| Question | Answer |
| What is the pathway of blood flow through the Heart? | SVC/IVC, R Atrium, tricuspid, R Vent, pulmonic valve, pulmonic artery, Lungs, Pulmonic vein, L atrium, L Vent, aortic valve, aorta, body, SVC/IVC |
| What is the order of valves in the heart? | Tricuspid, Pulmonic, Mitral, Aortic (TPMA) |
| What is the order of heart sounds? | Aortic (R 2nd), Pulmonic (L 2nd), Tricuspid (L 4th), Mitral-Apex-Apical (L 5th) |
| Where are S1 and S2 heard? | 4th and 5th intercostal space (easier to hear if pt is on their L side) |
| If pt has heart damage where can the sounds be heard best? | Laterally |
| What is preload? | The Amt of blood return to the heart (mostly R side) |
| What is after load? | the pressure in aorta and peripheral artery that the L Vent has to pump against to get blood out of heart to body.
Increased BP is added resistance that L Vent has to pump against. |
| If you increase the volume going back to heart (preload) what does that due to workload? | Increases work load |
| What can Increased BP lead to in terms of the heart? | CHF and PE- if you increase after load this decreases CO and wears out heart muscle. |
| What is the formula for CO and what affects it? | SV=HRxSV
-tissue perfusion
-changes dep on bodes needs (if your HR inc then your SV with inc and then your CO will inc)
-HR (if D or I too much CO drop)
-BV (less volume less CO)
-D contractibility (meds, MI, Muscle Dz) |
| What is SV? | amt of blood pumped out of vent with each heartbeat |
| Left Ventricle equals... | CO (cardiac output) |
| What happens to CO if you Increase after load? | Decrease (too much pressure to pump against) |
| What are some complications of Decreased CO? | - chest pain, wet lungs, SOB, cold/clammy skin, D UO, D peripheral P
-Bradycardia (D HR) is ok if CO is still functioning well (can't have any of above sx)
-NO CO = PULSELESSNESS/V-Tach/V-Fib |
| What is ANGINA? | Decreased BF to myocardium that leads to ischemia or necrosis
-Can be stable (know factors/tx) or unstable (unknown factors/tx) |
| What is ISCHEMIA? | -Temporary pain and pressure in chest usually caused by CAD
-Pain is caused by D O2 usually do to EXERTION
-Tx: REST and NITRO |
| How does NITRO work? | -Dilation of Veins and Arts (D pre/after which D workload on Heart)
-Dilation of Coronary Art (I BF to heart muscle brings O2 & stops pain)
-1 q 5 min x3 ( if this doesn't work go to ER)
will D BP but should go back up-never leave pt until stabilized |
| How do BB work? | -Antihypertensive
- slows HR and D contractibility
-D workload which D CO
-Blocks Beta receptors on heart that accept catacholemines (NE, Epi) |
| How do CCB work? | -antihypertensive
-dilate Coronary Art (more O2 goes to heart muscle) |
| Why do ASA's help with ANGINA? | prevents blood from sticking together in case they are actually having an MI (chewable is best bc it works fast)
-stops clot from forming
81-325mg |
| What are some NSG MGT for ANGINA? | -NO isometric exercises (no strenuous exercises on test!!)
-NO caffeine/drugs/overeating/smoking (Increases HR)
-wait 2 hrs after eating to exercise
-avoid Temp extremes
-NItro propholaticly (will be dizzy bc D BP, have pt sit down SAFETY) |
| What are 2 things to ask about before CARDIAC CATH? | -allergic to SHELLFISH/IODINE
-kidney problem (dye is excreted through kidney and could cause renal failure if it can't be excreted) |
| What med might be given if pt has kidney problems and needs cardiac cath? | Mucomyst (helps protect kidneys) |
| What are the 2 Sx someone will feel after getting a dye injection? | FLUSHING (and warmth) in face and METALLIC TASTE |
| What is the #1 complication of CARDIAC CATH? | HEMORRHAGE (rpt pain at puncture site STAT)
-always check 5 P's after
-hold Metformin before and after (48 hrs)
-lay flat in bed (extremity straight for 48 hrs) |
| ACS/MI/Unstable Angina | -Decreased BF to myocardium (ischema and necrosis)
-dont have to be doing anything to bring it on
-usually occurs in AM while in REM sleep (I HR/BP/WL)
-Rest and Nitro WONT help
-crushing chest feeling |
| What SX do WOMEN have when having an MI? | -Triad (indigestion (GI problems), fatigue, can't catch breath) |
| What SX do ELDERLY have when having an MI? | -SOB is #1 (might just faint)
-behavior change =pain |
| What is a SIGN and ELDERLY person is in pain? | Behavioral Changes |
| What does CPK/MB do? | -Enzymes that are heart specific
-they Increase when damage to heart cells w/in 3-12 hrs after onset of sx and peaks in 24 hrs |
| What does TRIPONIN do? | -Specific to MI damage
-MOST SPECIFIC (can tell if pt delays tx)
-elevates w/in 3-4 hrs and peaks at 3 weeks
-ONLY present when there is MI DAMAGE |
| What does MYOGLOBIN do? | -not specific to dx ACS/MI/Unstable Angina
-GOOD to R/O ACS/MI/Unstable Angina
-Increases w/in 1 hr, peaks at 12 hrs |
| What major ARRHYTHMIA can lead to sudden DEATH? | V-Fib (No CO bc tissue is dead so it can't be perfused)
-DEFIB the V-FIB |
| What are some TX for V-FIB? | -1st DEFIB
-2nd Epi (vasopressor)
-3rd Amiodorone (antiarrythmic- used when resistant to tx, can be given to prevent 2nd) or Lidocaine (D irritability of heart)
-TOXICITY = ANY NEURO CHANGES |
| Tx of MI? | -Oxygen
-ASA (165-325mh)
-NITRO
-MORPHINE (if pain not relieved by Nitro)
-HOB UP
-FIBRENOLYTIC (breaks up clot blocking BF to heart muscle) |
| What do FIBRENOLYTICS do? | -break up clot causing problem (can be used for brain anysm)
-Ex: Streptokinase
- Admin w/in 6-8 hrs (some say 12)
-Rsk: bleeding (ETOH,OD tylenol, liver dz)
-NO if: IC bleeding/aortic disection |
| What kind of meds are PLAVIX, INTEGROLIN, REOPRO) | Antiplatlet |
| What is a CABAG? | - surgery done when L main Art is occluded (aka widow maker) |
| What are SX of HF? | -weight gain
-ankle edema
-SOB
-confusion |
| What is the heart doing when it is REpolarizing? | -REsting
-filling with blood |
| What is the heart doing when it is DEpolarizing? | -DEspensing Blood
-Heart muscle contracts |
| What is an Epicardial Pace maker? | -temporary
-wires attached to heart during heart surgery |
| What is a TRANSCUTANEOUS PACEMAKER? | -Temporary
-Defibrillator on skin set to pacemaker mode (emergency situations)
-painful (requires analgesics) |
| What is TRANSVENOUS PACING? | -wires are placed into heart chamber
-power source is outside body (check batteries) |
| What should you not let you pt do after receiving a pacemaker? | -Dont raise arm above shoulder level
-avoid electromagnetic fields
-no trama to site (no contact sports) |
| What are SX of R side HF? | Backing up into venous system
-edema/acites
-weight gain
Always 2nd to something else (i.e. Pulmonary HTN)
-enlarged organs
-JVD
INCREASE WORKLOAD |
| What are SX of L side HF? | Blood is not moving forward, backs up in lungs
-pulmonary sx
-crackles
-restlessness
-SOB at PM
- Increased HR/BP
-cool/pale
DECREASE CO |
| What is the #1 cause of HF? | HTN
-complication that can result from heart problems (MI, HTN, endocarditis, cardiomyopathy) |
| What is the difference between SYSTOLIC HF and DIASTOLIC HF? | Systolic- heart can't contract and eject blood
Diastolic -heart can't relax and fill |
| What is the #1 cause of PULMONARY HTN? | HYPOXEMIA
-increase BP in lungs, increase WL on R side of heart (rsk for R side HF) |
| What is a SWAN GANZ Cath? | Central line w/balloon inserted into R Atrium, R Ventrical. Pulmonary Artery
-helps to determine cause of D CO, used in HF pt
Complications: Air embolism and Pulmonary Infarct |
| What is BNP? | Blood test to help determine HF (Sensitive Indicator)
-BNP is a peptide that is secreted when vent volume and pressure in heart Increase
-If on Neutracore (vasodilator and diuretic), will need to stop 2 hrs before test (will give false +) |
| What will a CXR show if you are in HF? | -Enlarged Heart
-Fluid in lungs |
| What does Digoxin/Digitalis/Lanoxin do? | -Decreased HR (gives Vent more time to fill with blood)
- Increases CO by squeezing down on more blood w/stronger contractions
-Increases Kidney perfusion (diuresisng helps get rid of fluid) |
| What is the TDL of DIG? | 0.5-2.0
you know it is working when CO increases
Sx: anorexia, N/V (early), weird arrhythmias, vision changes (late) |
| What are GOOD CO SX? | -Improved LOC
-skin warm/dry
-clear lungs
-No SOB
-pulses palpable
-Increased UO
-No Chest pain |
| What is the one electrolyte you really need to watch when a pt is on DIG? | K (potassium), DIG TOX
-any electrolyte imbalance while on Dig can cause toxicity but K gives the most problems |
| Anytime you DECREASE VOLUME you Decrease Pre/Afterload? | Preload (decreases) |
| What common type of medication with DECREASE PRELOAD? | DIURETICS |
| What does ALDACTONE Decrease? | ALDOSTERONE
-give in AM |
| If you have FLUID RETENTION what should you THINK 1st? | HEART PROBLEM
-Keep HOB elevated to Decrease preload bc heart can't handle more fluid or pressure in heart |
| What 2 meds are HF pt usually sent home on? | -BB and ACE
-decrease WL on heart
-prevent vasoconstriction (increases CO- keeps blood moving forward) |
| What electrolyte does Salt substitute have in it? | K (potassium) |
| What things have Increased Na? | -canned foods
-processed foods
-OTC meds
-fried foods |
| If a pt is hypoxic, restless, anxious, has a productive cough and pink sputum what would you assume is going on? | PULMONARY EDEMA
-usually hypoxic at night
-can be caused by any person getting fluids too fast, HF, kidney problems (fluid excreted out of kidneys if not it will back up) |
| What are the 2 main sx of HYPOXIA? | RESTLESS and ANXIOUS |
| How does LASIX work? | Vasodilate (traps more blood in arms/legs), decreases preload and after load
-give slow to prevent hypotension (D BP) and ototoxicity |
| What is the best position for a pt with PE? | Sitting upright with legs down
-helps improve CO
-gravity pulls fluid away from Lungs |
| What is a Cardiac Tampanade? | Blood/fluid/exudate leaks into pericardial sac and compresses heart from outside
-CVP is increased so pressure in heart is Increased |
| What is the Hallmark sign of CARDIAC TAMPANADE? | -Increased CVP
-Decreased BP/CO
***Usually BP and CVP have a direct relationship***
-also narrow P Pressure |
| FVE does what to CVP and BP? | -Increase CVP
-Increase BP |
| FVd does what to CVP and BP and CO? | -Decrease all |
| What main symptom can DECREASED CO lead to? | SHOCK (blood not perfusing vital organs) |
| What is paradoxical BP? | Different reading for inspiration and expiration |
| How do you determine pulse pressure? | The difference between the Systolic and Diastolic pressure
-normal is 40
-lower or NARROW would indicate significant blood loss (D preload/ CO)
-25 or below is due to D SV as in CHF or SHOCK/Cardiac/AV stenosis |
| What are the main sx of Arterial disorders? | sx are in lower extremities
-decreTampanadease peripheral pulse (check 5 P's)
-pain
-sensitive to COLD
Arterial blood not getting to tissue |
| NCLEX MOMENT | IF YOU GET AN ARTERY QUESTION FIGURE OUT WHAT PART OF BODY ITS PERFUSING - MOST OF THE TIME IT WILL BE THE LOC ANSWER |
| What is BURGERS DZ? | Inflammation of veins and arteries
-vasoconstriction
-usually in fingers and toes
-Usually in MALES
-Aterial Disorder |
| What is RYNODS DZ? | Vasoconstricion when upset, cold, stressed
Usually bilaterally in fingers (white-blue-red)
-Usually in FEMALES
-Arterial Disorder |
| What is a Venous problem? | -blood can get to tissues but can't get away (stagnant)
-Do NOT have O2 problem
Ex: inflammation and chronic ulcers
-edema, tenderness and sensitive to HEAT, + Homans sign (pain in calf dorsiflexed - indicates DVT)
#1 concern is dislodging DVT leads t |
| What FOOD would you want to LIMIT if a pt is on COUMADIN? | -green leafy veggies (high in vit K)
-vit K is antidote to Coumadin |
| What is the main cause leading to Glomerial Nephritis? | STREP (difference between GN and NS) also cathaterization
- it puts holes in glomerilus and proteins/blood/sediment leaks out into urine (smokey or rust colored) |
| Sx of STREP? | -Sore Throat
-HA
-Malaise (retaining toxins so makes you tired)
If it goes to heart it will attack valves (bad bc valves prevent back flow) |
| What does retaining toxins cause? | Tired/Malaise |
| What are Sx of Glomerial Nephritis? | -Increased BUN/CRE/SG/BP
-Sediment/blood/pro in UA due to holes strep caused (brown urine)
-Flank pain
-Facial Edema/ FVE
-D UO, I SG
Limit activity bc of fatigue (safety) |
| How do carbs work? | -carbs empty stomach fast
-body breaks them down for energy (increase when you don't want body to break down proteins for energy) |
| What are SX of RENAL FAILURE? | -malaise
-HA
-N/V
-anorexia
-weight gain
-Decreased UO |
| What is the difference between GN and NS (Nephrotic Syndrome)? | NS you are VERY EDEMATOUS and MASSIVE PROTEINURIA
-hypoalbumnic
-hyperlipidemia
-many things can cause NS unlike GN where step is usually cause |
| What does Albumin do? | Holds on to/pulls fluid (H20 and Na) in vascular space
-w/o this fluid goes to tissues (Decreased CVP)
RA pathway (produces Aldosterone) and hold onto H2O and Na instead of excreting it but w/o Albumin to hold it in vascular space we get more edematous |
| What is the term for total body edema? | Anasarca |
| What Dz would you assume if pt had sx of: proteinuria, hypoalbumina, edema, hyperlipidemia | Nephrotic Syndrome |
| Why are ACE good in a pt with Nephrotic Syndrome? | They block aldosterone secretion |
| What do Steroids do? | -Decrease Inflammation
Bad: Immunosupressed, Increase Blood Sugar, |
| What is the common rule in regards to proteins with kidney pts? | Decrease Protein
-except in Nephrotic Syndrome and Peritoneal Dialysis pt |
| What is Renal Failure? | Bilateral (bc you can live with one kidney)
-if blood can't get to kidneys or BP is below 90 (can take just 20 min to kill) SHOCK
Causes: enlarged prost, kidney stones, ABX (mycin -nephro toxic), Diabetes, dyes, HTN, edemitous stoma |
| S/S of Renal Failure? | -D UO, I SG
-anemia
-CHF, HTN (due to retained fluids)
-anorexia, N/V
-Increase K and Metabolic Acidosis (lethal arrhythmias)
-Increase Ca (osteroporosis) |
| NCLEX MOMENT | IN SELECT ALL THE APPLY- its NEVER all 5 |
| Anytime you are Decreasing UO or it has stopped what electrolyte are we most worried about retaining? | K (potassium)
-if you are putting out a lot of Urine then you are losing a lot of K |
| What are the 2 phases of Renal Failure? | 1. FVE (1-3 wks, Inc K, Dec UO)
2. Diuretic (sudden onset leads to shock, decreased K)
Complete recovery can take up to 12 months |
| Hemodialysis | Machine is glumerolis
-3-4x/wk
-given anticoag (Hep) stays in sys 4-6 hrs (no surf for this time)
-unstable Heart can't do hemodialysis
-HOLD (lisinopril, Nitro, ABX, vit, pepsid)
-need IV access (permanent)
Feel the thrill
300-800 ml/min
- |
| Peritoneal Dialysis | -fluid fills cavity, dwell time, fluid drained with toxins (should be straw colored , if cloudy=infx)
-turn side to side to get all fluid out
-2 types (CAPD & CCPD)
#1 complication peritonitis (abd pain, cloudy, constant sweet taste) |
| S/S of Peritonitis | -Abd pain, cloudy effluent, low back pain, D or C, anorexia, fever, N/V
Peritoneum membrane lines inside of abd wall and covers organs |
| NCLEX MOMENT | Avoid answers with Always/total/all - too specific |
| What is CRRT? | Continious Dialysis
-Done in ICU
-never more than 80ml of blood out of body at one time
-no drastic fluid shifts (unlike hemodyalysis)
-less stress on Cardiac system
-used for pt w/ acute RF and acute cardiac status |
| What is CAPD? | Peritoneal Dialysis
-manual exchange (3-4 x/day 7/days a week)
-less freedom
-not done at night
-back pain will occur as SE
Not for pt with prior back pain or colostomy |
| What is CCPD? | Peritoneal Dialysis
-pt is connected to cycler at night only
-more freedom
-continuous and automatic |
| What is the #1 complication of peritoneal dialysis? | Peritonitis (inflammation of the peritoneum) |
| What type of fluid is used in peritoneal dialysis? | Hypertonic (packed with particles)
-pt will have a constant sweet taste bc of the glucose in the solution |
| What is the exception to diet in Dialysis Pts? | -Increase protein and fiber bc of decreased peristalsis (usually you decrease protein in kidney its) |
| If someone were given Toradol, Diladid, Zolfran what are they trying to treat? | Kidney Stones |
| If someone was having pain, N/V, Inc WBC, hematuria (RBC in urine) what they have? | Kidney Stones |
| What happens when there is air/blood/exudate in the pleural space? | Lung will Collapse |
| What is a Thoricentesis? | Needle put into the pleural space to remove whatever is in there
-positioning; lay on unaffected side at 45 degree or sit on edge of bed bend over chair, no coughing or deep breaths, need to be very still
Rsk: FVD since fluid is being removed |
| What is the purpose of a CDU? | To restore vacuum pressure in the pleural space by removing air/particles in a 1 way system until lung is healed. |
| How many mL can a CDU hold? | 2,000mL
-if it overflows it will block the H2O seal chamber and cause a tension pneuothorax |
| What is the 1st chamber of the CDU for? | Drainage (can hold 2,000mL)
-record q hr for the 1st 24 hours then q 8 hrs after that
-rpt 100mL + in 1 hr or color change |
| What is the 2nd chamber of the CDU for? | H2O seal chamber-INTERMIT BUBBLING=patent
-Drainage stays in 1st chamber and the air goes to 2nd chamber
-Fluctuation with Respiration (stops=kinks or lung re-expanded)
-filled with 2cm of water
-BAD: continuous bubbling (air in system, tell MD) |
| What is the 3rd chamber of the CDU for? | Suction Control- CONTINUOUS BUBBLING
-allows air to vent out
-contolls Amt of suction need to pull fluid/air out
-20cm of sterile H2O (max const no matter how much wall suction)
-if dry suction no H2O = no bubbling |
| Should the CDU system be above or below the level of the chest? | Below
-if higher the drainage will go back into the pt
-DONT DELEGATE THIS TEACHING |
| If MD has you clamp a chest tube can you leave them while this is clamped? | NO
-never leave
-will only clamp for a few seconds
-can lead to tension Pnemothorax |
| What is a Hemothorax/Pneomothorax? | blood or air has accumulated in the pleural space = LUNG COLLAPSE
Tx: Thoresentesis, chest tube, daily cxr |
| What are S/S of a Hemothorax/Pneomothorax? | -SOB
-Inc HR
-diminished breath sounds on affected side
-less movement on affected side
-chest pain
-cough |
| What is subcutaneous emphysema? | -air that is trapped in sub q tissue (neck,face, chest)
S/S: cracking feel to touch (usually reabsorbed by body)
DX: of Hemothorax/Pneomothorax |
| What is Tension Pneumothorax? | Pressure has built up in pleural space = COLLAPSED LUNG
-pressure pushes everything to opposite side |
| What are some sx of Tension Pneumothorax? | -absent breath sounds on affected side
-asymmetry of thorax
-trachia will be off center
-Resp Distress
-MEDICAL EMERGENCY (Dec CO) |
| What is an Open Pneumothorax/Sucking Chest wound? | Opening into chest that is lg enough to allow air into pleural space
Ex: gun shot or stabbing victim |
| If someone had a fracture of their ribs or sternum what S/S would you expect to see? | -pain and tenderness
-naturally splinting side with hand
-shallow breaths to minimize pain (can lead to Resp Acid)
-crepidis (bone ends are grinding together)
Watch for other complications (hemo/pnemo/flail chest) |
| What type of medicine would you NOT want to administer for pain in a pt w/ fractured ribs or sternum? | -Narcotics (it will Decrease R even more)
-NO BINDER this will lead to shallow R, atalectasis and PNA |
| Intussusception | Telescoping or going backward of bowel from proximal to distal and forms obstruction
Sx: Currant jelly like stool (mucos/blood), sudden abd pain and V (infant colicky/inconsolable)
Tx: BE(also Dx it) or surg
-keep in hospital 12-24 bc it can reoccur |
| Hirschprung's | Cogenital abnormality, aganglionic (no nerves) in colon =obstruction, usually sigmoid
Sx: foul smelling ribbon stool, constipation (no parastalysis bc no nerves)
-Neonate (absence of meconium, abd pain distention 1st 24 hrs)
Tx: remove dz portion |
| TEF | Opening between trach and espophogaus
Sx: 3 C's (coughing, choking, cynosis)-especially w/drinking
1st feeding needs to be w/ sterile H2O or Breast Milk- watch closely (coughing or bubbling out of nose=Dx)
-Supine w/head & shoulders elevated |
| GERD | Regurgitation of gastric content into esophagus
Tx of infants: small frequent feeding w/ thick rice cereal, H2, PPI
Positioning: upright w/ feedings and at night, elevate prone to inc stomach emptying |
| Esophageal Estria | Saliva can't make it to stomach bc espoh ends in blind pouch (closed off at bottom)
Sx: no meconium bc they don't swallow amniotic fluid
Tx: GT w/button |
| Pyloric Stenosis | Sphincter at base of stomach connecting to SI
Sx: PROJECTILE V after eating, irritability, hunger, abd distention
Dx: olive shaped mass by umbilicus, ripple in abd (stomach trying to push content through small opening
Tx: hydration and surg |
| Celiac Dz | Genetic malabsorption disorder, intestinal intolerance to gluten
Tx: NO GLUTEN (B-barley, R-Rye, O-oats, W-wheat)
-GOOD (R-rice, C-corn, S-soy) and millitt |
| Enurisis | Never have had extended periods of dryness
-seen in children
-will outgrow w/o treatment |
| Cryprochridism | Both or one testes fails to decend through inguenal canal
Tx: surgical correction may be necessary , no vigorous activity for 2 wks after |
| Episadis | conginital defect
-abnormal placement of urethreal office of the penis (ABOVE)
(easy for bacteria to enter penis) |
| Hypospadias | congenital defect
-abnormal placement of uretheral office of penis (UNDER)
Tx: Surgery
-NO CIRCUMCISON bc the skin is needed for surgical repair |
| Where to look for JAUNDICE in CHILDREN | -scleara of eyes
-nail beds
-generalized skin color change (not in one location like abd)
-mucous membranes |
| Encopresis | Fecal Inconstance
Sx: soiled clothing and pt can be constipated |
| PKU | Tested in all 50 states in newborns |
| Gastroschisis | No protective membrane covering bowel
-Rsk for infection |
| Appendicitis | Sx: RLQ pain
Tx: NO HEAT, Surg, NPO and IV ABX
-position fetal
-RLQ sudden relief = BURST |
| What DIET would you give a CHILD with DIARRHEA? | BRAT
(Bananas, Rice, Applesauce, Toast) and carrots
NO DAIRY |
| Hepatitis SX | -Hepatomegly
-dark frothy urine
-jaundice
-RUQ pain
-Stool clay colored |
| What are some Sx of LACTOSE INTOLERANCE? | -Frothy Stools
-D |
| What is FLAIL CHEST and S/S? | Multiple Rib Fractures
Sx: pain, paradoxical breathing (outward E), dyspnea, cyanosis, Increased P |
| What is used to treat FLAIL CHEST? | -PEP (INVASIVE)
-CPAP/BiPAP (NON-INVASIVE)
-pt must breath on own
POSITIVE INSPIRATORY PRESSURE |
| What is CPAP? | Continuious Airway pressure
-delivers constant pressure during I and E
-non invasve (nasal cannula or face mask)
-used for fail chest and obstructive sleep apnea |
| What is BiPAP? | Bilevel Positive Airway Pressure
-used to wean pt from ventilation and acute reps failure (COPD,sleep apnea, HF) and Flail Chest
-excerts different levels of pressure along with O2
-pt must be able to breath spontaneously and co-operate w/support |
| What is PEP? | Positive pressure that is expelled to keep avoli open
-puts pressure down thorax which expands chest wall and realigns ribs |
| What do you need to check for anyone on PEP, BiPAP, or CPAP? | Bilateral Lung sounds
-q 2 hrs
-you are putting pressure into thorax so you could pop a lung (pneomothorax) |
| Pulmonary Embolis | Cause: dehydration, venous stasus (prolonged immobilization/surg), clotting disorder, heart arrythmias
-cause blood to get thick and goes to lungs
Sx: #1 HYPOXIA, R side heart failure and pulmonary HTN, coughing up blood, sharp chest pain
Dx: VQ scan |
| What are some MEDS for PE? | Heparin, Lovenox, Coumadin
-all decrease clotting |
| Can you be on Hep and Coumadin at the same time? | YES
-as you tapper off Heparin, you increase Coumadin which you are sent home on |
| Steroids | -Increase the breakdown of fat and protein
-Decrease Cerebral Edema (decreases ICP) |
| What is one VS that you can look at when assessing NEURO? | Pulse Pressure will widen with Increased ICP
-VS changes are a late sign of problem |
| What is the formula for PULSE PRESSURE? | Systolic-Diastolic
(normally around 40, the wider the gap = Increased ICP |
| If a patient has a head injury and starts complaining about a HA what would you assume? | Increased ICP |
| What is Occulosufalic Reflex? | DOLLS EYES
-these are good and means brain stem is functioning
-can only do this with someone who is out of it
Move head to the R and eyes should go L |
| What is Occularvestibulus Reflex? | Assesses brain stem fxn
-irrigates ear with 50ml of cool water
-eyes move toward water then back to midline |
| CT Scan | -can be with or w/o dye
-takes pictures in layers
-need to be still
-no talking
-can be claustrophobic |
| MRI | -Magnetic
-picks up pathology earlier
-no dye/radiation
-can talk and hear others when in tube |
| Cerebral Angiography | -DYE
-xray of cerebral circulation
-goes through femoral art (like heart cath)
Pre: Hydrated
Post: BR 4-6hrs, check LOC since dye in brain, 1 side weakness/paralysis, compare baseline vs |
| What Sx will you get with a DYE/CONSTRAST? | -WARMTH IN FACE
-METALLIC TASTE |
| EEG | Records electrical activity
-helps dx SEIZURES
NOT NPO this would Dec BS in brain
HOLD:
sedatives-D brain activity
caffiene -I brain activity
Enviroment must be quiet bc machine picks up stimuli |
| Lumbar Puncture | -Done in 3rd or 4th sub arachnid space
-gets CSF to analyze
Post: lie flat or prone for 2 hrs to decrease pressure), give fluids
Complication: most common HA, I pain when sitting up, brain herniation (know I ICP -procedure contraindicated) |
| S/S Menningitis | -Fever
-Chills
+ Brudinski/Kernigs
-V
-nuchal rigidity (STIFF NECK)
-LIGHT HURTS EYES |
| What procedure is contraindicated if pt is known to have Increased ICP? | Lumbar Puncture
-puncture creates opening for pressure to release and causes brain matter to get sucked down foramen magnum
-ICP BOTTOMS OUT, 99% Fatal |
| What is Cushing Triad and what does it indicate? | Dx: INCREASED ICP
-Increased SBP
-Irregular Respirations
-wide pulse pressure
-Decreased HR |
| What are SX of Increased ICP? | Cushing triad (I SBP, irregular R, wide pulse Pressure, Dec HR)
-HA
-V without N
-change in LOC |
| What is a Concussion? | Temporary loss of consciousness
-only a few seconds
-may just get dizzy
-complete recovery |
| What is a Contusion? | Brain is bruised
-unconscious for longer than a few seconds
-possible surface hemorrhage |
| What Electrolyte are all these foods high in and are they acidic or alkaline: Grains, Fruits, Veggies? | K
-Alkaline they Increase pH |
| Are salty foods alkaline or acidic? | Acidic (decrease pH) |
| What do all these cause in terms of volume and pressure: Pancreatitis/bleeding/hemorrhage? | Hypovolemic and Hypotensive
-Less volume= less pressure |
| If your H/H is HIGH are you Dehydrated or Bleeding? | Dehydrated |
| If your H/H is LOW are you Dehydrated or Bleeding? | Bledding |
| In Pancreatitis what lab values are up? | -WBC
-lipase/amylase
-SGOT
-PTT
H/H is LOW |
| What Electrolyte do all Proteins have? | Phospates |
| What follows GLUCOSE? | Water |
| What are the blood tests that are done for MI and which is the most specific? | -Myoglobin
-CK
-Triponin (MOST SPECIFIC -can tell if pt delays tx) |
| What position do you want to put a pt in post THR? | -No Flexion more than 45-60
-HOB no higher than 45
-Hip abduction with pillow (don't want to adduct) |
| What is Eclampsia? | A Seizure
-can occur to Decreased B/P postpartum |
| What happens to your BP as you get older? | It Increases |
| What is so info on RSV? | -Contact Precations (NO pregnant or contact lens RN)
-Sx are like a really bad cold
-Contagious
-Can lead to PNA
-Rsk for getting worse (less than 6 mo, heart or lung prob, older than 65, immunocompromised)
-Tx: Ribovirin |
| What is Dumping Syndrome? | Sx: dumps into small intestine, Severe D
Tx: Eat reclining, lie down 20-30 min after food, restrict fluid during meals, NO Cho, Increase Fiber, eat small freq meals |
| Can you keep a COPD pt and a negative pressure room pt together? | YES |
| What are Kussmal Respirations | Deep Rapid Respirations |
| CHF patho | The heart is not able to pump blood to the rest of the body at a normal rate. Lack of blood to body and a buildup of fluid. The fluid collects in Lungs (Congestive Heart Failure)
Sx: Accumulation of fluid in lungs abd, legs, feet, ankles = weight gain |
