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Principles I Test 3

Interpretation of Monitoring Data

What are the 5 signs and symptoms of hypocalcemia? tetany, twitching, laryngospasm, tingling lips and fingers, spontaneous action potentials generated
What are some possible causes of hypocalcemia? decreased PTH, decreased Mg+, alkalosis, massive blood transfusion, pancreatitis, hypoparathyroiddism, accidental removal of parathyroid
What are the 5 signs and symptoms of hypercalcemia? N/V, decrease in DTR, hypotonia, confusion, lethargy
What are some possible causes of hypercalcemia? hyperparathyroidism, cancer (esp. breast cancer)
What are the 3 signs and symptoms of hyponatremia? lethargy, cramps, decreased reflexes seizures
Serum Na+ of less than 120 is associated with what mortality rate? 50% mortality rate
Which is more common, hyponatremia or hypernatremia? hyponatremia
What is the typical cause of hyponatremia? high total body water (diluting out Na+ content)
What are the 7 signs and symptoms of hypernatremia? CNS changes, mental status changes, irritability, hyperreflexia, ataxia, seizures, hypotension after induction
What is the typical cause of hypernatremia? low total body water (dehydration/hypovolemia)
What effect does serum potassium have of digoxin? hypokalemia greatly enhances the effect of digoxin (can lead to toxicity), hyperkalemia inhibits effects of digoxin
What are the signs and symptoms of digoxin toxicity? N/V, diarrhea, headache, fatigue, colored vision, arrhythmias
How can hyperventilation lead to an increase in ventricular arrhythmias? hyperventilation causes electrolyte shifts and respiratory alkalosis; more likely when both Ca+ and K+ changes are noted
What effect can hyperventilation have on calcium? pH increase means an increase in ionized calcium binding to protein, so less unbound calcium = decreased serum calcium level
What effects can hyperventilation have on potassium? potassium is forced into the cell, resulting in an intracellular and extracellular concentration change
What is the treatment for hypercalcemia? maintain hydration and UOP, loop diuretics, monitor muscle relaxation with nerve stimulator
What is the treatment for hypocalcemia? avoid hyperventilation, avoid alkalotic conditions, maintain normal to hypercarbic state, IV replacement if severe symptomatology
Why is it better for patients to be a little acidotic when extubating? prevent laryngospasms
Low serum potassium does what to the resting membrane potential? lowers it, which hyperpollarizes the cells
High serum potassium does what to the resting membrane potential? moves it higher, making the cell closer to the depolarization threshold
How does low serum calcium affect the threshold potential? it lowers the threshold potential closer to the resting membrane potential
How does high serum calcium affect the threshold potential? raises the threshold potential moving it farther away from resting membrane potential
What are the EKG changes associated with hypokalemia? U waves, flattened T waves, low ST segment
What are the EKG changes associated with hyperkalemia? if > 6 prolonged PR interval, tall peaked T waves
What are some possible causes of hypokalemia? diuretics, N/V, GI losses
What is the treatment for hypokalemia? avoid hyperventilation, K+ replacement with 20 mEq over 30 - 45 minutes, avoid glucose containing fluids, watch for prolonged muscle relaxation
What are some possible causes of hyperkalemia? ESRD, hemolysis, DKA, drugs
What is the treatment for hyperkalemia? avoid hypoventilation, give Ca++ (moves threshold away from RMP), Lasix can help excrete K+, D10 + insulin (glucose drives K+ into the cell), NO Succ
Why are patients with hyperkalemia poor candidates for MAC anesthesia? will cause an increase in patients CO2 and therefore increase their K+ even farther.
What are the possible causes of hypomagnesemia? poor GI absorption, dialysis, ETOH
What are the signs and symptoms of hypomagnesemia? dysrhythmias (ventricular), muscle weakness, twitching, tetany
What is the treatment for hypomagnesemia? supplemental Mg++, avoid diuretics because Mg++ follows Na+
What are some possible causes of hypermagnesemia? infusions for preeclampsia pheochromocytomia
What are the signs and symptoms of hypermagnesemia? lethargy, loss of DTR, paralysis, hypotension, heart block, acidosis worsens effects
What are the treatments for hypermagnesemia? Calcium gluconate, dialysis, diuresis
Which type of pulmonary disease is more amenable to treatment: restrictive or obstructive? obstructive
What is FEV1? the volume forcefully exhaled in one second
What is FVC? the total volume that can be forcefully exhaled
What is FEV1/FVC? the ratio used to distinguish between obstructive disease and restrictive disease
If both the FEV1 and FVC are low and the ratio is < 0.7 then the patient has ___________ obstructive disease
What are the classifications of obstructive disease? Mild (ratios of 0.6 - 0.7), Moderate (0.4 - 0.6), Severe (< 0.4)
If both the FEV1 and FVC are low and the ratio is >/= 0.7 then the patient has ___________ restrictive disease
Post-op ________________ is increased with restrictive and obstructive pulmonary disease morbidity and mortality
What does the ejection fraction measure and how is it calculated? measures the degree of systolic dysfunction; (stroke volume) / (end diastolic volume)
What is a normal EF? 55%
According to the American Society of Echocardiology, what EFs correlate with mild, moderate, and severe systolic dysfunction? Mild: 45 - 54%; Moderate: 30 - 44%; Severe < 30%
What is mixed venous O2 (SvO2) measurement and indicator of? balance between oxygen delivery and consumption
What is the normal range for SvO2? 68 - 80%
What is normal oxygen extraction? around 25%
What are the 4 primary factors that impact SvO2? oxygen consumption (VO2), hemoglobin level, cardiac output, arterial oxygen saturation (SaO2)
When hemoglobin, SaO2 and VO2 are stable, changes in SvO2 reflect what? changes in cardiac output
SvO2 < 30% usually indicates what? anaerobic metabolism
How does the body compensate for increase oxygen consumption (VO2)? by increasing cardiac output
SvO2 varies _______ with hemoglobin, cardiac output, and SaO2 directly
SvO2 varies _________ with oxygen consumption (VO2) inversely
What conditions would cause a decrease in SvO2? fever, hyperthermia, anemia, hemolysis, decreased SaO2, MI, CHF, hypovolemic states
What conditions would cause an increase in SvO2? cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis, increased hemoglobin r/t volume depletion, increased SaO2, burns, inotropic drug therapy
Mechanical ventilation increases __________ and decreases ____________ Increases O2 supply; decreases work of breathing
What is considered to be the most accurate core temperature? bladder temperature
Created by: Mary Beth