

post cath/pci

Answer 43

perform assessment again and compare with baseline. assess cath insert site for bleeding, monitor ECG for dysrhythmia, monitor for pain, monitor IV infusions of anticoagulants and anti platelet, teach about d/c meds and activity restrictions (asa, clopidegrel, nitro), assess q15min for first hour. monitor map and bp- if not correlating, something is leaking. monitor blood sugar. 5 Ps distal to puncture site. bed rest, flat, leg straight for 4-6 hrs, hold metformin next 48 hrs. notify dr if chest pain

Question 44

come in with crushing substernal chest pain

Answer 44

oxygen, nitro, asa, morphine, ekg, health hx

Question 45

carvedilol

Answer 45

peripheral alpha blocker for HTN, take at bedtime to avoid dizzy, orthohypo, avoid excessive exercise, prolonged standing (constricts) and heat (dilates). OD can cause profound bradycardia, hypotension, bronchospasm and carcinogenic shock. take BP standing 1 hour after amin to assess tolerance, titrate down- or may cause sweating, palpitations and HA

Question 46

Risk for CAD

Answer 46

HTN, tobacco use, inactivity, stress, anger, anxiety, obesity, diabetes, family hx heart d/s, white middle aged men, age, elevated serum lipids: total cholesterol over 200. HDL <50, LDL >160, triglycerides >150

Question 47

hemorrhagic shock

Answer 47

aka hypovolemic shock. tx- crystalloid fluid replacement and colloids (fluid loss, blood loss) blood loss may need plasma expanders/ blood products. sxs-dcreased cardiac output- fast thready pulse, low BP, tachycardia, dizzy, lethargic, anxious- lots of blood in spleen, femur, heart.

Question 48

cardiogenic shock

Answer 48

pump prob. tx- pressers, inatropes, treat underlying problem, drugs to increase cardiac output. sis- tachycardia, tachypnea, pulmonary edema- not pumping, blood backing up, low UO

Question 49

anaphylactic shock

Answer 49

sensitivity prob, bronchoconstriction, laryngospasm- all smooth muscle tighten, chest pain, third spacing, flush, sweat, swell, n/v/d. maintain airway potency, epinephrine, antihistamines, risk for decrease BP from getting leaky- IV fluids and 02

Question 50

neurogenic shock

Answer 50

within 30 min of above t5 spinal cord injury. last up to 6 wks, lose sympathetic tone, heart rate slow, veins dilate- low bp, cold, dry skin, risk for hypothermia. lose reflexes. tx- vasopressors (dopamine), corticosteroid, may need to be paced or inatrope, may need ventilator, do need O2, maintain blood pressure and temperature (keep warm)

Question 51

distributive shock

Answer 51

lose perfusion to peripheral veins, neurogenic, anaphylactic and septic

Question 52

CO and Cardiac index

Answer 52

co=stroke vol X HR, CO is usually 4-8 L/min | cardiac index= CO/Body surface area (BSA). this adjusts the CO to boxy size. normal CI is 2.8 to 4.2

Question 53

ventricular remodeling

Answer 53

to compensate for damaged heart, unaffected ventricle hypertrophies and dilates. also, affected area grows scar tissue- don't want it too large/stiff. ACE inhibitors can prevent or reverse ventricular remodeling. if pt can't handle ACEI- then give ARB

Question 54

ventricle aneurysm

Answer 54

risk for 6 weeks- slowly increase activity and be mindful. sx: HF sxs, dysrhythmia, or angina. aneurysm harbor thrombi- risk of embolic stroke

Question 55

V tach w/ pulse tx

Answer 55

lidocaine and o2 first, epi (keep perfusing), amiodarone, maybe cardioversion. no pulse- epi, cpr, defib. monomorphic- all qrs look the same, polymorphic- look different, like tornadoes de points

Question 56

a fib tx

Answer 56

amiodarone first (if symptomatic ) anticoagulants, most common dysrhythmia, irregular rhythm

Question 57

premature atrial complex pac tx

Answer 57

no tx- find and tx underlying cause of atria irritation- caffeine, stress, hypok, CHF, MI..

Question 58

A flutter

Answer 58

prob from one place- ablation therapy. Atrial rate around 300, ventricle rate matters for perfusion. "controlled" if ventricle rate less than 100. no sx- no tx. regular rhythm

Question 59

2 degree AVB type 1

Answer 59

wenkebach. progressive prolongation of PR interval, bradycardia. if sxs- atropine to increase HR

Question 60

pacemakers for

Answer 60

symptomatic 2nd degree AVB type 2, 3rd degree AVB, Sinus brady (if atropine did not work, or suppression of persistent tachycardia. synchronous is synched with your heart- so only fires when needs to. a synchronous- has a set rate. fail to capture- regular rate, turn up. failure to sense- irregular rate of spikes- pacemaker malfunction

Question 61

sinus tachycardia tx

Answer 61

tx reason, adenosine, beta blocker, vagal nerve stimulation, verapamil

Question 62

hyperemic resp failure

Answer 62

paO2 <60 w/ O2 >60% normal 80-100

Question 63

ARDS

Answer 63

sudden and progressive- alveolar capillary interface becomes damaged and more permeable. P-PaO2, F- FiO2, norm P/F ration >400. 200-300 acute lung injury. <200 = ARDS most common early sxs- tachypnea anddyspnea

Question 64

chest tube- when to call dr

Answer 64

tracheal deviation, sudden increase WOB, Drained >100mL in 1 hour, Drainage stops after 24 hours (and can't find occlusion), pulled or falls out, visible eyelet, o2 sat <90,

Question 65

pneumothorax causes

Answer 65

trauma, PEEP, clamping chest tube, taping pneumothorax X4, emphysema,

Question 66

hemoglobin- anemia

Answer 66

normal hgb: 12-17 mild anemia: 10-12 moderate anemia: 2-10 severe <6