Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NVRN
NueroVascular RN
| Question | Answer |
|---|---|
| Stroke is _______ leading cause of death | 5th |
| What percent is Ischemic events? Hemmorrhagic events? | I - 80% H - 20% |
| What race has highest hemm strokes | Asian & Finns, AA > white |
| Define Stroke | rapid syndrome of sudden onset, non-epileptic neurologic deficit |
| what is ischemic infarct | dead tissue at core |
| What is common to happen after infarction? | Hemmorrhagic transformation HT` |
| What is penumbra | potentially viable brain tissue surrounding core infarction |
| What is Framingham Study | 1950s, Mass, about risk factors for stroke and CAD HTN single most imp risk factor, Incr total chol, decr HDL, whole grain reduce risk, Elev C protein in women risk for carotid atherosclerosis, New L BBB, |
| What is GCNKSS Gr. Cinn/North KY study | First ever stroke in AA > whites young/middle age, HTN/DM risks, prior stroke, 1st degree relative with hx of ICH |
| Northern Manhattan Stroke Study (NOMASS) | Carotid atherosclerosis White>AA/non hispanics, risks: HTN, DM, smoke, hyperchol, abd obesity, afib white/hisp > AA |
| Strong Heart Study | Native Am, >DM, smoke, obesity HTN = Arizona > Oklahoma Native Am, binge drinking |
| Southwest US Native Am. Stroke Study | Long time to get to hospital, common HTN, DM, alcohol consumption, prev. stroke/TIA, obesity |
| ReGARDS | born in stroke belt incr risk for stroke |
| What % of strokes are first time? What % need institutional care? | 70% 20% |
| Non-modifiable risk factors for stroke | Age: doubles 10y after 55y, >AA Race: AA greatest risk Gender: men > women Family hx: paternal side > risk |
| Modifiable risk factors | CAD, HTN, smoke, DM, afib, diet, sickle cell, obesity, (post menopausal) hormone replacement, incr chol. < mod. risks = alcohol/oral contrac/migraine/sleep disorders/hypercoag/inf dis/acute inf |
| ABCD2 Score | prediction for severity stroke with TIA: 1 - >60y 1 - BP >140/90 2 - wkn, 1 - speech w/o wkn 2 - >60min, 1 - 10-59min 1 - DM <4 = low, 4-5 = mod, >5 = high risk |
| What r 5 cat of TOAST - Trial of org in acute stroke tx | way to categorize what caused ischemic stroke. 5 categories: 1.Lg aa atherosclerosis - occl/stenosis lg major aa 2.Cardioembolism - afib/MI/inf endocarditis/myxoma 3. Lacunar - htn,dm,smoke,hyperchol |
| What r 5 cat of TOAST | 4. other etiology: hypercoag/venous thromb/vasculitis/art diss/cocaine/fat emboli 5. undertermined cause (cryptogenic): incomplete workup/workup with no source |
| What included in work up for stroke | brain imaging ( ct,mri) vasc imaging cta/mra/tcd/cranial ultra cardiovasc H/P: hrt snds/holman/12 ecg/caps /pulses/jug dist/bp Duplex ultra: carotid/vertebral Echo/TEE Labs: Protein C,S/antithrombin III incr |
| IPH/ICH most common cause | HTN #1, #2 Cocaine (ICH) trauma, amyloid angiopathy/aneurysm/vasculitis/alc abuse/cocaine/neoplasms/infections |
| Where are IPH's usually | subcortical region, near lateral ventricles (BG/thal) |
| 2nd most common hemm stroke | aneurysmal SAH, >women, ICA |
| Studies to incr public detection | FAST - 80% s/s face/arm/speech/time FLASH - 90% s/s face/leg/arm/speech/HA BE FAST - improve posterior stroke balance/eyes |
| Who uses EMS more? | AA, hemm stroke, incr in stroke severity, unemployed |
| Stroke Severity Scales | Los Angeles Motor Score - LAMS: lg vessel occl: face 0-1/grip 0,1,2/arm strength 0,1,2 Shortened NIH, sNIHSS 8 items |
| What should EMS not do with stroke | lower bp, give glucose IV, give excessive IV volume |
| What is Golden Hour for tx stroke? | initial MD eval - 10 min stroke team notified - 15 min CT - 25 min CT/labs interpreted - 45 min tPA - 60m |
| Golden 1/2 Hour | MD/stroke - arrival CT - 10m CT/labs read - 25m tPA - 30m |
| How many triage levels? What level need to have for stroke/TIA? | 5 levels Level 2 for stroke/TIA |
| What is med risk for cardio-embolism | PFO, L atrial turbulence (smoke), post op, mitral prolapse |
| What is TIA | sudden focal neurologic disablity, resolves in 24h, 300,000 annually |
| CHADS2 | 1 - CHF 1 - HTN 1 - >75y 1 - DM 2 - hx stroke/TIA |
| ED assessment/work up | ABCs, disability, non-contrast CT/MRI, labs, ecg, h/p: LKN, handedness, allergies, prev stroke/TIA, risk for CAD, drug/alcohol use, anticoag meds, hx brain hem/trauma, sx hx |
| Stroke mimics: can you use tPA | Yes. Conv. Dis, htn enceph, hypogly, complicated migraine, sz, AMS |
| What scale is used for Hemm? | GCS 3- unresponsive, 15- normal Eyes: 1 no open, 2 pain, 3 speech, 4, spont Verbal: 1 no verbal, 2 incomp sounds, 3 inapp words, 4 confused, 5 oriented Motor: 1 none, 2 Decer, 3 decor, 4 withdraw, 5 localize pain, 6 obeys commands |
| Which neuroimaging is 100% sensitive for blood? | Non-contrast CT |
| CTA is good to determine | Lg vessel occl, not lacunar |
| Which part of MRI is best for acute stroke confirmation | DWI - diffusion weighted imaging, w/in min. Ischemia = White MRP - detect presence/abscence viable tissue |
| which type of stroke is TCD used with | SAH - blood flow in lg aa |
| Which lab test is needed prior to tPA? | Blood glucose Coumadin - need INR |
| When is a lumbar puncture usually ordered, what kind of stroke? | SAH |
| Gen mgmt of all acute stroke pts | temp, NPO, card enzymes, arrhythmias, bp parameters, hyperglycemia, HOB |
| What are BP parameters for hemm & ischemic | H: <160/90 I: untreated = permissive 220/110 treated= <185/110, then <180/105 after bolus tPA |
| What is correct glycemic control | 80 - 140 mg/dL |
| What is correct HOB for hemm & ischemia | H: 30 deg I: 0 deg, pt turned to side 20% incr blood flow Zodiac trial - only did lg vessels |
| How many bones in skull and name | 8 bones: frontal/temporal(2)/parietal(2)/occipital/sphenoid/ethmoid |
| What is total cranial volume made up of and how much | 1400-1500ml: CSF, brain tiss, blood |
| What are sutures of skull | Sagittal - b/n 2 parietal Coronal - parietal to frontal Lambdoidal - parietal to occipital Squamosal - joins parietal, temp, occ |
| How many total vertebrae? How many cervical, thoracic, sacral, coccygeal? | total 33: 24 vertebral & 2 fused ( atlas C1, axis C2) Cerv 7, thor 12, sacral 5, coccy 4 |
| Name meningeal coverings of brain and spinal cord | Dura mater - strong, b/n bone & dura mater Arachnoid mater - thin, loose surround brain, contains lg vessels, below subarachnoid space Pia mater - adheres to brain, choroid plexus |
| Where is CSF manufactured | choroid plexus in Pia mater |
| Name and locate three ventricles in brain | Lateral (2): horns Third ventricle: b/n laterals & connected by foramen of Monro Fourth ventricle: connected by aqueduct of Syvius |
| What is communicating vs non-communicating hydrocephalus | comm: obstruction/lack of absorption non comm: obstruction in ventricle system |
| How much CSF is produced hour? day? total system volume? | Hour: 20ml/h day: 500ml/day, total vol: 150ml |
| What is cellular structure/fx of neuron | Dendrites: impulse reception Cell body: metabolic fx of cell Axon: carries impulse away |
| What makes up the Circle of Willis | Anterior and Posterior circulation Connection of 3 comm aa (AcomA, PcomA (2) |
| Where does the ant. and post. circ originate | common carotid CCA, R CCA: innominate aa/L CCA: aorta Post: subclavian aa, R innominate, L aorta |
| What is considered the Ant. circulation and leads off ICA | Ophthalmic aa OA PcomA: post comm. aa MCA: supply to deep subcortical area ACA: linked together by AcomA |
| What is posterior circulation include | Vertebral aa give off post inf cerebellar aa PICA Vertebral fuse to Basilar aa Basilar gives off to PCA (thalm), SCA, pontine, AICA |
| What % of circle of willis is ideal? Most common missing segments? | Only 50% 1. ACA, 2. One of the PcomA, 3. 1st seg of PCA |
| What is the cerebral cortex | 80% of brain wt. 2 hemispheres separated by corpus collosum 4 lobes: frontal/temp/parietal/occipital |
| What is major fx of Brodmanns Area 4 | Voluntary motor fx: Motor strip ACA territory ( esp leg) and some MCA (lower facial wkn) |
| Where is Area 44: Broca's area | Left MCA, frontal lobe Expressive aphasia: spoken/written lang. word finding, |
| Where is 9-11, cognitive fx area | ACA behind forehead seen in SAH affects orientation, memory, insight, judgement, arithmetic/abstract thinking |
| Where is Area 1-3, primary sensory | Parietal lobe sup ACA, inf MCA |
| Where is area 5 & 7: somesthetic assoc | MCA extinction, stereognosia (tell what object it is), graphesthesia (write on skin and decipher) |
| What is are 39 & 40, Wernicke's area | Left MCA receptive lang. |
| Where is area 41 & 28 | Temporal lobe, MCA |
| What does Occipital lobe show | visual integration & pathways |
| What does Area 17 & 18 primary visual cortex affect | PCA territory |
| Where would you find cortical blindness stroke | top of the BA or PCA occl. |
| Where is homonymous hemianopia found | always post. to chiasm Lg parietal - MCA Medial occipital - PCA |
| Double vision would indicate which part of brain | brain stem infarct |
| Internal capsule is which distrubution | MCA |
| Thalami is | PCA distribution |
| What does cerebellum control | fine motor coordination, equilibrium/balance, ataxia, ipsilateral side affected stroke, vertigo |
| Brainstem stroke affects | LOC, double vision, cardiac, resp, vomiting, sneezing, hiccups |
| What does cerebrum control | association, motor, sensory, contralateral |
| Name cranial nerves | 1 - smell, 2 - vision, 3,4,6 - EOM extraocular mvmt, 5-corneal reflex(S)/maxillary(S)/Mandibular(S)(M) teeth clench, 7-facial(S)(M), 8-acoustic/balance, 9,10-glosso/vagal, swallow, 11-spinal acc, 12-hypogloss, tongue mvmt |
| Where is midbrain and what are infarct findings | From thalamus to pons, CN3,4 pupil dilate, EOM dysfx, decr LOC, (M)(S) disrupt |
| Where is Pons and infarct findings | from pons to medulla oblongata, CN5,6,7,8 Pneumotaxic ctr: inhibit depth of resp/incr rate apneustic ctr: promotes inspiration gaze/diplopia, EOM dysfx, decr LOC, (M)(S), resp arrest |
| Where is Medulla oblongata and infarct findings | from pons to spinal cord, CN8,9,10,11,12 cardiac/vasomotor ctrs decr LOC, card/vasomotor dysfx, hearing loss, dysphagia, quadriplegia |
| What is important about basiar art thrombosis | Most misdiagnosed, hiccups, weird s/s, diplopia, vertigo, cortical blindness |
| Diff bn cortical and brainstem infarct | Above brainstem: loss (M)(S) same side with face brainstem: CN deficit same side as infarct, but opp extremity (M)(S), sudden loss of consciousness in non-hemm |
| When should you do NIH? Scoring is from 0 - _______ Best NIH monitoring p tPA | admission, discharge, 1 x shift, and any changes Score: 0 - 42 baseline pretx, post tPA, q4h q15-30 focused neuros, deterioration/improvemnet |
| What does ICH score predict | death in 30 day, 0- best prognosis, 6- dead. contains: GCS, ICH vol, Intraventricular component, Supra vs Infratentorial, Age |
| what is Modified Rankin Score for | disablility score, 0-6, intervention when score 0-1 |
| What are absorptions/color for CT | air - black/none, CSF - black/low, White matter - darker gray/low med, Gray matter - lighter gray/high med, Blood - white/high, Bone - bright white/high |
| How to read CT | start at base of brain and moves superiorly to top of skull, looking through bottom of feet to top of head, mirror image - L side reflects right brain, vice versa |
| Adv/Disadv for CT | Adv: fast, good for lesions dis: poor resolution, 6-8h delay b4 stroke shows |
| What are early/late signs for stroke on CT | early: clot in vessel, hyperdense aa late: hypodensity, darkened, subacute inf |
| What is scoring for Modified Ranking Score | 0- no s/s 1- able to carry out usual activities/duties 2- slight disable, can look after self w/o assistance 3- mod disable, some help, can walk w/o assistance |
| What is scoring for MRs | 4- mod severe disable, not walk w/o assist, not do bodily needs w/o assist 5- Severe disable, bedridden, incontinent 6- dead |
| NIH scoring LOC | 0- alert 1- not alert, arousable 2- needs repeated stimulation, obtunded, req strong painful stimuli to make mvmnts 3- Reflex motor response, totally unresponsive, flaccid |
| NIH Questions: Month/Age | 0-answers mo/age 1- ans one correctly, intubated, sev dysarthria 2-both incorrect/no answer, aphasic/stuporous not responding |
| NIH Commands to open/close hand/eyes | 0- obeys both 1- obeys one 2- Not obey/respond |
| NIH EOMs: horizontal eye mvmt, doll's eyes used if needed | 0- Normal 1- Partial gaze palsy, can come to ctr, but goes back 2- Forced deviation/total gaze paresis |
| NIH Visual Fields: upper/lower, confrontation | 0-no loss 1- partial hemianopia 2- complete hemianopia 3- bil hemianopia, blindness/cortical |
| NIH Facial Palsy: smile, raise eyebrows, grimace with noxious stimuli | 0- normal symmetric mvmt 1- minor paralysis, flattened nasolabial fold 2- Partial paralysis: total paralysis lower face only 3- complete paralysis lower/upper face |
| NIH Motor Arm: Count of 10 Left & right | 0- No drift 1- drift 2- some effort against gravity 3- No effort against gravity 4- No mvmt |
| NIH Motor Leg: Count of 5, Left & right | 0-No drift 1- drift 2- some effort 3- no effort 4- no mvmnt |
| NIH Limb ataxia: Finger to nose, heel to shin | 0- absent 1- present in one limb 2- present in two limbs |
| NIH Sensory: sensation, grimace, withdrawal | 0- Normal, no loss 1- mild to mod, dull, less sharp 2- severe to total loss, not aware of being touched |
| NIH Language: aphasia | 0- no aphasia 1- mild to mod 2- severe 3- mute, global: no speech/auditory comprehension |
| NIH Dysarthria: slurred speech | 0- normal 1- mild to mod: slur some words 2- unintelligible |
| NIH Extinction/Inattention | 0- No abnomality 1- visual, tactile, auditory, spatial, personal inattention, or to bil sensory 2- profound in >1 sensory, not recognize hand, etc |
| What is watershed infarct | b/n regions |
| which area is worst/best outcome for ICH: cortical, BG, thalamus, Pontine, Cerebellar | Worst: Pontine Best: Basal Ganglia, most common IPH, |
| What should you r/o with Intraventricular hemm | Presence of ACA or AcomA aneurysm, usually is expansion of hemm in BG, IPH |
| Where is SAH | Bleeding in subarachnoid space, usually from aneurysm rupture or trauma, "star" appearance or "hanging chicken" |
| What is 1st s/s SAH | thunder clap HA |
| What is tx and appearance of amyloid angiapathy hemm | more round and no tx can be done, more on surface |
| what are CTP scans for | Looking to save penumbra and ischemic penumbra, measures tiss perfusion, usuall for "wake up" strokes |
| In MRI, which is better for disease definition, T1 or T2 | T2, CSF- white, Fat- dark |
| What is GRE, gradiant Recall Echo in MRI | Rules out blood, microbleeds may be detected |
| What does the FLAIR show in MRI | older stroke, dating/timing of stroke onset, if neg and DWI pos, give tPA, shows 4-6h after stroke |
| Name MRI sequences | 1- GRE id blood 2- DWI ischemia 3- FLAIR timing of onset, old isch changes 4- MRA vascular imaging` |
| What is gold standard imaging for vascular | Catheter Angiography, IR, uses 1/2 of dye of CTA, invasive, can have IA rescue, safe to due p tPA |
| What is HOB for sheath mgmt | <15 deg |
| What is doppler shift | ultrasound to describe mvmt of blood away/towards probe |
| What is duplex imaging | image lg vessels in neck, see plaque & blood, stable(hyperechoic)/unstable(hypoechoic) plaque, |
| What is transcranial dopper TCD | flow of blood thru lg vessels in circle of willis, detect vasospasm (risk @ 5-7d), monitor tPA, brain death, sickle cell |
| What is risk of vasospasm? Tx of vasospasm | ischemia Tx: Triple H therapy: hemodilution/hypervolemia/htn Meds: Nimodipine(neuroprotective effect, not lessen spasm, Mg, statin Intra Art tx: angioplasty, verapamil inf |
| What was result of NINDs tPA stroke study | Got tPA FDA approved and standard of care |
| What is tPA dosing | 0.90mg/kg, total dose 90mg Waste 10cc, give 10% as bolus, then remaining 90% inf over 1 hour. |
| What should BP be b4 tPA and during/after | b4: 185/110 after: 180/105 |
| what are inclusion/exclusion criteria for tPA | incl: clear time of onset w/n 180 min of tx, deficits on NIH, neg CT for hemm Excl: prev stroke/trauma w/n 3 mos onset, major sz w/n 14 days, hx ICH, SBP>185/110, improve TIA |
| What are more excl of tPA | s/s SAH, hx GI/urin hemm past 21d, art px prev 7d, Sz Todd's paralysis(mimic), incr PTT, <100,000platelet, BG <50; >400 |
| At 3 mos, what % of pt w/ no deficits after tPA | 12%, no incr death, age not a factor, severe NIH not a factor, sICH rate 6.4%, 30% more likely to have mRS 0-1 @ 3 mos |
| What time frame should IV tPA be adm to acute stroke | w/n 4.5h |
| What are the drug choices to manage BP wtih tPA | labatelol 10-20mg q 5-15m up to total 150mg IVP Nicardipine drip: rapid onset/offset, less titrations Cleviprex: incr med 1-2mg = decr 2-4mg of BP, rapid |
| what are contraindications of labatelol | asthma, CHF, heart block |
| what is Poiseuille's Law | incr in extremity size = decr BP, cuff too lg decr extremity = incr BP, cuff too small |
| What is BP monitoring after tPA | BP q 15 x 2h, 30m x 6h, 1h x 16h, q4h |
| Post tPA mgmnt | No invasive procedure, No antiplatelet/anticoag for 24h |
| What is % for recanalization wtih tPA | 13-38%, better if tx is started earlier |
| Lg vs sm vessel occl tx wtih tPA results | Lg vessel: less likely to respond, need IR Sm. vessel: very well tx |
| What rare complication with tPA is more common with AA and pt taking ACE/ARBs? | oropharyngeal edema, may need intubation/drugs |
| What defines a symptomatic ICH during tx of tPA? | >4 pts from original NIH + IPH on non-contrast CT |
| Pt can't get tPA, what r IA tx, (intra-arterial) options? | thrombectomy, drip tPA directly on clot, angioplasty, stenting |
| List Guideline Classification for IA tx | Class 1: (strong) Benefit >>> risk Class IIa: benefit>>risk (tx reasonable) Class IIb: benefit > risk (tx may be considered) Class III: risk > benefit (harm) no tx |
| What is the TICI score? | Done for Thrombolysis cerebral infusion after tx Grade 0: no perfusion G1: penetration w min. perf G2: partial perf, G2a/2b: better G3: complete perf Goal is 2b/3 w/n 6h of stroke onset |
| What high risks are included with ICH | HTN, >55y, anticoag therapy, amyloid angiopathy, smoke, alcohol use, asians (highest), AA 65-74y, white older age |
| What is 6 mos mortality rate post-ICH | 30-50%, < independence in 6 mos, |
| Describe scoring for ICH score | Score 0 = 0 death in 30 days 1 = 14% death 2= 28% death 3=70% death 4= 95% death 5&6 = 100% death |
| Indicators for ICH scoring | GCS 3/4 - 2pts, 5-12 - 1 pt, 13-15 - 0pt ICH volume: >30ml 1 pt, <30ml - 0 pt IVH: Yes - 1pt, No - 0pt Infratentorial: Yes - 1pt, No - 0pt Age: >80 - 1pt, <80 - 0pt |
| What is significance of CT "spot sign" | probably active bleeding expansion, 72% in 24h, most common loaction for ICH is BG d/t HTN. 2nd: amyloid angiopathy in cortical/parieto/occipital (surface) |
| What are clinical s/s of ICH | impaired LOC, vomiting, severe HA, severe HTN |
| Ways to manage ICH | airway mgmt, INR >1.4 needs reverse anticoag, BP reduction 160/90, CPP 60-80mm Hg (MAP-ICP=CPP) |
| What is first tier therapy to manage ICP | ventriculostomy w CSF drainage, then manitol, hypertonic solutions, HOB 30deg, hyperventilation, sedation |
| What is second tier therapy to manage ICP | Hemicraniectomy, hypothermia, barbituate coma |
| Are prophylactic sz medication necessary in ICH | No, only if see sz. |
| When is surgery benefit in ICH? | Sx not usually help Sx better in cerbellar hemm >3cm to prevent herniation |
| Who is most common for SAH | women, 40-60y, Japanese, black>white, htn, smoke, alcohol, cocaine |
| Most common aa affected by SAH | Base of Circle of Willis: PcomA from ICA, AcomA - ACA, MCA |
| What are most common forms of aneurysms? Which aneurysm type most likely to rupture? What size is an aneurysm needing sx | Berry/sacular - 80-90% >7mm, worst HA |
| What diagnostics determine SAH? What is gold standard? | Non-contrast CT If CT neg, then lumbar px CTA Gold standard: catheter angiography |
| What scales are used to grade SAH severity | Hunt & Hess Grading Scale World Federation of Neurological Surgeons Scale |
| What tx is best to prevent re-bleed | coiling/clipping |
| What monitoring is needed for SAH rupture | monitor cardiac enzymes/telemetry, monitor for SIRS(HR>90, RR>20, WBC<4/>12, T >38C), hydrocephalus, hyponatremia (AcomA), 30%, cerebral salt wasting - decr free water, isotonic IV fluids |
| Pt 40y has sz, mass effect on CT and hemm w/ HA....what likely is cause | AVM |
| What is formula for cardiac output CO | CO = SV + HR |
| what is SV: stroke volume | amt of blood ejected by heart with ea contraction |
| What is Frank-Starling Law | Preload stretches heart muscle, incr degrees of stretch result in improved contractility until muscle is over stretched, dilated, & flaccid |
| What is afterload | resistance in vasculature that heart muscle must overcome to eject volume` |
| What causes resistance to flow in heart | atheroscloerosis, art pressure, metabolic factors(incr CO2 = dilate/decr CO2=constrict), intracranial pressure (ICP), extracranial pressure (stenosis in carotids/vertebrals), blood viscosity (incr hematocrit) |
| What is primary method to autoregulation | Vasomotor reactivity |
| Where is the phlebostatic axis and what is it for? What is leveled at the tragus? | 0 line for BP monitoring tragus: ICV |
| Normal hemodynamic values: cardiac output CO/MAP/SvO2/ICP/CPP | CO - 4-8L/min MAP - 70-105 mm Hg SvO2 - 60-75% ICP - 0-15mm Hg CPP - 70-100mm Hg |
| What is tidal volume | 5-8mf/Kg, volume of gas moved into/out of lungs in single normal insp or exp. Start with 8010ml/Kg and titrate down |
| What is Vital capacity and who benefits from monitoring this | volume of gas exhaled after the deepest possible inhalation. Guillan Barre pts |
| What factors reduce diffusion | pulm edema/thick membrane, fibrosis/surface area for gas exchange... |
| What improves ventilation/perfusion | HOB 45 deg, good lung down, prone |
| What is diff b/n PaO2 & SaO2 | PaO2: oxygen transported dissolved in blood serum SaO2: oxygen transported in combination w hemoglobin |
| With FiO2, what is goal | PaO2 >60% produces SaO2 >90%, use FiO2<50%. Add PEEP to incr SaO2 b4 incr FiO2 |
| pH/paCO2/PaO2/HCO norms | pH: 7.35-7.45 paCO2: 35-45 paO2: 90-100 HCO3: 22-26 |
| in resp acidosis/alkolosis how do you adjust RR with paCO2 of 55, pH 7.34 | acidosis: incr RR alkolosis: decr RR |
| What are factors with weaning success | LOC, hemodynamic stability, physiologic stability, sats, spontaneous ventilation, pulm mechanics |
| What are two non-invasive ventilations | Bipap: have to be able to take mask off and not be restrained. PS @ insp/ PEEP@ end of exp Cpap: provided PEEP w/o pressure support |
| What is most preventalbe cause of death in hospitals | VTE: DVT/PE/post-thrombotic syndrome |
| What is Virchow triad | factors of DVT: change in vessel wall (injury), pattern of blood flow(venous stasis), constituency of blood(hypercoag states) |
| What is best method for VTE/PE prevention? What is best dx of VTE? what is best dx of PE? | 1st: Medical mgmt: anticoags: lovenox 2nd: mechanical SCD Dx: LE dopplar PE dx: CT |
| What is Braden Scale for predicting pressure ulcer | 6 -skin breakdown risk 32 - no risk for skin breakdown |
| Factors influencing intensity/duration in Braden: Factors in skin/support tissues in Braden: | int/dur: Mobility/Activity/Sens perception skin/tiss: moisture/friction/nutrition/age/art press |
| A pt with an infarct with left neglect, visual field deficits &/or tactile neglect, & incontinence likely is right or left brain | Right brain asoc with falls |
| Normal BP/prehtn/high stage 1/high stage 2 | normal BP 120-80 prehtn: 120-139/80-89 high Stage 1: 140-159/90-99 Hight Stage 2; >160/100 |
| What is first line anti-htn drug givn with 2nd drug | thiazide diuretic w ACE in AA Pro: cheap, effective Con: dehydration, incr blood viscosity |
| what is 2nd drug of choice to combine with thiazide diuretics | Ca. Ch. blockers |
| When are BB best used for htn | CAD and afib Pro: cheap con: stopping can cause death, impotence/depression |
| What is best BP drug in stroke prevention/mgmnt | ACE/ARB pro: stroke reduction/cardiac remodeling/renal protection Con: not good to decr BP in pt that lack renin-based htn, avoid in preg, cough |
| When is okay to use Minoxidil | When no other agents lower BP, aggressive, monitor pericardal eff, combine with BB to prevent rebound tachy |
| What dose is best for statins in stroke? When does statin reduce first ever stroke? | Dose: 80mg statin First ever stroke prevention: elevated C-reactive protein |
| when ASA best for stroke pts? Which is better ASA or Aggrenox? | when not on ASA before Aggrenox bettern than ASA, risk is HA |
| Which is best ASA or Plavix for stroke | Plavix to reduce event Plavix + ASA to lower risk of embolic events, but not long term except wtih stents |
| When is anticoagulation best used in relation of stroke prevention/mgmnt | cardioembolic stroke/crescendo TIA/hypercoag states/art dissection assoc w embolization/cerebral venous thrombosis |
| Warfarin is best tx for young/old when? | warfarin is superior to placebo in reducing stroke risk. Younger: no comorbidities than use ASA Older: w comorb, use warfarin |
| How to determine ciggarette pack year hx | # of yrs smoked X # of cigg smoked / 20 |
| medications to support smoking cessation | gum: up to 24 pcs/d, pack b/n teeth and gum patch: >10cig/21mg, in 2wks/14mg, in 2wks/7mg |
Created by:
apalmer
Popular Nursing sets