ANCC Adult Gerontology Acute Care

ANCC Adult Gerontology Acute Care Review Test Exam 2023 Cardiac Index - ANS-2-4 SVR/Afterload - ANS-800-1200 MAP - ANS-mean CVx80/CO PA pressure - ANS-15-30 Wedge PCWP pressure - ANS-6-12 Hypovolemic Shock Parameters - ANS-Preload CVP decreased, SVR afterload increased, CI decreased, Oxygen delivery Decreased, Venous Oxygen saturation increased Types of hypovolemic shock - ANS-Hemorrhage, burns, pancreatitis Cardiogenic shock parameters - ANS-CVP preload increased, SVR afterload increased, CI decreased, oxygen delivery decreased, SV02 decreased Types of cardiogenic shock - ANS-Post mi, malignant dysrhythmia, acute myocarditis Obstructive shock parameters - ANS-Preload either, SVR increased, CI decreased, oxygen delivery decreased, SV02 decreased Types of obstructive shock - ANS-Tension pneumo, cardiac tamponade, PE Distributive shock parameters - ANS-Preload CVP decreased, afterload SVR decreased, CI increased, SV02 decreased, oxygen delivery increased Types of distributive shock - ANS-Septic shock, anaphylaxis, neurogenic shock CVP Preload - ANS-2-8 Cardiac Output - ANS-4-8 MAP - ANS-70-90 Fractional Excretion of NA <1% - ANS-Prerenal state of kidney dysfunction (i.e. dehydration) Fractional Excretion of NA >2% - ANS-ATN (acute tubular necrosis) CPP equation - ANS-MAP-ICP SIADH Hyposmolar hyponatremia "inappropriate water retention" - ANS-serum sodium low, serum osmo low <280, urine osmo high >100, no dehydration, tx restrict fluids if neuro symptoms give 3%NS DI Hyperosmolar hypernatremia dry - ANS-Serum sodium high, serum osmo high >290, urine osmo low <100, urine spec grave 1.005 (urine is like water), urine sodium >20, dehydration, if serum Na >150 give D5W to replace ½ volume deficit in 12-24 hours, avoid rapid lowering of Na, DDAVP for acute situations Serum Osmo - ANS-280 Urine Osmo - ANS-300-800 Sodium - ANS-~140 Total cholesterol - ANS-<200 Triglycerides - ANS-<150 HDL - ANS->40 LDL - ANS-<100 Management of pulm edema - ANS-02, sitting up, morphine 2-4mg, Lasix 40, another Lasix 40 if needed Left heart failure - ANS-LUNGS, dyspnea at rest, rales, wheezing, generally healthy except acute event, S3, murmur of mitral regurg Right heart failure - ANS-JVD, hepatomegaly, peripheral edema MR ASS - ANS-Mitral regurg, aortic stenosis, systolic murmurs MS ARD - ANS-Mitral Stenosis, aortic regurg, diastolic Mitral murmur locations - ANS-5th ICS, apex Aortic murmur locations - ANS-2nd or 3rd ICS, base S1 - ANS-AV valves closed, SL open S2 - ANS-SL closed, AV open Cardiac blood flow - ANS-SVC,RA, tricuspid, RV, pulmonic valve, pulmonary artery, lungs, pulmonary veins, LA, mitral, LV, Aortic valve, aorta, body Cushing's - ANS-Moon face, buffalo hump, hypertension, HYPERglycemia, HYPERnatremia, HYPOkalemia, tx depends on cause (stop meds, tumor) Addison's ADRENOcorticoid deficiency - ANS-Remember: SEX, SALT, and SUGAR Deficient cortisol, androgens, and aldosterone, hyperpigmentation in buccal mucosa, tanning, HYPOtension, scant hair, HYPOglycemia, HYPOnatremia, HYPERkalemia, cosyntropin is the rule out for addison's, manage: referral, glucorticoid, hydrocortisone, fludrocortisone inpatient: hydrocortisone and fluids HYPERthyroidism/Grave's - ANS-TSH LOW, T3 High, Grave's Disease, bulgy eyes, weight loss, fine thin hair, smooth skin, a fib Specialist referral, propranolol, methimazole, PTU, lugol's Thyroid crisis - ANS-PTU or Methimazole with adjunct within 1 hour Lugol's propranolol, hydrocortisone No ASA Hypothyroidism - ANS-(TSH assay most sensitive test) TSH ELEVATED, T4 LOW hasimototo's most common, LOW AND SLOW, cold intolerance, weight fain, brittle nails, brady, hypoactive BS, Levothyroxine 50-100mcg Myxedema Coma - ANS-AIRWAY, fluid replacement PRN, levothyroxine 400mcgIVx1 Subacute thyroiditis - ANS-Treated symptomatically with propanonlol Pheocromocytoma - ANS-Labile hypertension, TSH normal, postural hypotension, plama-free metanephrines to rule out, CT to confirm, surgical removal, postop: hypotension, adrenal insufficiency, hemorrhage urine catecholamines, alpha blockers phentolamine DKA - ANS--intracellular dehydration, kussmaul, hyperglycemia >250, ketonemia, hyperkalemia Management: 1L first hour>500ml/hr, 0.1/kg/hr, glucose <250 change to D51/2 when switching to subq insulin, inititate subQ insulin 2-3 hours prior to stopping insulin drip HHNK (Hyperosmolar Hyperglycemic NON KETOSIS) - ANS-Type 2 DM, super elevated glucose >600, hyperosmolar >310, normal anion gap, elevated hgbA1c, normal pH Continues...