CRITICAL CARE EXAM 1 2023

CRITICAL CARE EXAM 1 2023 P wave - CORRECT ANSWER-Depolarization of the atria PR interval - CORRECT ANSWER--Normal is 0.12 to 0.2 seconds - onset of atrial depolarization until onset of ventricular polarization QRS complex - CORRECT ANSWER--Normal is 0.06 to 0.11 seconds -Ventricular depolarization -systole T wave - CORRECT ANSWER--appears after QRS complex - Ventricular repolarization -Spiked T-wave occurs with hyperkalemia U wave - CORRECT ANSWER-- repolarization of the purkinje fibers - seen in patients with hypokalemia SA node - CORRECT ANSWER-the pace-maker of the heart; where the impulse conduction of the heart usually starts; located in the top of the right atrium just below superior vena cava *sends impulses 60-100 BPM Normal Sinus Rhythm - CORRECT ANSWER-Rate is 60-100/ minute Rhythm is regular P wave present PR interval: normal 0.12-0.20 QRS complex:normal Interpretation: normal sinus rhythm normal QRS: 0.06- 0.10 Sinus Bradycardia - CORRECT ANSWER-Rate is <60/minute Rhythm is regular P wave present PR interval: normal 0.12-0.20 QRS complex:normal Interpretation: treat sinus brady with *0.5mg atropine ( if emergent)* , dopamine, epinephrine, pacer. *normal in patients when sleeping or sleeping -may occur with use of Beta blockers or calcium channel blockers, digoxin, morphine, vagal stimulation, hypothermia, hypothroidism Sinus Tachycardia - CORRECT ANSWER-Rate is >100/min (usually below 160) Rhythm is regular P wave present PR interval: normal 0.12-0.20 QRS complex:normal 0.6-0.10 Interpretation: correct the underlying cause, adminster beta blockers or calcium channel blockers. *treat underlying cause.** - may be a normal response from a fever, exercise, anxiety, pain, dehydration. May accompany shock, LHF, hyperthyroidism, anemia, hypovolemia, PE, MI -can be caused by caffiene, nicotine, amphetemines, atropine, cocaine. Sinus Arrhythmia - CORRECT ANSWER-Rate: increases on inspiration, decreases on expiration Rhythm: *Always has irregular rhythm* P waves?: yes PR interval: normal QRS: normal Significance: usually a normal finding and usually is *not treated* Premature Atrial Complexes - CORRECT ANSWER-Rate: normal Rhythm:abnormal P waves?: Yes, has *EARLY* p waves PR interval? WNL QRS:WNL Significance: *electrical impulses start in atrium BEFORE beat finishes -CAUSES: stimulants, alcohol, anxiety, hypokalemia -common in normal hearts* - if EKG shows many, could be an early sign of SVT or A.fib TREAT underlying cause (minimize stress, dont drink caffeine) Atrial Flutter - CORRECT ANSWER-Rate: 250-400/min Rhythm: regular P waves: NO only flutter(sawtooth) waves are seen PR interval: N/A QRS: WNL Significance: SAWTOOTH waves *if ventricles try to catch up, can be a bad tachycardia *Patient can live fine with A. flutter, just control rate -CAUSES- pulmonary disease (COPD,OSA, Pulm. HTN), heart valve disease, after open heart surgery TREAT: CARDIZEM anticoagulants, perdoxa, dysrhythmic, amiodarone,BB, Digoxin, Cardioversion (if hemodynamically unstable and tachy) Atrial Fibrillation - CORRECT ANSWER-*most common adult arrhythmia Rate: >400 *can be normal* Rhythm: irregular P waves: No P waves PR interval: N/A QRS: normal Significance: becomes dangerous when ventricles try to catch up A.fib can be baseline and controlled if hr <100 -CAUSES- pulm. disease, increased age, males, overweight, chronic HTN, HF, open heart surgery -TREAT- Digoxin (to put into NSR), cardizem, amiodarone, corvert, cardioversion What is the same for NSR, SB, ST? - CORRECT ANSWER-*all have a P wave. * all have a normal PR interval. *all have a normal QRS interval. *All start at SA node. ***only difference is change in RATE** Atrial Kick - CORRECT ANSWER-Atrial kick is a term that represents the amount of the total CO that is supplied via atrial contraction. Pulse pressure - CORRECT ANSWER-Systolic # - Diastolic # = pulse pressure What should you assess in a patient with dysrhythmia? - CORRECT ANSWER-LOC rate and rhythm of apical and peripheral pulses heart sounds blood pressure pulse pressure signs of fluid retention health history Cardizem - CORRECT ANSWER--Trade name for Diltiazem, Calcium Channel Blocker, Vasodilator *first line treatment for A.flutter/ A.fib * Supraventricular Tachycardia - CORRECT ANSWER-*if hemodynamically stable, treat with oxygen, IV access continuous monitoring, and vagal maneuvers Rate over 160bpm *give adenosine if vagal maneuver does not work (6mg rapid IV push with 20ml NSS flush) Mean Arterial Pressure (MAP) - CORRECT ANSWER-Average of blood pressure forces on arteries * Systolic + (2x Diastolic) / 3* 60mmHg is adequate organ perfusion Optimal MAP is between 70-90mmHg *measures the blood pressure parameter used to measure organ perfusion Cardiac Output - CORRECT ANSWER-volume of blood ejected from L ventricle per minute *HR x SV* Phlebostatic Axis - CORRECT ANSWER-The reference point for the atrium when the patient is positioned supine. What characterizes a normal QRS complex? - CORRECT ANSWER-0.6 to 0.11 seconds long. ventricular depolarization AKA systole What characterizes a normal PR interval? - CORRECT ANSWER-0.12 to 0.2 seconds -onset of atrial depolarization until onset of ventricular depolarization Central Venous Pressure CVP - CORRECT ANSWER-*measures amount of blood returning to heart and function of right ventricle (monitored in the superior vena cava via the central line. normal 2-8mmHg *LOW CVP* -hypovolemia, diuresis, sepsis *HIGH CVP* RV failure, LV failure, PE, Pulmonary HTN, Hypervolemia -can attach to monitor Interventions for Inadequate sleep in the ICU - CORRECT ANSWER-provide darkness for melatonin response, control noise, create a bedtime routine, assess risk factors, provide comfort Delirium - CORRECT ANSWER-AKA ICU psychosis. -acute confusion. -dementia is ^ risk factor for delirum, - other risk factors: lack of sleep, electrolyte imbalance, UTI, dehydration -characteristics: confusion, agitations, dilusions, violence Restraints - CORRECT ANSWER-Assess necessity. Alternate interventions?: sitters, mits, posey vests, alarms, anticipate their needs Standards/rules: MD assessment, prescription, frequent RN assessment, reorder q24h Pain Assessment - CORRECT ANSWER-*Pain is what the PATIENT says it is* Observation Physiological Parameters The acuity of the patient's condition Altered levels of consciousness An inability to communicate pain Restricted or limited movement Endotracheal intubation The stress response - CORRECT ANSWER-Activation of the hypothalamic-pituitaryadrenal axis Increase catecholamine, glucocorticoid, and mineralocorticoid levels Leads to immunosuppression, hypoperfusion, tissue hypoxia, impaired healing *decreased digestion, increased HR BP R, pupillary dialation, blood goes to muscles and hear