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ADULT 3 first exam
ards and such
94
Health Care
Undergraduate 4
01/21/2013

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Cards

Term
what is dead space?
Definition
ventilation exceeds perfusion, alveoli cluster together and are termed dead space units
Term
examples of dead space
Definition
pneumonia and atelectasis
Term
what is shunting?
Definition
alveoli is adequately ventilated in the presence of perfusion is shunting..
Term
examples of shunting
Definition
pulmonary embolus or infarct
Term
what is the oxyhemoglobin dissocation curve..
Definition
Term
when you're hypoxic, you're ...
Definition
strictly low on oxygen for body's demands
Term
hypoxemia is ...
Definition
no perfusion to no tissues and vital organs
Term
BIPAP
Definition
intermittent pos press device- last resort to intubation. a mask thats sealed completely off.. makes patient more comfortable than CPAP
Term
nursing care for non invasive ventilation..
Definition
keep mask sealed very tight, stay w patient til stabilized, patient must be alert (not sedated) to manage airway.. head up 45 degrees, need intibiation kit AT BEDSIDE.
Term
indications for invasive mechanical ventilation
Definition
respiratory muscle fatigue, ARF, acute exacerbation of COPD, protect airway, drug OD, neurological dysfunction
Term
endotracheal tube..
Definition
ensure proper placement on a daily basis. order xray if out of place
Term
oral q4h to prevent.
Definition
ventilator aquired pneumonia
Term
PSV
Definition
pressure support ventilator.. allows patient to take own breath.. good for weaning
Term
presidex..?
Definition
used for procedures like weaning and extubation, it is non-sedating, just a calming effect :)
Term
nursing care for mechanical ventilation
Definition
verify settings of ventilator, document fi02, document tidal volume,, amount taken into lungs with each breath
Term
suction how often??
Definition
prn, not routinely.
Term
ARDS causes..
Definition
refractory hypoxemia, the more o2 you give them, the more the patient becomes hypoxic and hypoxemic
Term
ARDS looks like what on xray..
Definition
"white out" because of inflitrates.
Term
most common cause of ards..
Definition
sepsis, multiple emergency transfusions and aspiration pneumonia
Term
exudate phase of ARDS
Definition
fluid starts leaking into alveoli, this is when you have profound hypoxemia and impaired gas exchange.
Term
acute phase of ARDS.
Definition
movement of fluid begins to multiply, coninutes for like seven days, bilateral infiltrates tend to get worse..
Term
proliferative phase of ARDS
Definition
can last up to month, the lungs are attempting to resolve inflammation, decreased surfactant production causes further damage
Term
fibrotic phase..
Definition
lungs get stiffer and stiffer, and worsening hypoxemia, run risk of pneuomothorax
Term
early ARDS sxs
Definition
increase resp rate, and heart rate, restlessness, confusion, o2 sat goes down. altered LOC
Term
diagnostics of ARDS
Definition
abgs- dx early hypoxemia (respiratory alkalosis), chest xray to rule out other stuff, and ct
Term
management of ards..
Definition
resolve sxs as the occur. anticipate intubation and mechanical ventilation. Pao2 does not respond to increases in Fio2
Term
A/C..
Definition
set tidal volume, delivers specific amt of breaths per minute
Term
PEEP
Definition
positive end expiratory pressure- allows alveoli to stay open at end of expiration, helps adjust gas exchange at alveoli level.. you dont want fio2 to be above 50 for longer than 48 hours.
Term
complications of PEEP
Definition
increases thoracic pressure, increasing PEEP= squeezing heart, and decreases cardiac output. most common complication of PEEP is decreased cardiac output. low BP.. TENSION pneumothoraxes can happen too, the higher the pressure in lung, the greater the risk of the lung puncturing and causing a pneumothorax
Term
what is high frequency oscillation
Definition
allows lungs to maintain higher volumes at expiration, and the o2 scatters throughout the lungs, and oxygenation will increase.
Term
prone position...
Definition
helps oxygenate
Term
solumedrol ..
Definition
increases BG, and can cause electrolyte imbalances.
Term
nitric oxide and surfactant is only used with..
Definition
pedi patients
Term
conduction of electrical impulses slow as..
Definition
they move through the fibers and disperse
Term
depolarization is..
Definition
mechanical contraction called systole
Term
repolarization is
Definition
electrical relaxation and mechanical relaxation called diastole
Term
high potassium causes..
Definition
tall peaked t waves
Term
electrode mnemonic
Definition
clouds over grass and smoke over fire
Term
P wave is..
Definition
arterial depolarization
Term
QRS wave is..
Definition
ventricular depolarization
Term
T wave is..
Definition
ventricular repolarization
Term
time blocks on ekg paper equal..
Definition
.2 seconds
Term
P wave represents
Definition
Represents the electrical impulse starting in the sinus node and spreading through atria
Term
pr measurement
Definition
beginning of P to beginning of QRS, usually .12 to .2 second
Term
qrs complex lasts..
Definition
less than 0.12 seconds
Term
depolarization of the myocardial cells causes which complex
Definition
QRS
Term
the st segment is analyzed for signs of..
Definition
ischemia
Term
the t wave represents
Definition
ventricular repolarization
Term
usasam.amedd.army.mil/_fm_course/Study/UnderstandingECG.pdf
Definition
Term
figuring rate..
Definition
count QRS complexes in six seconds, multiply by 10
Term
sinus brady causes
Definition
*lower metabolic needs
*vagal stimulation
*medications
*increased intracranial pressure
*myocardial infarction
Term
treatment of sinus brady
Definition
*Assess patient for hemodynamic effect and possible cause
* *Give Atropine 0.5 mg IV bolus every 3-5 min to maximum dose of 3 mg
Term
sinus tachycardia..
Definition
everything's normal, just faster (>100 bpm)
Term
tx of sinus tachy
Definition
normally caused by medication, stimulants, anxiety.. meds rarely used to counter it, CCB, BB
Term
supraventricular tachy
Definition
greater than 150 bpm, QRS shape is narrow, p wave and t wave may be spliced.
Term
supraventricular tachy can cause..
Definition
syncope
Term
tx of supraventricular tachy
Definition
adenosine,
First dose 6mg
Second dose 12 mg
Third dose 12 mg
After 30 mg, it is ineffective and then must consider electrical cardioversion
Term
premature atrial contractions
Definition
early p waves, may be hidden in T waves.
Term
causes of premature atrial contractions..
Definition
*caffeine, alcohol, nicotine
*anxiety
*hypokalemia
Term
if premature atrial contractions happen more than 6 in a minute..
Definition
its bad, may worsen disease state and onset a fib
Term
Atrial fibrillation
Definition
no discernible P waves..squiggles with visible QRS, p:qrs ration.. many:1
Term
causes of a fib
Definition
Advanced age
*Valvular heart disease
*Hypertension
*Heart failure
*Diabetes
*Occurs in 11-64% o
Term
tx of a fib
Definition
meds first, then cardioversion. can use CCB like cardizem
Term
dangers of cardioversion in a fib
Definition
Cardioversion of a-fib > 48 hrs should be avoided unless pt has received anticoagulants (risk of embolization of atrial thrombi)
Term
atrial flutter has distinctive..
Definition
saw tooth appearance. like angry teef!
Term
in atrial flutter p waves are replaced by..
Definition
flutter waves. p:qrs many:1
Term
tx of a flutter..
Definition
Nonpharmacologic interventions to convert atrial flutter to sinus rhythm (if patient hemodynamically unstable, may cardiovert.) If present for more than 48 hrs, patient must be anti-coagulated.
beta blockers may be used too
Term
slide 45
Definition
Term
CVP
Definition
Central venous pressure 3-8
Term
SVR
Definition
systemic vascular resistance 8-12
900-1400mm hg
Term
PVR
Definition
pulmonary vascular resistance < 250
Term
Quarter over dime
Definition
pulmonary artery pressure BP of the lungs
15-25/5-15
Term
Increased PAP?
Definition
Pulmonary HTN
Term
PAOP,PAWP,PCWP
Definition
pulmonary artery occlusion pressure, pulmonary capillary wedge pressure
4-12
Term
What does PAWP measure
Definition
left heart, left ventricle back pressure
Term
LVP
Definition
left ventricular pressure 100-140
think regular blood pressure
Term
MAP
Definition
(diastole x 2) + (systole x 1)/3
Term
Cardiac index
Definition
2.8-4.2
Term
stroke volume
Definition
60-100 normal 70
Term
cardiac output
Definition
SV x HR ~~4-8liters/min
Term
frank sterling law
Definition
greater the stretch greater the volume
if stretched too far cannot repair itself
Term
What does a wedge waveform indicate in a patient who has a swancath?
Definition
the catheter has advanced
Term
what can you expect on the strip upon insertion of a swancath?
Definition
PVC
Term
phase 1
Definition
exudative phase
x-ray normal, use of accessory muscles,clear lung sounds, PAWP<18mm hg, change in LOC
Term
phase 2
Definition
acute fibroproliferative phase
surfactant decrease, type 2 aveolar damage, refactory hypoxemia, bilat infiltrates
Term
phase 3
Definition
recovery fibrotic phase
decrease lung compliance, fibrotic/scar tissue forms
leukocytosis, fever bilat infiltrates, lactic acidosis, increase HR & decrease BP, tension pneumo
Term
INR for a fib patient
Definition
2-3
Term
PTT
Definition
25-30 seconds
Term
dobutrex
Definition
increases contractility
Term
regular QRS no p-wave
Definition
A-flutter
Term
non associative atrial and ventricluar rhythms
Definition
junctional rhythm, complete block
Term
PEA
Definition
pulsness electrical activity; ECG strip with no pulse, misconnect with electrical activity and mechanically stretching of muscle fibers
Term
immediate defibrillation
Definition
V-fib, unstable v-tach(no pulse) V-tach( lidocaine, amiodarone)
asynchronous
Term
wide bizarre QRS complex
Definition
PVC "my heart is skipping a beat"
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