High Acuity

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Author:
TMill
ID:
173335
Filename:
High Acuity
Updated:
2012-09-25 19:50:02
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Exam
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Description:
Fluid and Electrolyte, Pain & Heart
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  1. What type of IV solution should you avoid in neurological patients?
    Hypotonic- cellular overexplansion can cuase increased ICP and mental status disorientation
  2. What fluid would you use for the treatment of SIADH or water intoxication and how would you need to administer it?
    3 % NS hypertonic solution through a central line and monitor neuros
  3. Third spacing of fluid would be moved into where???
    lungs, brain, etc. a special cavity where it should not be
  4. With fluid volume excess CVP would be increased or decreased?
    Increased
  5. With fluid volume deficit CVP would be increased or decreased?
    decreased
  6. What type of fluid would you use for shock and dehydration?
    isotonic
  7. What type of fluid would you use for water intoxication, hyponatremia, SIADH, or high solution osmolarity?
    hypertonic
  8. what type of fluid would you use for low solution osmolarity, or intracellular dehydration?
    hypotonic
  9. Dominant ECF electrolyte:
    Sodium
  10. Dominant ICF cation electrolyte:
    potassium
  11. What electrolte imbalance??

    confusion, thirst, twitching, coma
    hypernatremia
  12. Treatment for hypernatremia:
    • hypotonic solution
    • diuretics
  13. Which electrolyte imbalance can the thirsty person who can access water not get?
    hypernatremia
  14. Treatment of hyponatremia:
    NS or hypertonic if severe, retrict fluids, increase sodium
  15. If calcium is low what happens in the body?
    parathyroid hormone stimulates clacitrol to increase intestinal absorption and release of calcium from bone
  16. If calcium is high what happens in the body?
    thyroid hormone secretes calcoitonin to inhibit realease from the bone 
  17. What type of electrolyte imbalance does prolonged immonblization cause?
    hypercalcemia 
  18. What other two electrolyte imbalances are associated with hypocalcemia?
    hyperphosphatemia and hypomagnesium
  19. What type of electrolyte imbalance is secondary to removal of parathyrod?
    hypocalcemia
  20. Chvostek's sign (cheek) and trousseus sign (bicep) are manifestations of what electrolyte imbalance?
    hypocalcemia
  21. Tx of hypocalcemia:
    oral supplements and camlcium chloride or gluconate (adminster slow due to change of infiltration and irritation to veins)
  22. If you have acidosis what type of electrolyte imbalance would you suspect?
    high potassium
  23. What ECG change will you see with hyperkalemia?
    peaked or tall T waves
  24. What ECG change will you see with hypokalemia?
    U waves
  25. Food high in potassium:
    bananas, pears, dried apricots, fruit juices, team cola beverages, milk, meat, fish, baked potato, dried beans
  26. normal range for magnesium:
    1.3-2.5
  27. What type of electrolyte imbalance would use of antacids and laxatives cause?
    • hypermagnesium
    • (milk of magnesium)
  28. What does calcium gluconate treat?
    decrease cardiac effects in electrolyte imbalances 
  29. What type of electrolyte imbalance would you expect with tetany, trousseus and chovetsks signs?
    hypocalcemia and hypomagnesium
  30. Example of Prerenal, intrinsic or post renal injury:

    Excessive fluid loss: hemorrhage, burn, vomiting, diarrhea, polyuraia, diabetes insipidus
    pre renal injury
  31. Example of Prerenal, intrinsic or post renal injury:


    decreased renal perfusion from decreased cardiac output such as heart failure, MI  or third spacing of fluids
    pre renal injury
  32. Example of Prerenal, intrinsic or post renal injury:

    increased vascular capacity SHOCK 
    pre renal
  33. Example of Prerenal, intrinsic or post renal injury:

    vascular obstructin such embolus, dissecting aortic aneurysm, or tumor
    pre renal
  34. Example of Prerenal, intrinsic or post renal injury:

    Drugs that alter renal hemodynamics
    Angiotensin, cocain, cyclosporine, NSAIDS
    pre renal injury
  35. Example of Prerenal, intrinsic or post renal injury:

    ischemia
    intrinsic
  36. Example of Prerenal, intrinsic or post renal injury:

    nephrotoxicity
    intrinsic
  37. Example of Prerenal, intrinsic or post renal injury:

    rhabdomyolysis
    (crush injuries, severe burns, compartmetn syndrome, severe exertion, seizure, 
    intrinsic
  38. Example of Prerenal, intrinsic or post renal injury:

    intratubular obstruction
    uric acid crystals
    intrinsic
  39. Example of Prerenal, intrinsic or post renal injury:

    mechanical causes (blood clots, calculi, tumors, prostatic hypertrophy, prostate cancer, uretheral strictures)
    post renal
  40. Example of Prerenal, intrinsic or post renal injury:

    funcgtional causes (diabetic neuropathy, neurogenic bladder)
    post renal
  41. What do you give with aminoglycoside antibiotics to prevent intrinsic inury to the kidneys?
    mucomyst
  42. Criteria for acute kidney injury:
    Creatinine 0.3 increae or >50% increase or decrease in urine output <0.5 ml/kg/hr (after adequate fluid resuscitation within 48 hr period)
  43. Diarrhea, vomiting, bleeding, hypotension, low CO suspect which type of kidney injury?
    pre renal
  44. fluid overload, hypertension, nephrotoxic agents, multisystem involvment (DM), hematuria, prtoeinuria suspect which type of kidney injury?
    intrarenal
  45. hx of UTI, hx of calculi, poor urinary stream, full bladder suspec which type of kidney injury?
    post renal
  46. Laborartory findings with Acute Kidney Injury:
    • Elevated BUN >25
    • Elevated Cr >1.5
    • Elevated K >5.3
    • Decreased Ca <9
    • Elevated Phosphorus >4.5
    • Decreased Albumin
    • Metabolic Acidosis
    • Reduced RBCS 
    • Decreased H & H
  47. How to calculate creatnine clearanace?
    urine creatinine X  urine volume / serum creatinine
  48. What type of diet would you need for a person with AKI?
    restrict protein, sodium, potassium and fluids
  49. What is the quickest way to treat severe hyperkalemia with ECG manifestations?
    calcium gluconate (reduces excitability of cardiac muscle and stabilizes the membrane to resting potential)
  50. If a patient presented with headache, n & v, altered LOC, and hypertension after dialysis what would you expect?
    dialysis disequilibrium syndrome: cerebral edema r/t rapid changes
  51. Na ranges:
    135-145
  52. K ranges:
    3.5-5.0
  53. Calcium ranges:
    8.5-10
  54. Chloride ranges:
    98-106
  55. Magnesium ranges:
    1.3-2.1
  56. Phosphorus ranges:
    3.5-4.5
  57. serum osmolality range:
    270-300
  58. BUN ranges:
    9-20
  59. creatinine range:
    .6-1.5
  60. Depolarization=
    contracting or stimulation (Sodium moves in)
  61. Repolarization=
    resting (potassium moves out)
  62. Phases of action potential of cardiac cells:

    phase 0
    stimulus: rapid depolarization Na moves into cell
  63. Phases of action potential of cardiac cells:

    Phase 1
    partial repolarization K moves out of cell
  64. Phases of action potential of cardiac cells:

    Phase 2
    • plateau slow ca into cell (calcium channels open)
    • calcium channel blockers prevent this from happening 
    • cause vasodilation and decreased spasms of ventricles
  65. Phases of action potential of cardiac cells:

    Phase 3
    repolarization K into cell
  66. Phases of action potential of cardiac cells:

    Phase 4
    • resting state
    • if a pacemaker is in place there is constant Na flow into cell:automaticity
  67. Absolute refractory period:
    onset of QRS to peak of t wave abosoluely no impulse no matter how strong the stimulus
  68. Relative refractory period:
    • downslope of the t wave 
    • cardiac cells can be stimulated if stimulus is strong enough 
    • this may be a vulnerable period for the patient
  69. Supernormal refractory period:
    • corresponds with end of the t wave 
    • a weaker than normal stimulus can cause depolariztion of cardiac cells
    • R-on-T may occur here 
  70. The postive lead is placed in what area of the body?
    left leg
  71. Tx for brady rhythms:
    atropine, pacemaker
  72. Tx for tachy rhythms:
    vagal, adenosine, digoxin, beta blockers, calcium channel blockers, cardioversion
  73. hypotension tx:
    dopamine
  74. PVCs tx:
    amiodarone, lidocaine, magnesium, procainamide
  75. Pulseless rhythms tx:
    • CPR, ETT, IV acess, epi
    • vfib/vtach: defibrillate
    • asystole: atropine
    • PEA: etiology
  76. If a patient has a pacemaker and has a spike before the p wave is it ventricular pacing or atrial?
    atiral
  77. If a patient has a pacemaker and has a spike before the ORS is it ventricular pacing or atrial?
    ventricular 
  78. Cardiac output:
    • 4-8 L/min
    • HR X SV
  79. cardiac index:
    • best indicator for CO= CO/BSA
    • 2.4-4.0 L/min/m2
  80. stroke volume=
    60-100 
  81. failure to capture
    firing but atria isnt responding no p wave after
  82. failure to sense
    firing like crazy 

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