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Principles III Final Exam, Hearts Part 1 slides 2-11
Bacon makes everything better.
23
Nursing
Graduate
04/18/2010

Additional Nursing Flashcards

 


 

Cards

Term
What does it mean when athersclerotic pts become symptomatic???
Definition
It means that vessels are >75% occluded
Term
What happens when ischemic cells become irritable?
Definition

1) inc. vulnerability to VF

2) Alteration in conduction pathways

Term

This condition caused by Cardiopulmonary Bypass is usually d/t activation of the compliment cascade and inflammatory system in response to hemodilution, lung hypoxia, and increases in PA pressures-

 

what condition is this?

Definition
Acute Lung Injury
Term
What 2 bad things can happen as a result of "Pump" lung d/t CBP? 
Definition

1) Congestive Edema

2) hemorrhagic atelectasis

Term
What is the theory underlying "pump lung"?
Definition
The theory is that it is a result of microemboli or protein aggregates, destroyed platelets, damaged fibrin and fat particles that imbed in the lung. 
Term
What is one of the dangers of chest cooling in preparation for CPB?
Definition
Injury to the phrenic nerve which may reduce pulmonary function. 
Term

True or False

 

VQ mismatching is A- Okay with CPB.

Definition
No.  There is poor VQ mismatching with the nondependent lung ventilating better than dependent lung. 
Term

What approaches have been used to improve atelectasis as a result of putting a pt. on CPB?

 

 

Do all of these approaches work?

Definition

1) PPV

2) Intermittent Sigh breaths

3) CPAP

(None of the above have demonstrated reliable improvement)

4) Filtration of microemboli

5) Steroids

Term

1) What it the primary post operative neuro complication r/t CPB?

 

2) ________ patients demonstrate some neuro deficit after CBP.

 

 

Definition

1) Stroke

2) 50%

Term

1) Autoregulation of da brain occures between what MAP?

 

2) What is brain perfusion when autoregulation is intact?

 

3) What happens if autoregulation is lost?

Definition

1) 50-150

 

2) 50ml/100gm/min

 

3) Global ishemia occurs.

Term
Pump runs greater than _________ are associated with an increase in cognitive dysfunction
Definition
90 minutes
Term
Why does insulin resistance occur when a patient is on CPB?
Definition

1) catecholamine levels rise significantly as time on CPB increases (thereby jacking up glucose levels)

2) At the same time cells may even become resistant to exogenous insulin.

Term
What happens to the bowel on CPB?
Definition

It is sacraficed!!!!!  Aaahhhhhhhhhhhhh!!!!

 

Ischemic bowel leaks- and this my friends (I have been told) is not good.

Term

1) Renal impact of the CPB is dependent on what?

 

2) Pump times > _______ hours are associated with high incedences of post operative renal complications

 

 

Definition

1) Length of time on the pump.

 

2) 3 Hours

Term

Besides pump time, what are some other reasons or factors that can lead to renal failure during heart surgery?

 

(Gayle listed 6)

Definition

1) Type of procedure

2) Cardiac output (before and after)

3) Use of vasopressors

4) Acute MI

5) Massive transfusion

6) Use of IABP

Term

In regards to Post CPB:

 

1) What are normal creatinine levels?

 

2) What creatinine level is considered abnormal? 

 

3) What creatinine level is considered failure?

Definition

1) 1.8 mg/100 mg or less

 

2) 1.9 - 5 mg/100 ml is abnormal

 

3) 5 mg/100 ml is considered failure

Term

Fill in the blanks:

 

Preoperative creatinine levels are ____(1)______ proportional to post operative mortality and renal failure and ______(2)________ related to cardiac index.

Definition

1) Directly

 

2) Inversely

Term

More on the impact of CPB:

1) What does hypothermia do to renal blood flow?

 

2) What results in an adequate urine output during a pump run?

 

3) What is the target urine output?

 

 

Definition

1) reduces  it

 

2) maintaining hemodilution, using mannitol in the priming solution, and maintaining GFR results in adequate urine output during a pump run. 

 

3) 1 ml/kg/hr

Term
Which is better while on pump in regards to urine output- hypothermia or normothermia?
Definition
Neither- studies show that neither impact overall urine output while on pump.
Term

True or False:

 

1) The progressive rise in catecholamines during CPB contibutes to the rise in serum glucose.

 

2) Hyperglycemia is protective of renal tubules during CPB.

 

3) ADH is released during CPB

Definition

1) True

 

2) False- hyperglycemia is detrimental to renal tubules

 

3) True

Term
The release of catecholamines and ADH when someone goes on pump is thought to be due to what factors?
Definition

1) reduction in atrial pressure (decrease in preload)

 

2) hypotension

 

3) loss of pulsatile flow

Term

It is important for the kidney to rid the body of free water and potassium.

 

When are electrolytes checked?

Definition
After the pt. is placed on pump and after they come off.
Term

1) What coagulation tests will show prolongation with hypothermia resulting from CPB?

 

2) Platelets are non-functional by ______ degrees C.

 

3) What happens to potassium with hypothermia induced by CPB?

Definition

1) ACT, PT, PTT

 

2) 28 degrees C.

 

3) Cellular uptake increases resulting in hypokalemia

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