Taylor final exam part 2

What is the Glasgow Coma Scale (GCS)?

A widely used instrument to quantify neurologic impairment based on motor response, verbal response, and eye opening

What does a GCS score of >27/30 indicate?

Normal cognitive function

What does a GCS score of 20-26 indicate?

Mild dementia

What is the Richmond Agitation Sedation Scale (RASS)?

A scale that ranges from 0 for an alert patient to +4 for a combative patient and -5 for an unarousable patient

What does the Confusion Assessment Method for the ICU (CAM-ICU) evaluate?

Delirium based on acute changes in mental status, inattention, and disorganized thinking

What are the two common conditions related to consciousness?

Coma and delirium

What is Cheyne-Stokes respiration?

The most common abnormal respiratory pattern in patients with neurologic disorders

What components make up cardiac output?

Circulatory blood volume (venous return), heart rate, and contractile force of the heart (SV)

How does an increase in cardiac output affect tissue perfusion?

It increases tissue perfusion due to greater volume of oxygenated blood

What is the relationship between Mean Arterial Pressure (MAP) and Systemic Vascular Resistance (SVR)?

They are directly proportional; a decrease in SVR leads to a decrease in MAP

What is preload?

The load or tension on the cardiac muscle as it begins to contract, influenced by the volume of blood in the ventricle before the beat

What factors can decrease preload?

Decreased circulatory volume, increased heart rate, hypovolemia

What is afterload?

The pressure the heart must overcome to pump blood, directly proportional to vascular resistance

What can increase afterload?

Increased systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR)

What are cardiac glycosides used for?

To increase the force of cardiac contraction, commonly used for heart failure

What is the difference between cor pulmonale and CHF?

Cor pulmonale is right-sided heart failure; CHF is left-sided heart failure

What is cardiac output?

The volume of blood ejected from the left ventricle per minute

What is stroke volume?

The volume of blood ejected from the left ventricle with each beat

What is the clinical indication for vasopressors?

To support blood pressure during shock until the underlying cause can be reversed

What is another term for a cardiotonic agent?

Inotropic agent

What medications are used in the management of heart failure?

Beta-adrenergic cardiac stimulants (dobutamine, dopamine) and cardiac glycosides (digoxin, digitoxin)

What are Class 1A antiarrhythmic drugs?

Procainamide and Quinidine

What conditions are treated with Class 1A drugs?

A-fib, a-flutter, atrial ventricular rhythms

What is the Class 1B antiarrhythmic drug?

Lidocaine

What conditions are treated with Class 1B drugs?

Persistent PVC's and ventricular rhythms only

What is the Class 1C antiarrhythmic drug?

Flecainide

What conditions are treated with Class 1C drugs?

Persistent PVC's and ventricular rhythms only

What is the Class 2 antiarrhythmic drug?

Propranolol (Inderal)

What conditions are treated with Class 2 drugs?

A-fib, a-flutter, controls or prevents PSVT

What is the Class 3 antiarrhythmic drug?

Amiodarone

What are the effects of Amiodarone?

Decreases SA node output, prolongs PR, QRS, and QT interval (decreasing heart rate)

What are Class 4 antiarrhythmic drugs?

Verapamil and Diltiazem

What conditions are treated with Class 4 drugs?

A-fib and tachycardia

Which class of drugs includes calcium channel blockers?

Class 4

What medication is used for the treatment of SVT?

Adenosine

How does increasing total blood volume affect preload?

It creates more blood flowing throughout the body, filling the heart more before it pumps.

What types of drugs are used in the treatment of hypertension?

ACE inhibitors, Angiotensin II receptor blockers, Calcium channel blockers, Beta-blockers, Diuretics, Centrally acting adrenergic agents, Alpha1-adrenergic antagonists, Antidiuretic agents, Vasodilators.

What do beta blockers end in?

LOL

What do thrombolytics end in?

ASE

What are the major body organs affected by hypertension?

Heart, brain, kidneys, eyes

What is primary hypertension?

Increase in sodium loss, lower vascular resistance by reducing plasma volume, not maintained with chronic diuretic.

“essential”

hypertension that has no identifiable cause, often related to genetic and lifestyle factors.

What is secondary hypertension?

Accounts for 10% of all cases, disease or drug induced.

What are the uses for diuretics?

Increase sodium loss, lower vascular resistance by reducing plasma volume.

How do ACE inhibitors work to decrease BP?

Blocks the conversion of angiotensinogen 1 to angiotensinogen 2, leading to decreased SVR and vasodilation.

How do Angiotensin II receptor blockers work?

Block receptor sites to stop vasoconstriction.

How do calcium channel blockers decrease BP?

Blocks the influx of calcium into cardiac and vascular smooth muscle cells, creating vasodilation.

How do diuretics decrease BP?

Thiazides and potassium-sparing diuretics increase sodium loss and lower systemic vascular resistance by reducing plasma volume.

What do vasodilators do?

Lower BP by direct relaxation of vascular smooth muscle.

What is angina?

Severe chest pain.

What type of drugs treat angina?

Antianginal agents.

What medications are examples of antianginal agents?

Nitrates and nitroglycerin.

What is the most common side effect of septic shock?

Hypotension.

What are the three vasopressors?

Norepinephrine, Dopamine, Dobutamine.

What does norepinephrine do?

Increases peripheral resistance, causing an increase in systolic and diastolic BP.

What does dopamine do at moderate doses?

Increases HR and contractility (beta-1 receptors).

What does dobutamine do?

Increases force of contraction and BP (beta-1 receptors).

What are anticoagulants?

Medications that interfere with prothrombin and thrombin system of clot formation.

What are antiplatelets?

Medications that affect the clotting mechanism by interfering with the role of platelets.

What do thrombolytics do?

Cause interruption of clotting mechanisms.

What is tPA most commonly given for?

Stroke and STEMI.

Why is SaO2 monitoring helpful?

It reflects how well O2 is being delivered to the tissue.

What is the correlation between VO2, SvO2, and SaO2?

SaO2 = oxygen supply; VO2 = oxygen consumption/demand; SvO2 = oxygen reserve.

What is the normal SvO2?

75%.

What is SvO2 monitoring used for?

To measure the venous O2 saturation of blood within the pulmonary artery.

What causes increased SvO2?

Increased CO, inotropic drugs, increased SaO2, increased Hb.

What causes decreased SvO2?

Decreased CO, decreased SaO2, decreased Hb, increased O2 demand.

What type of blood sample comes from a central line?

Mixed venous.

What type of blood sample comes from an arterial line?

Arterial.

What type of blood sample comes from the proximal port of a PAC?

Venous.

What type of blood sample comes from the distal port of a PAC?

Mixed venous.

What are the components of a fluid-filled monitoring system?

Includes a manifold that holds the transducer on the pole.

What is a manifold?

A device that holds the transducer on the pole.

What is an in-situ catheter?

A catheter placed within the body compartment to be monitored.

What does a pressure transducer do?

It converts applied pressure into an electrical signal.

What are the types of pressure transducers?

Reusable and disposable.

What is a catheter tip transducer?

A transducer limited to research labs with a pressure-sensitive diaphragm.

What is the function of an amplifier in pressure monitoring?

It increases the small electrical signal from the transducer to a clinically useful amplitude.

What does an oscilloscope do?

It provides continuous, real-time viewing of the amplified pulse pressure wave.

What is the pressure set at on the flush bag in a fluid-filled monitoring system?

300 mmHg.

What is the preferred insertion site for an intra-arterial catheter (A-line)?

Radial.

What is the calculation for Mean Arterial Pressure?

Systolic + (Diastolic x 2) / 3.

What happens to the heart to create blood pressure?

The left ventricle contracts, sending blood through the aorta.

What are the causes of a dampened arterial line waveform?

Excessively long tubing, air bubbles, blood clot, kinking of the tube, catheter diameter, length, and stiffness.

What can cause an increase in Central Venous Pressure (CVP)?

RV failure, tricuspid/pulmonic stenosis, chronic left ventricular failure, pulmonary HTN, cardiogenic shock.

What can cause a decrease in Central Venous Pressure (CVP)?

Hypovolemia, hemorrhage, vasodilation, spontaneous inspiration, air bubbles.

What are the ports of a Pulmonary Artery Catheter (PAC) and their uses?

Distal for measuring PAP and PCWP; Proximal for aspirating blood samples and injecting drugs.

When should the balloon be inflated on a PAC?

During insertion to confirm placement and get a reading on PCWP.

What are the normal values for RAP, PAP, RVP, PAWP?

RAP: 2-6, PAP: 25/8, RVP: 25/0, PAWP: 4-12.

What can increase Pulmonary Artery Pressure (PAP)?

Left heart failure, pulmonary embolism, pulmonary HTN, ARDS, hypoxia, hypovolemia.

What can decrease Pulmonary Artery Pressure (PAP)?

Right heart failure, hypovolemia, vasodilation.

What is normal Ejection Fraction (EF) and what does a value less than 30% indicate?

Normal EF: 60-70%; <30% indicates the heart's inability to maintain cardiac output demands.

What is the difference between the dicrotic notch on the arterial pressure waveform and the PAP waveform?

Arterial waveform indicates aortic valve closure; PAP indicates pulmonic valve closure.

What is normal PvO2?

40 mmHg.

How is cardiac output (Qt) affected when SvO2 increases?

Qt increases.

How is cardiac output (Qt) affected when SvO2 decreases?

Qt decreases.

describe P wave

-depolarizing the atria

-impulse that generates = SA node

describe QRS complex

-ventricles are depolarizing

-atria is repolarizing

-bundle branches and Purkinje fibers

describe T wave

-repolarization of ventricles

-impulse is returning to start point

what is normal P-R interval?

-onset of P wave to onset of QRS complex

-represents AV conduction time

-time for atrial depolarization to the beginning of ventricular depolarization

-0.12 - 0.2 seconds (3-5sm boxes)

describe action potential

-depolarization (physical squeezing of heart/heart is in action)

-before the heart can mechanically contract, depolarization of the cells must happen

-process of depolarizatino and repolarization (heart is beating)