Advanced Medsurg Final (Drugs/Labs)

Sodium

135-145

Potassium

3.5-5

Calcium

8.5-10.5

How does ondansetron affect can EKG?

Prolongs QT interval

Magnesium

1.3-2.1

What is a normal co2 level?

20-40 mmHg

What are our thrombolytic agents for a MI?

• t-PA

• Streptokinase

• Reteplase

• Heparin

Vasodilators

• Nitroglycerin

• Nitroprusside

• Hydralyzine

• Digoxin

Vasoconstrictors

• Epinephrine

• Norepinephrine

• Dopamine

• Vasopressor

• Phenlyphrine

What is a normal GFR?

80-125

What are some nephrotoxic agents?

• Antibiotics: vanc

• NSAIDS

• Furosemide

  • Contrast

What is a kidney protectant?

Acetylcysteine & mucomyst

What drug can cause rhabdomylosis?

Statins

What is a normal hourly urine output?

30ml/hr

What MAP value in indicative of the kidneys not being properly perfused?

<60

How can dopamine be helpful for AKI?

May increase renal blood flow

Explain the Richmond Agitation Sedation Scale

• 1—>6 more agitated

• 0 alert

• -1 —> -6 more sedated

EEG values

• 0: flat EEG

• 100: awake

With a surgical patient, where is the ideal sedation level?

40-60, deep enough with amnesia

What is the med used for delirium?

• Who do we not use it in?

• What is a side effect?

Haloperidol

• Not best in older patients

• SE: respiratory depression

What are the contraindications to an epidural?

• Coagulopathy (DIC)

• Physical instability 

• Sepsis 

• Spine injury 

• Infection of the skin (cannot go through infection because you are pushing the infection deeper into the spinal fluid)

• Alcohol intoxication 

• Patient refusal 

• Drop blood pressure

What are some sedatives?

• What are they used for?

• Benzodiazepines (long term)

• Propofol (short term): risk for infection tubing change every 24 hours

• Dexmedetomidine: no respiratory side effects

What are the two neuromuscular blockades?

• Antidote

• Vecuronium & Succinylcholine

  • Neostigmine

What is an ideal map?

70-105

What MAP values concerns us?

60

Where do we level the transducer for arterial pressure monitoring?

Phlebostatic axis: Fourth intercostal space, midaxillary line

What pressure to we set the transducer at in arterial pressure monitoring?

300 mmHg

If we use heparin in arterial pressure monitoring how much do we use?

2-5ml

what is normal RAP/CVP? what do those values mean?

2-6 mmHg

• <2: hypovolemia

• >6: fluid overload

When is air appropriate to be placed in a PAC (pulmonary artery catheter) and how much?

• To get the Pulmonary artery pressure through during wedge pressure.

• No more than 1.5 ml of air

SvO2 Normal

60-75%

Normal Cardiac Output

4-8L/min

What is the fluid rule for hypovolemic shock?

3-1 rule

• 300 ml per every 100 ml loss

What are some positive inotropes ?

• Dopamine

• Dobutamine

• Digoxin

What is the only shock with bradycardia?

Neurogenic

What meds do we give for anaphylactic shock?

• Epinephrine

• Steroids

• Albuterol

• Benadryl

• Vasopressors

What is the best lab to use to determine sepsis?

Lactic Acid

What is the max amount of fluid that is to be given for shock?

2 L

What blood do we give in trauma?

O-

What shock has a direct effect on airway?

Anaphylactic

What are the requirements to be put on insulin drip?

Two consecutive blood glucose readings above 180

What might you give for someone in neurogenic shock that is experiencing bradycardia?

Atropine

When do enteral feedings need to be started in a shock patient?

24-48 hours from admission

How often do we turn our shock patients?

Every 2 hours

Mortality rates for MODS

• 45-50%: 2 organs

• 80%: 3 organs

• 100%: 4 organs

To maintain adequate tissue oxygenation in MODS where do we want to maintain our oxygen sat and hemoglobin?

• O2: 88-92%

• Hemo: 7-9

Compare the following…

• Atelectasis

• Pneumonia

• Pulmonary edema

• Atelectasis: collapsed alveoli

• Pneumonia: mucus and inflammation

• Pulmonary edema: fluid filled alveoli

What is the normal levels for….

• PaO2

  • Needs tx

  • Life threatening

• SaO2

PaO2: 80-100 mmHg

• Needs tx: <60 mmHg

• Life threatening: <40 mmHg

SaO2: 92-99%

• Never want a patient satting at 100%, can over oxygenate

Normal ABG Values

pH: 7.35-7.45

• Compensate: pH within normal range

• Uncompensated: pH out of range

CO2: 35-45

HCO3: 22-26

What are the lungs and kidneys in charge of for ABG’s? Which one compensates faster?

Lungs: CO2 **compensate faster**

Kidneys: Bicarb

Normal end tidal CO2 (what the patient is exhaling)

3-5 mmHg less than PaCO2

For Acute respiratory failure patients where do we keep there O2 levels at?

92-94%

What is the med tx for ARF?

• Beta 2 agonist

• Corticosteroids

• Antibiotics (if the cause is pneumonia)

• Caution with sedatives

What is the treatment for Exacerbation Asthma?

• IV corticosteroids

• Rapid acting beta 2 agonist

• Oxygen

When someone has a pulmonary embolism they feel chest pain worse on inspiration or expiration?

Inspiration

What are some meds to prevent a pulmonary embolism?

• Heparin

• Low molecular weight heparin (enoxaparin)

• Warfarin (long term)

What is the treatment for pulmonary embolism?

1. CT Scan

2. ABC

3. Thrombolytic agent

4. Surgery (embolectomy or vena cava umbrella)

What are the three different types of airways?

Oral, Nasopharyngeal and Endotracheal

What are the correct sizes for an ETT for a women and male?

• Women: 7.5-8

• Men: 8-9

When should the ballon be inflated in an ETT tube?

When there is ventilation going on.

Explain the process of inserting an ETT

• Position: slight tilt up with towel roll under the shoulders

• Paralyze: succinylcholine

• Intubate: within 30 seconds, if not stop and bag valve

What do we DO and what do we NOT do when needing to thin a patients secretions with ETT suctioning?

• DO: hydration, chest percussion, guaifenesin

• DO NOT: normal saline

Indications the ventilation

• Hypoxemia

  • PaO2 </= 60 mmHg on FiO2 > 0.5

• Hypercapnia

  • PCO2 >/= 50 mmHg with a pH </= 7.25

• Increasing RR, decrease in tidal volume, increase in WOB and accessory muscle use.

FiO2

• What?

Amount of O2 we are delivering and move down at a 5-10%

PEEP values

• Concerning values?

5-20

• >10 assess cardiac output—> lead to obstructive shock—>low blood pressure

What is tidal volume?

The amount of air we breath in and out

Volume Assist/Control Ventilation

• Potential Causes

• Set respiratory rate (not ready to be weaned)

  • Hyperventilation and respiratory alkalosis

Pressure ventilation

• What can it cause?

Vent delivers air until a set pressure is reached

• Can cause hypoventilation and respiratory acidosis

What is pressure support?

Delivering pressure when needing which is useful in weaning

Pressure assist control

Set RR

What is a normal PIP in vent patients?

<40

Total respiratory rate in ventilated patient

Set rate + patient effort

Alarms on vent: high and low pressure

• Low: leak, loss in connection

• High: bite, kink, pulmonary edema, pneumothorax, mucus plug, coughing and airway secretions

CPAP trial

Wean patient off 30 minutes

Where does the normal cuff pressure need to be for a ETT?

No higher than 25-30 cm H2O

FiO2 sign for oxygen toxicity

1.0 for 24 hours

HOB for vent patient

30 degrees

What do we use for oral care with a vent?

Chlorhexidine

How do we do feeds with a ventilator?

OJ tube

What are the requirement to be weaned from a ventilator?

Rass: -1 to 0

O2 Sat: >92% on low amount of FiO2

RR: 12-20

What are the values to stop the weaning the process?

• RR >35 or <8

• Low or spontaneous VT <5 ml/kg

• O2 <90

• HR or BP >20% from baseline

• Dysrhythmias/st elevation

Where do we see the earliest signs of hypoxemia and hypercapnia?

Neurological system