UTA NURS 4581 Critical Care Final Review
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| bariatric surgery criteria guidelines | BMI ≥40 or a BMI ≥35 with one or more severe obesity-related medical complications (e.g., hypertension, type 2 diabetes mellitus, heart failure, or sleep apnea) AND documentation of three unsuccessful attempts at medically supervised weight loss programs
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| Benefits of restrictive bariatric surgery vs. malabsorptive | Since digestion is not altered, the risk of anemia or cobalamin deficiency is low. Procedures can be performed using a laparoscopic approach, decreasing postoperative pain, hospital stays, and the rate of wound infection and hernia formation
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| Dumping syndrome | gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients
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| Nutritional therapy postgastrectomy dumping syndrome | divide meals into 6 small feedings; fluids not taken with meals (at least 30-45 min before or after); avoid concentrated sweets; increase protein and fats (meat, cheese, and eggs); cobalamin injection monthly
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| General Adaptation Syndrome (GAS) stages | alarm reaction, stage of resistance, and stage of exhaustion
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| Respiratory acidosis causes | Chronic obstructive pulmonary disease, Barbiturate or sedative overdose, Chest wall abnormality (e.g., obesity), Severe pneumonia, Atelectasis, Respiratory muscle weakness (e.g., Guillain-Barré syndrome), Mechanical hypoventilation
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| Respiratory acidosis manifestations | Drowsiness, Dizziness, Headache, Disorientation→ Stupor & coma; ↓ Blood pressure, Ventricular fibrillation (related to hyperkalemia from compensation), Warm, flushed skin (related to peripheral vasodilation); Seizures; Hypoventilation and hypoxia
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| Respiratory acidosis management | identify/treat cause (do not give bicarbonate) by increasing ventilation and decreasing dead space (increase rate and volume of respiration); for COPD it is normal for them to be in fully compensated acidosis and no treatment is necessary
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| Respiratory alkalosis causes | Hyperventilation (caused by hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, fever); Stimulated respiratory center caused by septicemia, encephalitis, brain injury, salicylate poisoning; Mechanical hyperventilation
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| Respiratory alkalosis manifestations | Lethargy, Light-headedness, Confusion; Tachycardia, Dysrhythmias (r/t hypokalemia compensation); Nausea, Vomiting, Epigastric pain; hypocalcaemia manifestations (Tetany→ convulsions & unconsciousness); hyperventilation
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| Respiratory alkalosis management | slow ventilation, rebreather mask, increase dead space
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| Metabolic acidosis causes | Diabetic ketoacidosis, Lactic acidosis, Starvation, Severe diarrhea, Renal tubular acidosis, Renal failure, Gastrointestinal fistulas, Shock, Poisoning
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| Metabolic acidosis manifestations | Drowsiness, Headache, Disorientation→coma; ↓ BP, Dysrhythmias (r/t hyperkalemia from compensation), Warm, flushed skin (related to peripheral vasodilation); Nausea, vomiting, diarrhea, abdominal pain; Kussmaul respirations (Deep, rapid)
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| Metabolic acidosis management | indentify/treat underlying cause; sodium bicarbonate (NaHCO3) if severe
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| Metabolic alkalosis causes | Severe vomiting, Excess gastric suctioning, Diuretic therapy (increased excretion of H+), Potassium deficit, Excess NaHCO3 intake, Excessive mineralocorticoids
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| Metabolic alkalosis manifestations | Dizziness, Irritability, Nervousness, confusion; n/v, Anorexia; hypokalemia (Tetany, Tremors, Tingling of fingers and toes, Muscle cramps, hypertonic muscles, Seizures); hypocalcemia (r/t increased calcium binding to proteins); Hypoventilation
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| Metabolic alkalosis management | treat underlying cause, Diamox (acetazolamide)
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| volume ventilation | a predetermined tidal volume (VT) is delivered with each inspiration, and the amount of pressure needed to deliver the breath varies based on the compliance and resistance factors of the patient-ventilator system.
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| pressure ventilation | the peak inspiratory pressure is predetermined and the VT delivered to the patient varies based on the selected pressure and the compliance and resistance factors of the patient-ventilator system.
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| Usual Tidal Volume Setting on Mechanical Ventilator | 6-10 mL/kg
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| Usual FIO2 setting on Mechanical Ventilator | may be set between 21% (essentially room air) and 100%; usually adjusted to maintain PaO2 level >60 mm Hg or SpO2 level >90%
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| Assist-Control (AC) or Assisted Mandatory Ventilation (AMV) | The ventilator sensitivity is set so when the patient initiates a spontaneous breath, a full-volume breath is delivered.
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| Intermittent Mandatory Ventilation (IMV) and Synchronized Intermittent Mandatory Ventilation (SIMV) | In between “mandatory breaths,” patients can spontaneously breathe at their own rates and VT. With SIMV, the ventilator synchronizes the mandatory breaths with the patient's own inspirations.
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| Pressure Support Ventilation (PSV) | Provides an augmented inspiration to a spontaneously breathing patient. When the patient initiates a breath, a high flow of gas is delivered to the preselected pressure level and pressure is maintained throughout inspiration.
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| VAP prevention | elevate HOB 45 degrees, maintain ET cuff pressure at 20 cm H2O, good handwashing, and meticulous oral care
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| Train-of-four assessment | used for administration of paralytics; use of a peripheral nerve stimulator to deliver four successive stimulating currents to elicit muscle twitches. The usual goal is 1-2 twitches out of 4.
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| Indicators for Weaning from mechanical ventilator | reversal of underlying cause; adequate oxygenation; hemodynamic stability (absence of myocardial ischemia or clinically significant hypotension); and ability to initiate an inspiratory effort
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| Mechanical ventilator weaning parameters | maximum inspiratory pressure -20 to -30; minute ventilation <10 L/min; PaCO2 normal for patient (e.g., elevated for COPD); PaO2 ≥ 60; FIO2 ≤ 50%; PEEP ≤ 5 cm; and PSV ≤ 10
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| factor commonly responsible for sodium and fluid retention in the patient on mechanical ventilation | decreased renal perfusion with increased release of renin
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| Hypoxemic vs. hypercapnic respiratory failure | in hypoxemia, the PaO2 is 60 mm Hg or less when the patient is receiving an inspired oxygen concentration of 60% or greater; in hypercapnic, the PaCO2 is above normal (> 45) in combination with acidemia (arterial pH < 7.35)
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| acute respiratory failure management | identify/treat cause; O2 therapy, mobilization of secretions (hydration/humidification, CPT, airway suctioning), positive pressure ventilation; goal: PaO2 55-60 with least amount of O2 admin
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| PaO2/FIO2 ratio is 200-300 etiology | acute lung injury (ALI)
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| PaO2/FIO2 ratio is less than 200 etiology | acute respiratory distress syndrome (ARDS)
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| ARDS management | Respiratory therapy (O2 administration, Lateral rotation, PEEP, prone positioning, mechanical ventilation); supportive therapy
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| Angina decubitus | chest pain that occurs only while the person is lying down and is usually relieved by standing or sitting
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| Prinzmetal's angina | variant angina; occurs at rest, usually in response to reversible, severe spasm of a major coronary artery
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| Chronic stable angina management | decrease oxygen demand and/or increase oxygen supply (e.g., preventing an increased HR decreases demand)
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| First action taken when transesophageal echocardiography (TEE) is ordered | Make the patient NPO.
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| percutaneous coronary intervention (PCI) complications | dissection of the newly dilated coronary artery. If the damage is extensive, the coronary artery could rupture, causing cardiac tamponade, ischemia and infarction, decreased CO, and possible death.
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| Post-cardiac catheterization insertion monitoring | Check peripheral pulses every 15 minutes during the first hour post-procedure; monitor the patient's apical pulse and blood pressure frequently
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| Goal for emergent PCI (percutaneous coronary intervention) | to open the affected artery within 90 minutes of arrival to a facility with an interventional cardiac catheterization lab.
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| Sign that chest pain is caused by an acute myocardial infarction (MI) | Pain has lasted longer than 30 minutes.
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| common MI complication | dysrhythmias
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| myocardial infarction (MI) management | ONAM: initiate oxygen, sublingual NTG, and aspirin then, if pain unrelieved, morphine
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| Cardiac marker that remains elevated 10-14 days after MI | Troponin; begins to rise at 4-6 hrs
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| Cardiac marker that begins to elevate within 2 hrs of an MI | Myoglobin; returns to baseline within 24 hrs
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| ECG changes during MI | ST-segment elevation( ≥1 mm above the isoelectric line), Pathologic Q wave (≥25% of the height of the R wave), and T wave inversion
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| MI Healing process | Within 24 hours, leukocytes infiltrate and the inflammatory process begins. At 10-14 days, new scar tissue is still weak and vulnerable to increased stress. By 6 weeks, scar tissue has replaced necrotic tissue and injured area is considered healed.
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| Left-sided HF manifestations | pulmonary congestion and edema; shortness of breath
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| Right-sided HF manifestations | jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal (GI) tract, and peripheral edema.
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| Beck’s Triad | classic signs of cardiac tamponade; increased CVP and jugular vein distention; muffled heart sounds; and narrowed pulse pressure.
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| hemodynamic changes expected after successful initiation of an intraaortic balloon pump in a patient in left ventricular failure | decreased PAWP (pulmonary artery wedge pressure) and increased CO (cardiac output).
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| An IABP (intra-aortic balloon pump) complication | Vascular injuries such as dislodging of plaque, aortic dissection, and COMPROMISED DISTAL CIRCULATION
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| common complication of coronary artery bypass graft surgery | supraventricular dysrhythmias, especially atrial fibrillation
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| commissurotomy (valvulotomy) | surgical procedure of choice for patients with pure mitral stenosis; removes thrombi from the atrium, makes a commissure incision, and, as indicated, separates fused chordae by splitting the underlying papillary muscle and debriding the calcified valve.
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| valvuloplasty | repair of the valve by suturing the torn leaflets, chordae tendineae, or papillary muscles. It is primarily used to treat mitral or tricuspid regurgitation.
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| Annuloplasty | Further valve repair for patients with mitral or tricuspid regurgitation. Reconstruction of the annulus, with or without the aid of prosthetic rings (e.g., a Carpentier ring).
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| Valve replacement | surgical treatment of choice for combined aortic stenosis and aortic regurgitation
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| Resumption of Sexual activity | Resumption of sexual activity can begin 7-10 days after uncomplicated MI when able to climb 2 flights of stairs without SOB. Avoid after a heavy alcohol intake, a big meal, or with an unfamiliar partner in the immediate post-MI period.
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| Post Valve replacement teaching | antibiotics for invasive or dental procedures
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| Peritonitis manifestations | cloudy peritoneal effluent with a WBC count greater than 100 cells/μL (more than 50% neutrophils) or demonstration of bacteria in the peritoneal effluent by Gram stain or culture.
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| Kidney Failure Nutritional Therapy | 30 to 35 kcal/kg with 0.8 to 1.0 g of protein/kg of desired body weight and increased fat (at least 30% to 40% of total calories); Potassium and Sodium restrictions.
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| Metabolic changes in kidney failure | hyperkalemia (treated with calcium gluconate) and hypernatremia; potassium and sodium restricted diets are required
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| most common complication during a hemodialysis treatment | hypotension.
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| Peritoneal Dialysis (PD) Complications | exit site infection, peritonitis (look for cloudy effluent), hernias, lower back problems, bleeding, pulmonary complications (atelectasis, pneumonia, and bronchitis), protein loss
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| maximum amount of weight gain between dialysis treatments | 1.5 kg
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| oliguric phase of acute renal failure (acute kidney injury) management | To prevent life-threatening pulmonary edema, fluids should be limited and I and O strictly monitored.
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| Intervention to reduce chances that the dye used during a renal arteriogram will damage the kidneys | NS IV
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| serum electrolyte imbalances seen in the diuretic phase of acute renal failure (acute kidney injury) | Hypokalemia and hyponatremia.
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| Intrarenal damage prevention for patient with AKI due to myoglobin release | maintaining a positive fluid balance.
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| primary goal of treatment for acute kidney injury (AKI) | eliminate the cause and provide supportive care while the kidneys recover.
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| hypotention management during hemodialysis treatment | Decrease the volume of fluids being removed and infuse NS
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| Absolute hypovolemia | fluid is lost through hemorrhage, gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis.
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| relative hypovolemia | fluid volume moves out of the vascular space into the extravascular space (e.g., interstitial or intracavitary space). This type of fluid shift is called third spacing. Seen in sepsis, burns, and FRACTURED FEMUR.
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| Cause of large weight gain in shock patients | third spacing
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| elevated serum lactate (lactic acid) level in patient with hypovolemic shock indication | significant hypoperfusion.
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| Fluid used for initial volume replacement in most types of shock | Isotonic (0.9% NaCl, LR)—caution with LR d/t increased lactic acid
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| Indications of successful fluid resuscitation | Assessment of end organ perfusion, such as an adequate urine output (at LEAST 0.5 mL/kg/hr), is the best indicator that fluid resuscitation has been successful.
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| Pulse oximetry placement on patient in shock state | ear, nose, or forehead (not finger because of poor peripheral circulation
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| Reason elevated temperature and shivering must be controlled in shock patient | they increase metabolic need for oxygen
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| septic shock management | O2, intubation/mechanical ventilation; AGGRESSIVE FLUID RESUSCITATION; antibiotics (after culture)
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| Only shock with Bradycardia | neurogenic shock
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| Indication that septic shock is progressing | change from warm and dry skin to cool and clammy skin
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| systemic inflammatory response syndrome (SIRS) manifestations | Fever, decreased SVR/BP, elevated HR/Stroke Volume
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| First system to show signs of dysfunction in SIRS and MODS | respiratory (assess for lung sounds and oxygenation status to monitor for early organ damage)
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| Sign that cardiogenic shock is developing into multiple organ dysfunction syndrome (MODS) | elevated serum creatinine (indicates renal failure) or other sign of involvement of an organ other than the heart
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| multiple organ dysfunction syndrome (MODS) risk factors | older adults, patients with chronic diseases (e.g., diabetes mellitus, chronic kidney disease, heart failure), patients receiving immunosuppressive therapy or who are malnourished or debilitated
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| develop disseminated intravascular coagulation (DIC) cause | abnormal activation of the clotting mechanism causing accelerated clotting
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| hepatic encephalopathy | changes in neurologic and mental function resulting from high levels of ammonia in the blood that a damaged liver cannot detoxify
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| Asterixis | flapping tremor (liver flap) commonly affecting the arms and hands that is a manifestation of hepatic encephalopathy
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| Fetor hepaticus | musty, sweet odor of the patient's breath which occurs in some patients with encephalopathy from the accumulation of digestive by-products that the liver is unable to degrade.
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| cirrhosis metabolic manifestations | hypokalemia; hyponatremia; hypoalbuminemia
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| Cirrhosis management | I&Os, daily weights, abdominal girth and extremity measurements to assess extent of edema; paracentesis (to remove excess fluid from abdominal cavity); monitor for hemorrhage and low blood count; avoid heavy lifting or stress; assess for LOC; drug therapy
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| Cirrhosis diet | high calorie (3000 cal/day) with high carbohydrate and moderate to low levels of fat. Low sodium (with ascites and edema); monitor potassium; fluid restriction (< 1 L/day)
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| Sengstaken-Blakemore Tube | Type of tube used for balloon tamponade in patients with esophageal and/or gastric varices; the gastric and esophageal balloons put mechanical compression on the varices.
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| Pancreatic autodigestive enzymes | Trypsin, Elastase, Phospholipase, Lipase, Kallikrein
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| Most common causes of pancreatitis | alcoholism (men), biliary tract disease (women); trauma, infection, drugs
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| Pain associated with pancreatitis | sudden onset, deep, piercing, continuous/steady LUQ or midepigastric pain that commonly radiates to the back
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| Pain associated with cirrhosis | RUQ or epigastric pain
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| First priority in managing acute pancreatitis | administration of IV fluids and electrolyte repletion
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| Most effective means of relieving pain from pancreatitis | NPO status
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| Stroke nonmodifiable risk factors | age (doubles each decade after 55 years of age, 2/3 occur >65 yrs of age), gender (more common in men, more deaths in women), ethnicity/race (African Americans have higher incidence), family history/heredity
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| transient ischemic attack (TIA) | transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of the brain; clinical symptoms typically last less than 1 hour
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| right-brain damage manifestations | paralyzed left side (hemiplegia); left-sided neglect; spatial-perceptual deficits; tends to deny or minimize problems; rapid performance, short attention span; impulsive, safety problems; impaired judgment
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| left-brain damage manifestations | paralyzed right side (hemiplegia); impaired speech/language aphasias; impaired right/left discrimination; slow performance, cautious; aware of deficits (depression, anxiety); impaired comprehension r/t language and math
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| treatment of choice for individuals with atrial fibrillation who have had a TIA | Oral anticoagulation using warfarin
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| Stroke acute care management | airway, Fluid therapy (NS), maintain adequate O2 and BP, remove clothing, obtain CT immediately (w/o contrast), position head midline and elevate 30 degrees, administer thrombolytics (for ischemic stroke), NPO until swallow reflex evaluated
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| Ischemic Stroke management | Tissue plasminogen activator (tPA) IV or intraarterial and MERCI retriever
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| Hemorrhagic Stroke management | Surgical decompression if indicated; Clipping or coiling of aneurysm; nimodipine (Nimotop) administration to decrease vasospasm; Antiseizure drugs, such as phenytoin (Dilantin) or levetiracetam (Keppra), are given if a seizure occurs.
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| The LICOX brain tissue oxygen system | a catheter inserted through an intracranial bolt. The system measures oxygen in the brain (PbtO2), brain tissue temperature, and intracranial pressure (ICP)
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| “ATES” of ICP management | ElevATE, StrAIGHT, RegulATE, SeparATE, IntubATE, CoagulATE, MedicATE, HyperventilATE, EvacuATE, OperATE
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| Kidney cold ischemic time | can be preserved for up to 72 hours, but most transplant surgeons prefer to transplant kidneys before the cold ischemic time reaches 24 hours.
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| Organ cold ischemic times | Kidney longest (up to 72 hrs), Liver (20 hrs), Pancreas (12 hrs), and heart shortest (4-6 hrs)
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| Organ recipient criteria | <70 years, absence of infection, absence of general malignancy
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| Test used to detect rejection of transplanted heart and timing of tests | an endomyocardial biopsy (EMB) is obtained on a weekly basis for the first month, monthly for the following 6 months, and yearly thereafter.
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| Heart’s Breath Test | measures methylate alkalies in patient’s breath and compares with results of endo to separate less severe (low levels) to more severe (higher levels)
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| Leading cause of death after renal transplant | cardiovascular disease
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| Leading cause of death in the early period after lung transplantation | bacterial, viral, fungal, or protozoal infections
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| allogeneic transplantation | stem cells are acquired from a donor who, through human leukocyte antigen (HLA) tissue typing, has been determined to be HLA matched to the recipient.
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| syngeneic transplantation | a type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other.
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| autologous transplantation | patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy
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| crossmatch | uses serum from the recipient mixed with donor lymphocytes to test for any preformed anti-HLA antibodies to the potential donor organ; POSITIVE CROSSMATCH IS A CONTRAINDICATION TO TRANSPLANTATION
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| Effects of aging on drug-receptor interaction | brain receptors become more sensitive, making psychoactive drugs very potent.
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| Effects of aging on drug metabolism | liver mass shrinks, hepatic blood flow and enzyme activity decline, metabolism drops, and enzymes lose ability to process some drugs, prolonging drug half-life.
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| Effects of aging on drug absorption | gastric emptying and motility slow, absorption capacity of cells and active transport decline.
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| Effects of aging on drug circulation | vascular nerve control less stable, may cause increased effect (anti-HTN drops BP too low, Digoxin slows HR too much)
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| Effects of aging on drug excretion | kidney function declines, blood flow and waste removal slow, lengthening half-life for renally excreted drugs (oral antidiabetic stay in body longer)
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| Effects of aging on drug distribution | lean body mass decreases and adipose stores increase, total body water declines, raising concentration of water-soluble drugs (increased digoxin can cause heart dysfunction), plasma protein diminishes, raising blood levels of free protein-bound drugs.
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| Risks of electrical injuries | dysrhythmias or cardiac arrest, severe metabolic acidosis, and myoglobinuria, which can lead to acute tubular necrosis (ATN).
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| partial-thickness burn | varying degrees of epidermal and dermal skin injury in which some skin elements remain viable for regeneration
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| full-thickness burn | destruction of all skin elements and subcutaneous tissues with possible involvement of muscles, tendons, and bones
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| Rule of nines | Guide for determining total body surface area affected or the extent of a burn; 9% for each side of each leg; 9% for both arms for each side; 18% for trunk for each side; 4.5% for head for each side; and 1% for groin
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| greatest initial threat to a patient with a major burn | hypovolemic shock
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| Adequate fluid resuscitation urine output | 0.5 to 1 mL/kg/hr; 75 to 100 mL/hr for electrical burn patient with evidence of hemoglobinuria/myoglobinuria
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| Trauma center designation | from Level I, capable of providing total care, to Level IV, ability to provide trauma life support prior to transfer to higher level
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| Trauma ABC | A: Airway (and c-spine); B: Breathing; C: Circulation; D: Disability (neuro); E: Exposure control; F: full VS, focused adjuncts, family; G: give comfort measures (pain control); H: History/Head-to-toe assessment; I: inspect posterior surfaces
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| Fractured rib management | DON’T strap or bind chest; NSAIDs, opioids, and nerve blocks are used to reduce pain and aid with deep breathing and coughing. Patient teaching should emphasize deep breathing, coughing, use of incentive spirometry, and use of pain medications
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| management of chest wound with object that caused it still in place | do not remove it until a physician is present. Stabilize the impaled object with a bulky dressing.
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| Kehr’s sign | pain over the scapula caused by irritation of the phrenic nerve by free blood in the abdomen or ruptured spleen
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| Abdominal girth increase with abdominal bleed | 1 inch/500 mL - 1 L of blood
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| Peritoneal lavage | most sensitive technique for detecting injuries to hollow organs and mesenteric structures; large catheter inserted into abdomen, attempt to aspirate, if < 10 mL aspirated inject saline and drain, observe fluid, especially for blood, send to laboratory
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| Bowel sounds in the chest indicates | may indicate a diaphragmatic rupture
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| spinal shock resolution signs | return of reflexes (especially flexors to noxious cutaneous stimuli), a state of hyperreflexia rather than flaccidity, and reflex emptying of the bladder.
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| Level of lesion that causes tetraplegia | cervical (C8 and above)
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| Level of lesion that causes paraplegia | thoracic and lumbar (T1 and below)
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| Level of lesion that corresponds with total loss of respiratory muscle function | above the level of C4
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| Brown-Séquard syndrome | damage to one half of the spinal cord characterized by spastic paralysis on the body's injured side, loss of postural sense (proprioception), and loss of the senses of pain and heat on the other side of the body
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| Autonomic dysreflexia most common precipitating cause | a distended bladder or rectum
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| Marked perspiration above the level of injury concern | Autonomic dysreflexia
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| Autonomic dysreflexia management | elevation HOB 45 degrees or sitting the patient upright, notification of the physician, and assessment to determine the cause. Possible immediate catheterization or checking of existing catheter for kinks, or digital rectal exam (after anesthetic).
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| Factors that predict a poor outcome after head injury | the presence of an intracranial hematoma, older age of the patient, abnormal motor responses, impaired or absent eye movements or pupillary light reflexes, early sustained hypotension, hypoxemia or hypercapnia, and ICP levels greater than 20 mm Hg.
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| Tests to determine if fluid leaking from nose or ear is CSF | if no blood, glucose test (Dextrostix, Tes-Tape strip)—positive if CSF; if blood is present, look for halo/ring sign (when dripped on white pad/towel, yellowish ring encircles blood if CSF is present)
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| initial period of unconsciousness at the scene, with a brief lucid interval (up to 12 hours) followed by a decrease in LOC indication | epidural hematoma
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| posturing (decorticate vs. decerebrate) that may indicate more serious damage | decerebrate
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| Oropharyngeal airway purpose | Maintain airway in unconscious patients and used as a bite block for patients with endotracheal tubes
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| Oropharyngeal airway sizing | place the airway on the patient’s cheek with the flat plate at the lips. The end of the airway should hit the jaw.
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| Nasopharyngeal airway purpose | Facilitates suctioning in semi-conscious/conscious patient
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| Nasopharyngeal airway sizing | place the airway on the patient’s cheek with the flange at the nares. The end of the airway should hit below the mandible.
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| Endotracheal Tube airway purpose | Provide stabilization of airway; Ensure proper ventilation via mechanical ventilator; Facilitate removal of secretions
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| Endotracheal Tube placement confirmation | listen for breath sounds bilaterally (if on one side, too far); use CO2 detector (if not detecting CO2, not far enough); chest x-ray
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| Tracheostomy purpose | Bypass an upper airway obstruction; Facilitate removal of secretions; Permit long-term mechanical ventilation; Permit oral intake and speech in the patient who requires long-term mechanical ventilation
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| Cuffed tracheostomy tube | When properly inflated, low-pressure, high-volume cuff distributes cuff pressure over large area, minimizing pressure on tracheal wall.
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|
||||
| Cuffed tracheostomy tube indication | used with patients at risk of aspiration or in need of mechanical ventilation
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|
||||
| Fenestrated tracheostomy tube | When inner cannula is removed, cuff deflated, and decannulation plug inserted, air flows around tube, through fenestration in outer cannula, and up over vocal cords. Patient can then speak.
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|
||||
| Tracheostomy dislodgement management | immediately attempt to replace it; if cannot be replaced, raise to semi-fowlers to alleviate dyspnea; if severe dyspnea causes a respiratory arrest, cover stoma with a sterile dressing and ventilate patient with bag-mask ventilation until help arrives
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||||
| Blood infusion time constraints | Do not keep blood out of monitored refrigerator >30 min. before starting transfusion; Do not use same blood filter for > 4 hours or 2 units; Do not allow unit of blood to “hang” for > 4 hours.
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|
||||
| Acute hemolytic blood transfusion reaction manifestations | chills, fever, low back pain, increased heart rate, increased respiratory rate, decreased blood pressure then shock, possible arrest.
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|
||||
| Blood transfusion reaction management | Stop the transfusion. Keep IV open with NS. Report to MD and blood bank immediately. Re-check ID tags and numbers. Treat sx and monitor V/S. Send to blood bank. Collect blood and urine samples and send to lab. Document thoroughly. Pt/family teaching
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|
||||
| most common complication encountered during the insertion of a pulmonary artery catheter | Dysrhythmias
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|
||||
| Arterial line complication prevention | Luer-Lok connections, check arterial waveform, activate alarms, inspect for s/s of inflammation and systemic infection, Allen test before inserting, assess continuous flush every 1-4 hrs, and hourly neurovascular checks
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|
||||
| Pulmonary artery catheter complications prevention | aseptic technique, check catheter for balloon integrity before insertion, aspirate (should not see blood), never inflate balloon beyond capacity or leave inflated more than 4 breaths (8-15 seconds), monitor PA pressure waveforms, continuously flush cathet
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|
||||
| Pulseless rhythms | VF (ventricular fibrillation)/VT (ventricular tachycardia without a pulse), PEA (pulseless electrical activity), and Asystole
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|
||||
| Chylothorax | the presence of lymphatic fluid in the pleural space due to a leak in the throacic duct (trauma, surgical procedures, malignancies)
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|
||||
| Empyema | an accumulation of purulent exudates in a body cavity, especially the pleural space, as a result of bacterial infection, such as pleurisy or tuberculosis
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|
||||
| Chest Tube removal | removed at end of expiration and close with dressing (Vaseline gause) ASAP; chest x-ray
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|
||||
| Positioning of pt with Chest Tube | position patient on operative side to facilitate expansion of remaining lung
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|
||||
| ideal training age-related heart rate | 220 – age * 80% (e.g., 220-65 * 80% is 124)
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|
||||
| Calculation of Cerebral Perfusion Pressure (CPP) | MAP-ICP
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|
||||
| Calculation of MAP | [SBP + 2(DBP)] / 3
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|
||||
| Parkland Formula of Fluid Resuscitation (>20% TBSAB) | 4 mL LR x kg x %TBSAB; give ½ in first 8 hours, remaining over next 16 hours
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|
||||
| BP normal | SBP <120 mm Hg and DBP <80 mm Hg4
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|
||||
| RR normal | 12-20 breaths/min
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|
||||
| HR normal | 60-100 beats/min
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|
||||
| Glucose (fasting) normal | 70-99 mg/dL
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|
||||
| PaCO2 Normal | 35-45
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|
||||
| HCO3- Normal | 22-26
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|
||||
| pH Normal | 7.35-7.45
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|
||||
| Base excess (B.E.) Normal | +/-2.0
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|
||||
| PaO2 Normal | 80-100
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|
||||
| O2 Sat Normal | 96-100%
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|
||||
| CVP normal | 2-8 mm Hg
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|
||||
| Steady CVP WNL indicates | right heart is still adequately handling venous return
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|
||||
| Decreased CVP etiology | hypovolemia
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|
||||
| Elevated CVP etiology | right ventricular failure or volume overload
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|
||||
| PAWP normal | 6-12 mm Hg
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|
||||
| Elevated PAWP etiology | left ventricular heart failure and fluid volume overload (should not infuse IVF as this will exacerbate problem)
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|
||||
| CO normal | 2-8 L/min
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|
||||
| CI normal | 2.2-4 L/min
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|
||||
| Decreased CO and CI etiology | shock states (e.g., cardiogenic, hypovolemic) and heart failure
🗑
|
||||
| SVR normal | 800-1200 dynes/sec/cm-5/m2
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|
||||
| Decreased SVR etiology | vasodilation, which may occur in shock states (e.g., septic, neurogenic) or with drugs that reduce afterload
🗑
|
||||
| Elevated SVR etiology | vasoconstriction from shock, hypertension, increased release or administration of epinephrine and other vasoactive agents, or left ventricular failure
🗑
|
||||
| ICP normal | 5 to 15 mm Hg
🗑
|
||||
| CPP normal | 60-100 mm Hg
🗑
|
||||
| Decreased CPP etiology | ischemia and neuronal death
🗑
|
||||
| MAP normal | 70-105 mm Hg
🗑
|
||||
| MAP where autoregulation is effective | 50 to 150 mm Hg
🗑
|
||||
| Decreased MAP etiology | <60 will not adequately perfuse and sustain the vital organs; if remains low for long, vital organs with be underperfused and will become ischemic
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|
||||
| GFR normal | about 125 mL/min
🗑
|
||||
| Decreased GFR etiolgoy | Chronic Kidney Disease
🗑
|
||||
| Elevated serum lactate (lactic acid) level in a hypovolemic shock patient indicates | significant tissue hypoperfusion
🗑
|
||||
| elevated ALT etiology | liver damage
🗑
|
||||
| Lab value most useful in evaluating improvement in kidney function for a patient with chronic kidney disease (CKD) | Calculated glomerular filtration rate (GFR)
🗑
|
||||
| Creatinine normal | 0.6-1.3 mg/dL
🗑
|
||||
| BUN normal | 6-20 mg/dL
🗑
|
||||
| elevated blood urea nitrogen (BUN) and creatinine levels etiology | impaired kidney function, due to hypoperfusion as a result of severe vasoconstriction or occurs secondary to catabolism of cells (e.g., trauma, infection)
🗑
|
||||
| elevated serum creatinine level etiology | impaired kidney function due to hypoperfusion as a result of severe vasoconstriction; is more sensitive indicator of renal function than BUN
🗑
|
||||
| Chest tube drainage normal | < 100 mL/hr drainage
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|
||||
| EKG grid paper small squares width | 0.04 seconds
🗑
|
||||
| EKG grid paper large squares width | 0.2 seconds
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|
||||
| PR interval normal duration | 0.12-0.2 seconds (or three to five tiny boxes)
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|
||||
| QRS interval normal duration | 0.06-0.1 seconds (or 1.5 to 2.5 tiny boxes)
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|
||||
| Elevated amylase etiology | Injuries to pancreas
🗑
|
||||
| Cholesterol normal level | <200 mg/dL
🗑
|
||||
| HDL normal level | Male: >40 mg/dL; Female: >50 mg/dL
🗑
|
||||
| LDL recommended level | <100 mg/dL (Near optimal: 100-129 mg/dL)
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|
||||
| LDL level with Moderate to High risk for CAD | Moderate risk: 130-159 mg/dL; High risk: >160 mg/dL
🗑
|
||||
| Triglyceride level with risk for CAD | ≥150 mg/dL
🗑
|
||||
| Hypertension | >140/90 (or >130/80 in patients with diabetes or CKD)
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|
||||
| BP with risk for CAD | elevated systolic BP >160 mm Hg
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|
||||
| Obesity | BMI > 30 and Waist circumference ≥40” in men and ≥35” in women
🗑
|
||||
| BNP (B-type Natriuretic Peptide) levels suggestive of HF | 100-500 pg/mL (HF probable); >500 pg/mL (HF highly probable)
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|
||||
| Drug that Prinzmetal's angina would respond best to | Calcium channel blocker.
🗑
|
||||
| ACE inhibitor actions | Decreased preload and afterload.
🗑
|
||||
| Primary drug administered in anaphylactic shock | epinephrine (Adrenalin)
🗑
|
||||
| Drug used to treat cardiogenic shock | dobutamine (Dobutrex) to increase myocardial contractility
🗑
|
||||
| Dobutamine (Dobutrex) classification and use | Adrenergic direct-acting β1-agonist, cardiac stimulant; Causes increased contractility, increased CO without marked increase in HR; used for cardiac decompensation due to organic heart disease or cardiac surgery
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|
||||
| Sodium nitroprusside (Nipride) classification and use | a potent IV vasodilator that reduces both preload (CVP) and afterload (SVR), thus improving myocardial contraction, increasing CO, and reducing pulmonary congestion.
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|
||||
| Drug used for rapid reduction of hypertensive crisis | Sodium nitroprusside (Nipride)
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|
||||
| amlodipine (Norvasc) classification and use | Calcium channel blocker; Decreases spasms of the coronary artery by blocking movement of extracellular calcium into cells, causing vasodilation and decreased heart rate, contractility, and SVR (afterload).
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|
||||
| nitroglycerin (Nitro-Bid IV, Tridil) classification and use | Vasodilator; used to relieve chest discomfort associated with chronic stable angina and acute coronary syndrome; Relaxes arterial and venous smooth muscle, reducing preload and SVR
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|
||||
| Vasopressin (Pitressin) adverse effect | Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion, causing chest pain.
🗑
|
||||
| Norepinephrine (Levophed) classification and action | Potent peripheral venous/arterial vasoconstriction
🗑
|
||||
| Drug given to treat severe hypotension | norepinephrine (Levophed)
🗑
|
||||
| Norepinephrine bitartrate (Levophed) classification and use | positive inotropes/β-adrenergic agonists; used to treat hypovolemia when patient has persistent hypotension AFTER fluid resuscitation and normalized CVP; increase or improve contractility
🗑
|
||||
| Norepinephrine (Levophed) contraindication | Adequate fluid administration is essential before administration of vasopressors to patients with hypovolemic shock. If CVP is low (normal 2-8 mm Hg), provide more volume replacement before administering.
🗑
|
||||
| drug that will help relieve a patient's anxiety in addition to improving cardiac output | Morphine sulfate (MS)
🗑
|
||||
| Nitroglycerin teaching | make certain the medication is stored in a dark container.
🗑
|
||||
| statin drugs critical side effect | can cause liver damage (check for elevated ALT levels)
🗑
|
||||
| Enalapril (Vasotec) classification and use | an ACE-inhibitor; It reduces blood pressure by inhibiting angiotensin converting enzyme, reducing the conversion of angiotensin 1 to angiotensin 2, thus reducing vasoconstriction.
🗑
|
||||
| Enalapril (Vasotec) consideration | Because it blunts the renin-angiotensin-aldosterone system to some degree, it can result in hyperkalemia (especially in those with conditions such as CKD which can also cause hyperkalemia)
🗑
|
||||
| fibrinolytic therapy use | Treatment of MI to stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium (chest pain should decrease after administration)
🗑
|
||||
| Thrombolytic (fibrinolytic) agent major complication | acute intracranial bleeding, which presents as a decrease in the level of consciousness, from break down of protective clots.
🗑
|
||||
| Sodium polystyrene sulfonate (Kayexalate) contraindication | should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur.
🗑
|
||||
| nitroprusside (Nipride) indication of effectiveness in treating cardiogenic shock | Warm, pink, and dry skin indicates that perfusion to tissues is improved.
🗑
|
||||
| Diamox (acetazolamide) classification and use | Diuretic, carbonic anhydrase inhibitor, antiglaucoma agent, antiepileptic; used to treat acute altitude sickness; glaucoma; seizures; and edema
🗑
|
||||
| ARDS medication management | inotropic/vasopressor meds [dopamine (Intropin), dobutamine (Dobutrex), norepinephrine (Levophed)], diuretics, sedation/analgesia, neuromuscular blockade)
🗑
|
||||
| Propofol (Diprivan) classification and use | anesthetic; used as short-term sedation of patients receiving mechanical ventilation
🗑
|
||||
| Propofol (Diprivan) side effects | hypotension, bradycardia, and increased triglyceride levels
🗑
|
||||
| Neuromuscular blocking agents suffix | “URIUM” or “ONIUM” (e.g., Atracurium besylate, Cisatracurium besylate, Doxacurium chloride, Pancuronium bromide, Vecuronium bromide)
🗑
|
||||
| First drug given for SVT | Adenosine (Adenocard)
🗑
|
||||
| Adenosine dosage | 6-12-12: Initial dose 6 mg over 1-3 seconds followed with 20 ml 9% NACL and Subsequent doses (after 1-2 minutes)of 12 mg over 1-3 seconds. May repeat once.
🗑
|
||||
| First drug given for pulseless rhythms | Epinephrine
🗑
|
||||
| Epinephrine dosage | 1 mg IV/IO q 3-5 min
🗑
|
||||
| First drug given for Vtach with a pulse | Amiodarone (Cordarone)
🗑
|
||||
| Amiodarone (Cordarone) contraindications | Cannot use in patients with iodine allergy
🗑
|
||||
| Drug given for bradycardia | Atropine
🗑
|
||||
| Drug given for unstable junctional rhythms | Atropine
🗑
|
||||
| Drug given for Second Degree AV Block, Type 2 | Atropine
🗑
|
||||
| Drugs used to treat tachycardia | Beta blockers
🗑
|
||||
| Beta blockers suffix | "OLOL"
🗑
|
||||
| ACE inhibitor suffix | "PRIL"
🗑
|
||||
| Drugs given for atrial flutter or atrial fibrillation | calcium channel blockers (e.g., Cardizem), amiodarone, beta blockers, digoxin, and anti-coagulation
🗑
|
||||
| Drug given for ischemic stroke | Tissue plasminogen activator (tPA)
🗑
|
||||
| Tissue plasminogen activator (tPA) precautions | noncontrast CT or MRI scan to rule out hemorrhagic stroke, blood tests for coagulation disorders, and screening for recent history of gastrointestinal bleeding, stroke, or head trauma within the past 3 months, or major surgery within 14 days.
🗑
|
||||
| Drug given to treat cerebral vasospasm either before or following aneurysm clipping or coiling | nimodipine (Nimotop)
🗑
|
||||
| Drug used to treat delayed gastric emptying | Metoclopramide (Reglan)
🗑
|
||||
| Medication given within 8 hours of spinal cord injury that significantly improves motor function and sensation | methylprednisolone (MP)
🗑
|
||||
| methylprednisolone (MP) contraindications | penetrating trauma to the spinal cord and should be used with caution in the elderly population
🗑
|
||||
| Drugs that prevent a cell-mediated (Helper T cell) attack against the transplanted organ | Calcineurin inhibitors (e.g., tacrolimus and cyclosporine)
🗑
|
||||
| Drugs used pre-treatment for transplantation | Monoclonal antibodies (e.g., Muromonab-CD3 [Orthoclone OKT3], daclizumab [Zenapax] and basiliximab [Simulect])
🗑
|
||||
| Drugs used as induction therapy to severely immunosuppress an individual immediately after transplantation | Polyclonal antibodies (e.g., Lymphocyte immune globulin [Atgam])
🗑
|
||||
| Drug therapy for Hemostasis and control of bleeding in esophageal varices, constriction of splanchnic arterial bed | vasopressin (Pitressin); octreotide (Sandostatin)
🗑
|
||||
| Statin drug complications | liver damage and myopathy that can progress to rhabdomyolysis (breakdown of skeletal muscle); Symptoms of myopathy (e.g., muscle aches, weakness) should be reported to the healthcare provider
🗑
|
||||
| information obtained to evaluate the effectiveness of calcium gluconate | Cardiac rhythm
🗑
|
||||
| Drug therapy for hyperkalemia | calcium gluconate or IV glucose and insulin
🗑
|
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