Question | Answer |
Balance of Fluids & Electrolytes | Homeostasis |
is vital to neuromuscular function and acid based balance | Electrolyte balance |
Inflammation and decreased protein cause | Fluid shifts |
Fluids are drawn to | Na+ and glucose |
Decreased concentration to increased concentration (cell -> Vasc. space) | Osmosis |
Increased concentration to decreased concentration (vasc. space -> cell) | Diffusion |
Pulls fluid in | Osmotic pressure |
Push fluid out | Hydrostatic pressure |
Decreased BP, Hypovolemia, Hyponatremia, Hyperkalemia cause: | Adrenal gland to secrete aldosterone;
Kidney retains H2O & Na+, Excretes K+ |
The concentration of fluid that affects the movement of water between fluid compartments | Osmolality |
The higher the osmolality the greater the pulling power of water. (_______ pressure) | Osmotic |
Drawn to H+ ions | Chloride |
Maintain acid balance | Bicarbonate |
Move fluids into diff. spaces
Intravasc. -> ICF/ECF | Crystalloids |
D5 & H2O: Iso in bag, _____ in body.
Body metabolizes sugar, H2O is _____. | Hypotonic |
Hypotonic solution | Cells grow |
Isotonic Solution | Volume Expansion |
Hang Blood | Hang ISO |
D5 1/2 NS ________ in bag
________ in body | Hyper
Hypo |
Hypertonic solution | Cells Shrink |
Contain proteins (ex. albumin) that remain intravascular and pull fluid from cells & interstitial space (very high osmotic pressure) | Colloid |
Interstitial edema, +2 pitting edema
Swollen legs -> fluid in interstitial spaces | Second Spacing |
M: 37 - 49
F: 36 - 46 | Hematocrit (HCT) |
8 - 22 mg/dL | Blood Urea Nitrogen (BUN) |
135 - 145 mEq/L | Na+ |
70 - 110 mg/dL | Glucose |
Fluid accumulates where fluid is not normally at in large amounts: anasarca | Third Spacing |
Give colloids + diuretics to get the fluid back where it belongs | Third Spacing |
98 - 106 mEq/L | Chloride (Cl-) |
8.5 - 10 mg/dL | Calcium (Ca+) |
3.5 - 5.0 mEq/L | Potassium (K+) |
1.3 - 2.1 mEq/L
1.6 - 2.6 mg | Magnesium (Mg+) |
1.7 - 2.6 mEq/L
2.5 - 4.5 mg | Phosphate (PO4-) |
275 - 295 mOsm/kg | Serum Osmolality |
M: 14 - 18 gm/dL
F: 12 - 16 gm/dL | Hemoglobin (Hgb) |
First line med for V-tach | Amiodarone |
2nd line med for V-tach | Lidocaine |
Shockable??? | V-tach
V-fib |
Unstable, pulseless V-tach | Call Help
Call Code
Start CPR
D-fib
Epinephrine
Vasopressin
Amiodarone
Lidocaine
Resuscitation |
Stable V-tach w/pulse | Amiodarone
Lidocaine
Mg+, K+
Sync Cardiovert |
HR >180
Acute MI, CAD, Cardiomyopathy, Heart Failure, Valvular disease
K=, Mg+ imbalance
Artifact - Ck. Pt. | V-Tach |
Amiodarone
Lidocaine | Antiarrhythmics |
40 - 60 bpm
No P wave - No Atrial Kick
Always Regular | Junctional Escape |
HR 150 - 250 bpm
Always Regular
May or may not see P waves
Drug of choice: Adenosine | Superventricular Tachy (SVT) |
O2
IV access
Heart monitor
Vagal maneuvers
Adenosine | Stable SVT Treatment |
ADENOSINE - Chest pain, Dropping BP, other distress
Ca+ Chan Blocker
Beta Block
Cardiovert - LAST RESORT | Unstable SVT Treatment |
Control HR & Rhythm
Diltiazem
Amiodarone
Digoxin | Atrial Tachy Treats |
Sinus Node Disease
Meds (Beta Blocks)
Hypoxia
Athletes | Sinus Brady Causes |
O2
IV Access
Atropine Sulfate(if symptomatic)
Continuous Monitoring | Sinus Brady Treats |
Blocks PNS to Increase HR
anticholinergic | Atropine Sulfate |
"Early" Atrial depolar
Usually Asymptomatic
Treat the cause | PAC - Premature Atrial Contraction |
Stress, anxiety, fatigue, infection, lack of sleep, meds, cafiene, Heart failure, Electrolyte imbalance, MI | PAC causes |
Chaotic firing of Atrium - No Pattern
Irregularly - Irregular
No meaningful P waves
Loss of Atrial Kick
Decrease C.O. 20 - 30% | A-Fib |
Amiodarone | A-fib
(treats arrhythmias) |
HR 100 - 150
ALWAYS has a cause: anxiety, pain, fever, activity, dehydration, Heart fail, anemia
FIX CAUSE -> FIX RHYTHM | Sinus Tachy |
FIX CAUSE -> FIX RHYTHM
Give O2
Beta Blocks (lopressor)
Ca+ Chan Blocks
(Decrease HR) | Sinus Tachy Treats |
Beta Blocker - Decreases HR | Lopressor |
HR>250 bpm - SAWTOOTH
Conduction Ration P:QRS -> 4:1 | A-Flutter |
Cardioversion
Ca+ Channel Blocks
Beta Blocks
Digoxin | A-Flutter Treats |
Ideal RASS Score | -2: Lt. Sedation - Briefly awakens w/eye contact to voice (<2 secs) |
HOB > 30*
Prevent Stress Ulcer
DVT Prophylaxis
Sedation Vacation
Oral Care q2hrs
Weaning Trial | Vent Bundle |
Low Pressure Alarm | Leak in Line or disconnection |
High Pressure Alarm | Resistance in circuit:
Kinked Tube
Pt. Biting Tube |
AIR IN
Amt air delivered to lungs -> 1 breath
5-12 mL | Tidal Volume |
3-5 cm H2O > 20 + Dmg can occur
Keeps Alveoli inflated during expiration | PEEP |
Hyper inflated lungs take space from Heart -> Heart can't fully open and close -> Increases PEEP -> | Increased PEEP -> Decreased C.O. |
Assist Control Vent
(set # of guaranteed breaths) | CPAP to wean from vent (Pt breathes on own -> alarm for Apnea) |
Coumadin Reversal | Fresh Frozen Plasma |
Left Heart Failure Manifestations? | Decreased C.O. -> Weak peripheral Pulses |
Electrical CHAOS!!!
Vents wiggle -> No Squeeze -> No Pulse -> Pt. Always Unconscious
#1 Cause: Acute MI
D-Fib w/in 5 mins or DEAD!
SHOCKABLE!!! | V-Fib |
#1 Cause of V-Fib | Acute MI |
Hypo & Hyperkalemia can cause: | V-Fib |
Hypovolemia
Hypoxia
Hypoglycemia
Hypothermia | V-Fib Causes |
Conduction problem in the AV Node | AV Blocks |
A-V Node Conduction Delay
PR >.20
Usually age, Asymptomatic & Benign | 1st* AV Block |
Mobitz I (Wenkebach)
Mobitz II | 2nd* AV Block |
PR Lengthens PROGRESIVELY
Less Serious
Treat Symptoms
AV Node can't keep up - usually temporary and fixes itself | Mobitz I (Wenkenbach) |
PR same & constant
More Serious
Some QRS's Drop | Mobitz II |
MI
AV Node/Bundle Branch disease
More serious than Type I | AV Block Type II |
Atropine
Dopamine
Epinephrine
Temporary Pacemaker, if unstable | AV Block Type II - Treatments |
AV Node can't keep up _-> P progressively lengthens until QRS drops off -> Starts over -> Temporary, No treatment | Mobitz I (Wenkenbach)
2nd* AV Block |
P wave w/o QRS -> usually rqrs. Pacemaker (if unstable) -> Atropine, Dopamine, Epinephrine | Mobitz II
2nd* AV Block |
Complete Heart Block
Decreased C.O.
LOC, Syncope, can progress to Asystole
SERIOUS!!! | 3rd* AV Block |
Atria <- No Communication with -> Ventricle
ALWAYS more P's than QRS's | AV Block Type III |
Meds: Digitalis toxicity
Degenerative Heart Disease
Acute MI
Myocarditis | 3rd* AV Block
Causes |
Treat symptoms
Usually gets perm. pacemaker
Atropine, Dopamine, Epi. - while awaiting pacemaker | 3rd* AV Block
Treats |
One of the 2 Bundle Branches is blocked
Wide QRS >0.12
12 lead EKG -> determine R or L
Not treated unless acute | Bundle Branch Blocks (BBB) |
Causes
Acute conditions - MI or Heart Fail
Increased HR | Bundle Branch Blocks (BBB)
Temporary |
Causes:
Infarct of Bundle Branch
Congenital Heart Disease
Rheumatic Heart disease
Cardiomyopathy
Severe aortic stenosis
Any heart disease causing scarring of conduction system | Bundle Branch Blocks (BBB)
Permanant |
Pt: HR 40, Sinus Rhythm, SOB, Chest pain, BP 87/60 | Symptomatic Bradycardia
Give Atropine 1 mg IV to increase HR |
Pt: Heart beating out of chest, diaphoretic, Tachypneic, BP 70/40
Heart Monitor: SVT
Valsalva & 3 doses Adenosine - NOT working
Immediate action?? | Unstable SVT
Valsalva & Adenosine Failed...
Prepare for Synchronised Cardioversion |
8 hrs. post CABG: Report what?
Mediastinal drainage of 100 mL/hr
T: 98.8*
BP 160/80
K+ 3.8 | Increased BP -> Increased Vascular pressure may cause bleeding @ incision sites |
35 - 45 | PaCO2 |
22 - 26 | HCO3- |
Necrosis of Heart Muscle do to lack of O2
Decreased O2 & Increased Demand | MI |
Peripheral Edema
Jugular Vein Distension
Ascites Heptomegaly
Fatige | R Sided Heart Failure |
Tachycardia
Dyspnea
Decreased Cerebral perfusion
SOB, Wt Gain, Confusion | L Sided Heart Failure |
CHEST PAIN??
M.O.N.A. | Morphine
O2
Nitro
Aspirin |
Congestive Heart Failure
UNLOAD FAST | Upright
Nitrates
Lasix
O2
Ace inhibitors
Digoxin
Fluid Restrict
Afterload Decreased
Sodium restiction
Test (Dig, ABG, K+) |
Block Beta Receptors in Heart:
Decrease HR, Force of contraction, Rate of AV Conduction | Beta Blockers |
Bradycardia, Lethargy, CHF, Depression, GI Disturbances, Decreased BP | Beta Blockers
S/E |
PropranOLOL (Inderal)
AtenOLOL (Tenormin)
MetroprOLOL (Lopressor) | Beta Blockers |