BKAT ICU Post Test

Nitroprusside purpose

decreases preload and afterload by vasodilation (mainly afterload)

Dobutamine mechanism of action

contractility

Dopamine at a low-end dose "renal dose"

0.5-4mcg/kg/min

increases renal and mesentric perfusion

Dopamine at a mid-range dose

4-10mcg/kg/min

increases contractility and heart rate

Dopamine at a high-range dose

greater than 10mcg/kg/min

vasoconstriction and increases BP

Dopamine and Levophed infiltration

leads to tissue necrosis

Dopamine antidote

regitine (phentolamine)

TpA monitor for

bleeding-hemorrhagic CVA

diltiazem (cardizem) works by?

(calcium channel blocker) slows ventricular rate by slowing conduction through the SA and AV node

Diltazem (cardizem) biggest effect on which hemodynamic

hypotension

diltazem is used for patients with

a-fib or a-flutter

amiodarone (Cordarone) is a

antiarrythmic

prolongs the cardiac duration

You MUST use a __________ when using amiodarone infusion

0.22 micron filter

Watch out for ____________ in patients on a amiodarone infusion

hypotension, prolongation of QT interval and bradycardia

amiodarone is used for patients with

a-fib, a-flutter and VT

how much amiodarone is given to a stable VT with a pulse and a unstable pulseless VT/VF?

150mg over 10min for VT with pulse

300mg push; repeat x1 at 150mg

Epinephrine has what effect on the body?

increases HR, BP, and contractility

what is the first line drug for pulseless arrest?

Epinephrine

What rhythms are considered fatal?

V-fib, Vtach (pulseless), and asystole

Epinephrine is also given for?

anaphylaxis and as a vasopressor for hypotension

Heparin is used for? Antidote is?

anticoagulant

Protamine Sulfate

What is the osmotic diuretic of choice to decrease intracranial pressure?

mannitol

How does mannitol work?

pulls fluids into intravascular space to be excreted by the kidneys to reduce intracranial pressure

what insulin is given IV?

What is the peak?

Regular insulin can only be given IV

2-4 hr peak time

Which insulin has a peak of 8-14 hrs?

NPH

Atropine is ineffective in which heart rhythms types?

high degree AV blocks: 2nd degree type2 and 3rd degree

Atropine works by?

increasing heart rate-increasing conduction through SA node

Atropine is given to treat?

symptomatic bradycardia

Dilantin is given to treat

seizure disorders

DO NOT give __________ with dilantin because ________ will happen.

DO NOT give with dextrose containing solutions because it will crystalize

Which corticosteroid is usually given in insufficient adrenal activity or hypersensitivity/inflammation reactions?

Cortisone

If chronically using cortisone be sure to _____ to prevent _____.

If chronically using cortisone be sure to taper the medications to prevent acute adrenal insufficiency

This medication is a cardiac glycoside that increases contractility.

Digoxin

Digoxin increases contractility by

slowing the heart rate which decreases conduction through the AV node

What should be monitored in patients taking Digoxin?

hypotension, bradycardia, and symptoms of toxicity

Signs/Symptoms of Digoxin toxicity

nausea, yellow vision/halo, paroxysmal atrial tachycardia (PAT with block).

True/Flase:

Digoxin WILL NOT cause rapid AV conduction or hypertension

True

what medication is a antiarrhythmic that suppresses automaticity and depolarization?

lidocaine

Lidocaine is used to treat?

ventricular dysrhythmias

lidocaine toxicity sign

mental confusion/change in LOC

Monitor serum levels with _________

Lidocaine

DO NOT give _______ medications to patients with suppressed respirations

Narcotics (morphine, dilaudid)

What changes on a EKG would you expect to see on a patient with a acute MI?

ST elevation

normal QRS:

Prolonged QRS indicates:

Distinguishing V-fib

fibrillatory waves with no recognizable pattern

Defib the Vfib

Distinguishing V-Tach

atrial rhythm and rate cannot be identified

"Tombstones"

First degree block interpretation

looks like sinus rhythm but the PR is longer than normal. there will be 1 p for every qrs, but the PR interval will be greater than 0.20 sec

Type 1 second degree block interpretation

"Wenckebach"

"Longer, Longer... drop" prolonged PR intervals and the missing QRS

Type 2 second degree block interpretation

PR interval is constant...QRS is missing

"2 small p waves right after each other"

give atropine, dopamine, or epi to increase HR is symptomatic bradycardic

Third degree AV block interpretation

a strip of p-waves laid independently over a strip of QRS complexes. Note that the p wave doesn't conduct the QRS complex that follows it.

A-flutter interpretation

abnormal p-waves that produce a saw-tooth appearance

Failure to Capture interpreation

spike without a complex

Failure to Pace interpretation

no pacemaker activity or spike at the set rate on an ECG. usually caused by battery or circuit failure, cracked or broken pacing leads, loose connections, oversensing, or the pacing output is too low--->can lead to asystole

Failure to Sense

undersensing: giving help when not needed; spikes occur on the ECG where they shouldnt

Pacemaker ECG rhythms

failure to capture: spike without a p wave or QRS complex following it

failure to pace: no spike on ECG at the rate set

failure to sense:

spike when intrinsic activity already present (undersensing)

no spike when patient needs it

(oversensing)

Which ventricular stimulus is dangerous

R on T phenomenon

Indications for a pacemaker?

symptomatic bradycardia

higher AV blocks (2nd degree type 2 or Complete)

what is not a treatment for higher degree AV blocks

atropine

because of the impaired conduction through the AV node

A-flutter happens because?

an irritable spot of the atrium fires rapidly

A-flutter can cause _______

an increase in ventricular rate

A-flutter is treated by:

antiarrhythmics (cardizem, beta blockers)

cardioversion

What do you do if you notice a lethal rhythm on the monitor (VT/VF)?

check the patient first

-establish unresponsiveness

call for help

-begin CPR if needed

When defibrillating VT/VF use _____ joules for biphasic defibrillator or _____ joules for monophasic.

200

360

Normal PR interval is

0.12-0.20 seconds

Patient presents with anginal pectoris. what is initial management?

allow rest, amdinister oxygen, nitroglycerin, etc.

Causes of elevated cardiac enzymes

MI, pericarditis, closed chest trauma, cardiac surgery

Goal of treatment for cardiogenic shock (any shock)

increase the patient's cardiac output

A patient exhibits depression after their recent MI, you should

encourage the patient to verbalize their concerns and allow interaction with family

How does a cardiac tamponade occur

blood or fluid accumulates in the pericardial space

what does a cardiac tamponade do to the heart

prevents the heart to pump effectively (impaired ventricular filling and contraction)

S/S of cardiac tamponade

pulsus paradoxus, decreased BP, JVD, tachycardia, muffled heart sounds

PAP values

Systolic: 15-25

Diastolic: 8-18

PAOP (wedge)

6-12

PA Catheter waveforms

PAOP (wedge) reflects pressures in the

left ventricle

An elevated PAOP may indicate

left ventricular failure

If you notice a continual PAOP wave form is present you should

ensure the balloon is deflated, reposition the patient and try have the patient cough

You should not do what to PA catheter if a continual wedge pressure is present

Flush the line

What reading reflects the right atrium

CVP

An elevated CVP may indicate

fluid overload, right ventricular failure, pulmonary HTN, cardiac tamponade

Eventually ______ sided heart failure will lead to an elevated _______.

right sided HF will eventually lead to increased CVP

decreased CVP can be from

hypovolemia

True/False

Medication can be administered through an a-line

False: no medications are to be given via a-line

Arterial line waveform:

-Overdampened

-Underdampened

-dicrotic notch on the downslope

-overdampened: air bubbles, blood clots, kinked tubing, loose connections

-underdampened:excessive tubing length or too many stopcocks

How long should pressure be held when removing an a-line

5-10 minutes

Why would a ventilators high pressure alarm be sounding

increased secretions or mucus plugs

patient biting on the tube

coughing or trying to talk

pulmonary edema

*anything that would cause decreased airway compliance

Why would a ventilators low pressure alarm be sounding

not enough air moving through the ventilator circuit

*most commonly due to disconnection of tubing

You have a patient that just received thoracic surgery.

-You should observe/assess for?

-how much is considered excess drainage output for this patient post op

-how do you know it is working properly

-you should never.....

-assess for air leaks, chest tube drainage quality, breath sounds

-anything greater than 150ml/hr is excessive drainage

-the water seal chamber should fluctuate with respiration, but there should not be bubbles

-never raise the chest tube drainage system above the level of the chest

in a chest tube what breath sound would indicate atelectasis

diminished

After a patient is intubated you should?

get an x-ray to confirm placement and confirmed by a physician

RN should listen for bilateral breath sounds

When caring for patients with ETT or trach always assess

placement and cuff function

Your patient with an ETT is making audible sounds (or can be a trach without a passy-mauir valve) it is most likely related to....

the cuff is deflated which allows air to pass through the vocal cords

In a patient with any kind of chest trauma ALWAYS assess for symptoms of

pneumothorax

impaired gas exchange, SOB

S/s of tension pneumothorax

deviated trachea, acute respiratory distress

trauma patients are at risk for developing _____ embolisms, especially those with long bone fractures.

fat

S/s of fat embolus

may develop after surgery

SOB, tachycardia, petechiae over upper body

Your patient has diminished breath sounds and you notice limited movement of their chest. This can indicate possible atelectasis due to ____________

hypoventilation

ABG Interpretation

pH: 7.35-7.45

PaCO2: 35-45

HCO3: 22-26

(ROME)

What antibiotics are given to TB patients

INH, Rifampin, Rocephin

What antibiotics should be renal-dosed

Vancomycin, gentamycin, and tobramycin