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Principles I Test 3
Interpretation of Monitoring Data
| Question | Answer |
|---|---|
| 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
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