Critical Care Final

Card Set Information

Author:
plbernal
ID:
187755
Filename:
Critical Care Final
Updated:
2012-12-12 12:30:51
Tags:
Final part two
Folders:

Description:
final part two
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user plbernal on FreezingBlue Flashcards. What would you like to do?


  1. Meds while on vent
    (3)
    • 1. Sedative/Antianxiety (propofol)
    • 2. Neuromusclular Blocker (Norcuron)
    • 3. Pain (morphine, fentanyl)
  2. Which do meds do you ALWAYS give together in a patient on a vent?
    Sedative + Neuromuscluar Blocker
  3. Define ARDs 
    **#1 sign**
    • Injury to lungs leads to resp failure
    • (pO2 < 60, pCO2 > 45, pH < 7.35)
    • **Hypoxemia does NOT respond to O2 therapy**
  4. Late signs of decreased neuro
    • Loss of consiousness
    • Dilated pupils
    • Posturing
  5. Interventions of stroke during the chronic phase
    • - Approach on unaffected side
    • - Place objects within visible field
    • - Increase mobility
    • - Fluids/ High Fiber
    • - Need for assistive devices
    • - Transfer teaching needed
  6. Spinal Cord Injury
    Lose ______ input
    results in (4)
    • Lose sympathetic imput
    • Results in: bradycardia, hypertension, venous stasis, loss of temp control
  7. What is Cushing's Triad?
    What is it a sign of?
    Widening pulse pressure, Irregular/slow breathing, Bradycardia

    Late sign of increased ICP
  8. S/S of ARDS
    • Dyspnea
    • Tachypnea
    • Decreased lung compliance
    • Increased PIP
    • Alveoli infiltrated on CXR
  9. Equipment for A line
    (5)
    • 1. Invasive catheter
    • 2. Noncomplient tubing
    • 3. Transducer & stopcocks
    • 4. Pressurized flush (hep or non-hep)
    • 5. Bedside monitor
  10. Indications for arterial line
    (4)
    • 1. Hemodynamic instability
    • 2. Assess efficency of vasoactives
    • 3. Frequent ABGs
    • 4. Internal BP (more accurate)
  11. How do you level the transducer in hemodynamic monitoring?
    • Plebostatic Axis
    • - 4th intercostal, mid-axillary line
    • - Rt atrium (lowest pressure gradient)
  12. Formula to configure MAP
    MAP=(2)(diastolic)+systolic/3
  13. CO2 ____________ the brain?
    • vasodilates
    • will lead to increased icp
  14. Natural chemical mediators in regulation of blood flow
    (6)
    • 1. epi
    • 2. norepi
    • 3. adrenocortical hormones
    • 4. thyroid hormones
    • 5. antidiuretic hormones
    • 6. aldosteone balance
  15. What disease would cause increased PAP?
    • PAP: 25/10 mean: 15
    • Anything that decreases compliance in the lungs
    • - pulmoary HTN
    • - Asthma
    • - Increased CVP
  16. What would you assess for a fluttered arterial wave form?
    • - occlusion
    • - bent tubing
    • - loose connections
    • - empty pressure bag
    • - line pulled out
  17. PA lumens (white)
    • Proximal infusion
    • IV fluids, meds, vasoactives
    • Passive infusion
  18. Interventions for ARDS
    • low TV
    • PEEP
    • High FiO2
    • Sedate/paralyze
    • O2, lasix, albumin, steroids
  19. Interventions for VAP
    • - Keep off vent if possible
    • - Vent bundle
    • - Univeral precautions
    • - Aseptic suctioning
  20. 3 elements of the Calgary Family Assessment Model
    • Structural (environmental)
    • Developmental (Erikson's)
    • Functional (coping, communication)
  21. Describe a murmur
    • Whooshing sound
    • Valves not closing proplerly
    • Systolic or Diastolic
    • Mitral & Aorta most common (Think: connected to L ventricle)
  22. Describe a rub
    • Squeaky rubber band sound
    • Inflammation/Pericarditis
    • SHARP PAIN
  23. Lab tests for heart problems
    • Electrolytes
    • Enzymes (ROMI)
    • H&H
    • Coags (if trauma)
  24. Define stable angina.  Treatments? Conservative meds? Surgery?
    • Myocardial O2 demand exceeds supply
    • No cell death
    • Occurs with exertion, relieved on rest
    • Treatment: Nitro
    • Conservative Meds: Nitro, beta bockers, ccb
    • Surgery: Stent/CABG
  25. Define unstable angina.  Is it part of ACS? Treatments? Meds? Surgeries?
    • Clot occurs from rupture of plaque, but some blood flow continues
    • Part of ACS
    • SEVERE pain, unpredictable, ST decrease, inverted T wave
    • Hospital stay, rest, nitro, antiplatelets, revascularization
  26. MI patient goes home on Metropolol + Lisinopril why?
    • Metoprolol: beta-blockers, decreases mortality/infarction size, decreased contractility & rate wich increase myocardial O2 supply.
    • Lisinopril: ACE Inhibitor to decrease heart remodeling (watch for cough)
  27. Complications of heart cath
    (7)
    • 1. coronary artery dissection
    • 2. bradycardia
    • 3. v-fib (code)
    • 4. hypotension
    • 5. bleeding
    • 6. hematoma
    • 7. retroperitoneal bleeding restenosis
  28. Complications of MI
    • dysrhythmias
    • heart failure
    • thromboembolism
    • rupture of heart
    • pericarditis
    • infarct extension
    • cardiogenic shock
  29. PA Lumens (Blue)
    • Proximal Injectable
    • IV pushes - no high alerts (heprin, ect..)
    • CO/CI/CVP
  30. What is the difference between CO & CI
    CI is more awards, measures CO based on body weight
  31. What reading obtained by the PA cath measures contractility?
    Indirectly via CO
  32. PA Lumens (Red)
    • Balloon
    • Measures PAOP (8-12 mmHg)
    • Syringe for inflating attached
  33. 3 drugs to treat contractility
    • 1. digoxin
    • 2. dopamine
    • 3. milrinone
  34. AMI Core Measures
    -Meds on arrival
    - Meds on d/c
    - Door to needle time
    - Door to ballon time
    - Counsel
    • Arrival: Aspirin, ACE Inhibitors
    • D/C: Aspirin, LOLs, Statins, ACE
    • Needle time: 30 min
    • Balloon time: 90 min
    • Counseling: STOP SMOKING
  35. Causes of heart failure
    • Hypertension
    • Myocardial Infarction
    • Valve replacement
    • Cardiomyopathy
    • Endocarditis
    • IV drugs
  36. 3 conditions that leads to low lung compliance
    • Pulmonary fibrosis
    • ARDS
    • Pulmonary edema
  37. Complications of ET suctioning
    • - hypoxemia
    • - airway trauma
    • - infection
    • - increased ICP
    • - decreases PEEP
  38. Why administer PEEP?
    to decrease a high FiO2
  39. Vent Bundle
    • - HOB elevated 30 - 45 degrees
    • - Sedation vacation q 24 hours
    • - DVT prophylaxis
    • - Peptic ulcer disease prophylaxis
    • - Oral care q 4 hours
    • - Chlorhexadine q 12 hours
  40. Risk factors for ARDS
    • - Sepsis (causes decreased CO, leaky vessels)
    • - Pneumonia
    • - Trauma
    • - Aspiration
    • - Blood transfusions
  41. Complications of mechanical vent
    (7)
    • 1. intubate right main
    • 2. barotrauma (tension pneumo/alveoli rupture)
    • 3. O2 toxicity (FiO2 100% no more than 24 hrs)
    • 4. Infection
    • 5. Hypotension/decreased CO (esp with PEEP)
    • 6. Stress ulcer/GI bleeds
    • 7. Anxiety
  42. Contractility:
    affected by __________
    measured by __________
    using only the __________
    • affected by PRELOAD
    • measured by CO (4-8 L/min), CI (2.5-4.2 L/min/m2)
    • using only the Swan-Ganz
  43. Chronotropic Drugs: examples & purpose
    • Examples: Inderol, atropine
    • Purpose: increase/decrease conduction
    • *Will see improvement in BP too*
  44. 4 mechanisms that regulate heart rate
    • SA Node
    • Autonomic (symp/parasym)
    • pH
    • Temp
    • (increased: increased metabolic demands, increased heart rate and decreased cardiac output; Decreased: decreased heart rate, decreased cardiac output)
  45. Treatments of increased afterload
    • **TOO MUCH RESISTANCE***
    • - too much vasoconstriction
    •      - hypertension, pulmonary hypertension
    • - vasodilate
    •      - nitroprusside
    • - LDL
  46. Define hemodynamics
    relationship between heart rate, blood, O2 delivery, tissue perfusion
  47. Treatments of decreased afterload
    • VASOCONSTRICTION!!!
    • -epi
    • -norepi - harder on circulatory system
  48. CK
    - Means_____
    - Normal level
    - Onset
    - Peak
    • Means muscles dying
    • < 200
    • 2-6 hours for onset
    • 18 - 36 hours for peak
  49. CK-MB
    - Means _____
    - Normal level
    - Onset
    - Peak
    • Heart dying
    • < 5%
    • 2-6 hrs onset
    • 18-36 hrs peak time
  50. S/S of decreased afterload
    • **TOO LITTLE RESISTANCE**
    • low bp
    • decreased urine output
    • decreased SVR/PVR

What would you like to do?

Home > Flashcards > Print Preview