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Critical Care I

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Created by: lost little girl

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Fluid and Electrolytes

Need to know lab values for Nclex

Hints from Exam Cram NCLEX

Commonly used Abbreviations

Anatomy Questions for HESI entrance exam

Cardiovascular Pharmacology

1 A Cardiac Assessment

NCLEX Cram Simplifying Pharmacology

Fluid & Electrolyte & Acid-Base Balance

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(-) roots and meanings end of word

1 A Cardiac Rhythym Strip Analysis

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