BKAT Critical Care Review (2022/2023) Rated A+

BKAT Critical Care Review (2022/2023) Rated A+ Normal Central Venous Pressure (CVP) range 2-8 mmHg Normal Pulmonary Artery Occlusion Pressure (PAOP) range 6-12 mmHg Normal Pulmonary Artery Systolic (PAS) range 20-30 mmHg Normal Pulmonary Artery Diastolic (PAD) range 5-15 mmHg Normal Pulmonary Artery Mean (PAM) 11-20 mmHg Normal Systemic Vascular Resistance (SVR) range 800-1200 mmHg Preload volume left in the left ventricle at the end of diastole What is preload affected by? venous return to the heart, atrial kick, total volume, and ventricular compliance What drugs can affect preload? Furosemide and nitroglycerin Afterload Amount of pressure heart has to overcome to pump blood out What drugs may affect afterload? Vasoconstricters and vasodilators Contractility the contractile force of the heart, how much will it take to move the preload out against the afterload What is the appropriate hold time after pulling an arterial line? 5-10 min What part of the heart does the PAOP affect? Left ventricle What part of the heart does the CVP affect? Right ventricle What does it mean when the PAOP is elevated? Increased left ventricular end diastolic pressure that could be indicative of left ventricular dysfunction or failure What does it mean if CVP is elevated? Fluid overload or decreased compliance (such as with ARDS and COPD) Difference between stable and unstable angina Stable angina: pain happens with certain activities but then goes away with rest. Unstable angina: chest pain can occur at rest, becomes more sever or frequent, or lasts longer ECG changes with an acute MI? ST elevation or depression ECG changes with hyperkalemia Peaked T waves What conditions may cause elevated cardiac enzymes? Trauma, acute MI, CABG, and pericarditis What is the goal of treatment with cariogenic shock? to increase cardiac output What are the effects of nitroprusside (Nipride) and dobutamine (Dobutrex) on preload, afterload, and contractility? They both increase cardiac output, heart rate, and contractility Special precautions of Nipride It can cause severe hypotension and cyanide toxicity Where to listen to assess with a murmur associated with aortic stenosis right upper sternal border What is the most important thing to watch for when administering tPa? mental status changes Anti-clotting medications Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), warfarin (Coumadin), heparin, apixaban (Eliquis), and enoxaparin (Lovenox) Heart rate controlling medications Beta blockers (-lol), calcium channel blockers (-ipine), Digoxin Heart rhythm controlling medications Na+ channel blockers (lidocaine) and K+ channel blockers (amiodarone) R on T phenomenon When pacing, a strong ventricular stimulus occurring on top of the T wave that can initiate a sustained ventricular tachyarrythmia Normal PR interval 0.12-0.20 seconds What can a long PR interval (>0.20 seconds) indicate? 1st degree heart block, hypokalemia, acute rheumatic fever, or carditis associated with Lyme disease Normal QRS complex 0.12 seconds or less What could a wide QRS complex (>0.12 seconds) indicate? Right or left BBB, pacemaker, hyperkalemia, or ventricular pre-excitation associated with Wolf-Parkinson-White pattern Normal QT interval Less than or equal to 0.04 seconds What could a long QT interval (>0.04 seconds) indicate? Antibiotic use or hyperkalemia What to watch out for with Dopamine administration in regards to skin Reflex erythema, central blanching, and piloerection Heparin antidote protamine sulfate Coumadin antidote Vitamin K Antidote for Coumadin Vitamin K ACLS drug and dose for symptomatic sinus bradycardia Atropine 0.5 mg repeated up to a total dose of 3 mg Signs and symptoms of digitalis toxicity Loss of appetite, nausea, vomiting, diarrhea, tachycardia, and vision changes including blind spots, blurred vision, seeing spots, and changes in how colors look Causes of low volume ventilator alarm Tube disconnection Causes of high pressure ventilator alarm Biting on ETT, coughing, mucus plug, bronchospasm, mucus or water in the tube, or kinked tubing How much is too much output in chest tube over one hour following surgery? >150 mL Appropriate pressure for suctioning is 120 mmHg Causes of decreased breath sounds Pneumonia, heart failure, pleural effusion, and increased chest wall thickness Nursing action to check for proper ETT placement Listen to bilateral breath sounds Most common reason for development of PE following trauma with multiple long bone fractures Fat emboli What is the most important nursing action in relation to cervical spine injury? Respiratory impairment is the most common complication of CSI, so need to protect airway, maintain adequate respirations, and keep spine straight Earliest sign of increased ICP Headache and vomiting Drug frequently used to decrease ICP Mannitol How many hours can lapse between onset of stroke symptoms and administration of tPA? Up to 4.5 hours Most important part of neurological assessment Evaluation of LOC Signs of diabetes insipidus in a post operative craniotomy patient Extreme thirst and urine output >1000 mL What anti-seizure medication should never be mixed with D5W and why? Dilantin because it causes crystallization Signs and symptoms of DKA Frequent urination, extreme thirst, elevated glucose, elevated urine ketones, nausea and/or vomiting, abdominal pain, confusion, and fruity-smelling breath Signs and symptoms of hypoglycemia Shakiness, dizziness, hunger, irritability, anxiety, and headache Treatment for DKA IV fluids and correction of potassium of </= 3.3 before insulin, administration of 0.1 unit/kg bolus of insulin, and insulin infusion at 0.1 units/kg/hr Peak action time of regular insulin 2-4 hours Peak action time of NPH insulin 8-14 hours What is cortisone? A synthetic form a cortisol for replacement of cortisol, a hormone produced in then adrenal gland Normal BUN ranges 7-20 Normal creatinine range 0.5-1.3 Normal potassium range 3.5-5 Normal urine specific gravity range 1.003-1.030 Adequate urine output level At least 0.5 mL/kg/hr Is medication that is excreted through the kidneys increased or decreased in dosage for patients in acute renal failure? Decreased Recommended renal diet Low Na+, low phosphorus, and low protein Sudden development of dyspnea and tachycardia in acute renal failure patients in most indicative of what? Fluid overload Low intermittent suction is used with OGT and NGT to do what? Decompress the stomach and prevent vomiting Best way to confirm OGT/NGT placement X-ray "Coffee ground" NGT aspirate may indicate what? Bleeding that has occurred in the recent past and become partially digested Signs and symptoms of blood transfusion reactions Back pain, dark urine, chills, fainting, dizziness, fever, flank pain, skin flushing, and shortness of breath Most important treatment in burn patients with 24 hours following airway securment IV fluid resuscitation Why should a hypothermic patient not be rapidly re-warmed? Rebound increased ICP True or false: A medical power of attorney gives the person the right to make all medical decisions for the patient while in critical care? False ACLS rhythms that amiodarone is used to treat V-fib and pulseless v-tach Amiodarone dosage for ACLS 300 mg Signs and symptoms of cyanide toxicity Mental status changes, tachycardia, seizure, a need for an increase in dose, and unexplained metabolic acidosis