FCCN 2 QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS) /ALREADY GRADED A+

FCCN 2 QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS) /ALREADY GRADED A+ “PaO2 - CORRECT ANSWER partial pressure of oxygen in arterial blood, obtained using an ABG 80-100mmHG PaO2 60=SpO2 90%" "SpO2 - CORRECT ANSWER saturation of peripheral oxygen, obtained using pulse ox 90-100% SpO2 90%=PaO2 60" "PaCO2 - CORRECT ANSWER 35-45" "respiratory acidosis - CORRECT ANSWER low pH, high CO2 causes: CNS depression from drugs such as sedation, injury, or disease breathe too slow, retaining CO2" "respiratory alkalosis - CORRECT ANSWER high pH, low CO2 causes: pain, fever, sepsis breathe too fast, not retaining enough CO2" "HCO3 - CORRECT ANSWER 22-26" "metabolic acidosis - CORRECT ANSWER low pH, low HCO3 causes: diarrhea, DKA, hyperkalemia" "metabolic alkalosis - CORRECT ANSWER high pH, high HCO3 causes: vomiting, suctioning, hypokalemia" "minute ventilation - CORRECT ANSWER tidal volume x respiratory rate volume inspired during 1 minute normal is 5-8L/min" "pressure support - CORRECT ANSWER -eases the work of breathing, helps to overcome airway resistance of breathing through artificial airway -cannot be used with AC or CMV -CAN be used with SIMV -Patient can take breaths between mandatory breaths -used to wean from ventilator" "peak airway pressure - CORRECT ANSWER highest pressure recorded at the end of inspiration" "SIMV - CORRECT ANSWER synchronized intermittent mandatory ventilation mandatory breaths have a set tidal volume, pt initiated breaths have varying tidal volume initial mode for ventilation or weaning mode disadvantage: increased work of breathing and can lead to pt/vent asynchrony" "AC/CMV - CORRECT ANSWER Assist control or continuous mandatory ventilation pt initiated or ventilator control breaths have set tidal volume disadvantages: hyperventilation which may cause respiratory alkalosis or hyperinflation, less comfortable for pt" "oxygenation - CORRECT ANSWER the process of delivering oxygen to the blood" "diffusion - CORRECT ANSWER movement of gases between air spaces in lungs and bloodstream" "how do we know that ventilation and/or oxygenation is less than optimal in our pts? - CORRECT ANSWER -respiratory assessment -pulse oximetry -ABGs -imaging -P/F ratio" "perfusion - CORRECT ANSWER movement of blood in and out of capillary beds" "P/F ratio - CORRECT ANSWER tells us the degree of sickness of our pt's lungs, and helps assess oxygenation PaO2/FiO2 normal is 300-500" "ARDS - CORRECT ANSWER -hypoxemia within 7 days of pulmonary insult -alveoli fill with fluid and may collapse -bilateral opacities that isn't explained by pleural effusions, pneumothorax, or pulmonary nodules -respiratory failure not attributed to volume overload -mild, moderate or severe P/F ratios in presence of PEEP" "distinguish ARDS from CHF - CORRECT ANSWER check BNP and edema which may indicate CHF is the cause look at lung films and for a pulmonary insult within the last 7 days which may indicate ARDS" "ARDS severity - CORRECT ANSWER look at P/F ratio mild: 200-300 moderate: 100-200 severe: <100" "injury to alveoli - CORRECT ANSWER -causes release of proinflammatory cytokines -cytokines recruit neutrophils to the lungs -neutrophils become active and release toxic mediators -damage to capillary endothelium and alveolar epithelium -proteins leak out from vascular space -normal oncotic gradient, fluid doesn't stay where it should. gets into airways and interstitial spaces" "ARDS s/s - CORRECT ANSWER -hypoxemia after pulmonary insult -bilateral opacities -crackly lungs -diaphoresis -chest pain -cough -accessory muscle use -rapid deterioration -increasing demand for supplemental oxygen" "depolarizing agents - CORRECT ANSWER mimic ACh Bind to ACh receptor on motor end plate and depolarize post junctional neuromuscular membrane. paralysis occurs because depolarized membrane can't respond to subsequent stimuli by ACh succinylcholine" "succinylcholine - CORRECT ANSWER rapid onset 30-60 seconds, ultra short duration, absence of adverse effects on smooth muscle metabolized in blood and excreted by kidneys side effects: hypotension, bradycardia, hyperkalemia, malignant hyperthermia" "non-depolarizing agents - CORRECT ANSWER competitively block ACh transmission at post-junctional receptor sites. level of paralysis increases as number of receptor sites occupied by drug increases pancuronium, atracurium, cisatracurium, vec, roc" "NMB considerations - CORRECT ANSWER NMBs do not have sedative analgesic or amnestic properties. assure pain and sedation medication given beforehand. precedex should not be used due to light sedative properties" "assessments for effectiveness of NMB - CORRECT ANSWER -TOF -spontaneous breathing or movement -resistance to turning -diaphoresis -vitals -ETCO2" "Train of four monitoring - CORRECT ANSWER -series of four twitches at 2 hz, every half second for 2 sec. -reflects blockade percentage -TOF based on provider order for pt's clinical goals 4 twitches: 0-75% of receptors blocked 3: 80% 2: 85% 1: 90% 0: 100% must establish baseline before initiating NMB" "PVR - CORRECT ANSWER afterload to right heart" "SVR - CORRECT ANSWER afterload to left heart" "contractility - CORRECT ANSWER heart's ability to squeeze" "oxygen delivery/consumption - CORRECT ANSWER goal: deliver enough oxygen to tissues to meet tissue demand major determinants of o2 delivery are Hgb and CO" "ScvO2 - CORRECT ANSWER central venous oxygen saturation" "SvO2 - CORRECT ANSWER reflects balance between oxygen delivery and demand normal is 60-80%" "thermistor port - CORRECT ANSWER measures body temperature" "what can be injected into the red balloon port? - CORRECT ANSWER 1.5 mL or less of air" "which port should you use to infuse calcium chloride? - CORRECT ANSWER clear/white" "what can be infused through the yellow port? - CORRECT ANSWER 3mL/hr NS flush" "RN role with PAC - CORRECT ANSWER -use ports appropriately -level, zero, square wave, waveform analysis -prevent infection -measure skin to tip q4h and document changes from placement measurement -print PA wave strip and ECG strip -site care prn or once a week -d/c lines asap w/ order" "PAC safety - CORRECT ANSWER -secure device -do not tape over plastic sheath -monitor for wedging -monitor for ventricular placement -assure you are getting quality data" "osmosis - CORRECT ANSWER diffusion of water across a selectively permeable membrane" "pituitary gland - CORRECT ANSWER endocrine system's most influential gland. under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands" "thyroid gland - CORRECT ANSWER produces hormones that regulate metabolism, body heat, and bone growth" "parathyroid glands - CORRECT ANSWER small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues" "adrenal glands - CORRECT ANSWER glands that help the body recover from stress and respond to emergencies" "pancreas - CORRECT ANSWER Regulates the level of sugar in the blood" "ovaries/testes - CORRECT ANSWER produce sex hormones" "symptoms of dysfunctional endocrine system - CORRECT ANSWER -behavioral changes -fluid/lyte imbalances -pain -fight or flight response impaired -seizures, coma -thermal regulation impaired" "SIADH - CORRECT ANSWER oversecretion of ADH, leading to water retention and concentrated urine caused by head trauma, cancers, CHF, or can be drug induced" "SIADH s/s - CORRECT ANSWER -low uop -lung crackles -headache -dilutional low sodium -low serum osmolality -high urine sodium -high urine osmolality -seizures -altered LOC -weight gain -tachypnea -thirst" "SIADH treatment - CORRECT ANSWER -fluid restriction -high sodium diet -declomycin to block ADH (for chronic treatment only) -prevent falls -seizure precautions -hypertonic fluids" "DI - CORRECT ANSWER deficiency of ADH, leading to excess urination of clear, diluted urine caused by brain tumor, head trauma, meningitis, TB, sarcoisosis" "DI s/s - CORRECT ANSWER -polyuria -polydipsia -nocturia -fatigue -dehydration -weight loss -muscle weakness -poor skin turgor -dizziness -dry mucous membranes -hypotension -tachycardia -hypernatremia -low urine specific gravity" "DI treatment - CORRECT ANSWER -ADH (desmopressin or vasopressin) -hypotonic fluids -monitor UOP -monitor fluid status -low sodium diet" "mineralocorticoids - CORRECT ANSWER promote reabsorption of Na+ and excretion of K+ in kidneys, help regulate fluid retention and BP aldosterone" "glucocorticoids - CORRECT ANSWER raises blood sugar levels during times of stress, prevents water loss from cells into tissue fluids, used as an anti-inflammatory agent cortisol" "Addison's disease - CORRECT ANSWER occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone poor stress response, treat with low dose hydrocortisone. will need low dose pressors for refractory hypotension" "pancreatic endocrine complications - CORRECT ANSWER severe hypoglycemia, DKA, HHS" "hypoglycemia - CORRECT ANSWER abnormally low level of sugar in the blood caused by: -taking insulin at wrong time -taking too much insulin -not eating enough after taking insulin -skipping meals -exercising more or at a different time than usual -drinking alcohol" "hypoglycemia treatment - CORRECT ANSWER if symptomatic or BG <60, do one of these: -4 oz juice (no orange in renal failure pts) -5 packets sugar -glucose tabs or gel -1/2 amp D50 -1mg glucagon and then q15min sugars until >80" "DKA - CORRECT ANSWER hyperglycemia in Type 1 patients which leads to acidosis, ketones in urine" "DKA treatment - CORRECT ANSWER -airway/breathing -aggressive rehydration -assess and replace potassium prior to insulin start -IV Insulin per DKA order set -monitoring-ABG's, lytes, glucose, EKG, I&O -may need NG, Foley, intubation, etc if pt unconscious -sodium bicarb drip slowly if pH<7 -treat underlying cause of DKA -VTE prophylaxis" "DKA s/s - CORRECT ANSWER polyuria, polydipsia, n/v, severe fatigue, abdominal pain/tenderness, fruity breath, kussmaul respirations, mental status changes" "HHS s/s - CORRECT ANSWER polyuria, polydipsia, dehydration, tachycardia, hypotension, mental status changes" "HHNS - CORRECT ANSWER hyperglycemia in Type 2 which is really just dehydration" "cerebral perfusion pressure - CORRECT ANSWER MAP-ICP adult normal 50-100" "ICP - CORRECT ANSWER 0-15 mmHg" "early signs of increased ICP - CORRECT ANSWER -AMS -headache -vomiting -papilloedema -seizures -focal neuro signs" "late signs of increased ICP - CORRECT ANSWER -stupor, coma -changes in pupil size or reaction -seizures -hemiplegia, paralysis -cushing's triad (decrease HR, widening pulse pressure, respiratory irregularities)" "interventions to decrease ICP - CORRECT ANSWER -semi fowlers -control bp -quiet room -osmotic diuretics -hypertonic saline -corticosteroids -anticonvulsants -antihypertensives -analgesics -sedatives -surgery (mass removal, bone flap removal, burr holes, EVD)" "ICP nursing management - CORRECT ANSWER -don't cluster cares -neuro assessments -facilitate venous return to heart -neck positioning -I&Os -bowel care -reduce environmental stimuli -monitor fluid/lytes -reduce metabolic needs, cool them off" "things that increase ICP - CORRECT ANSWER -PEEP -agitation/stimulation -suctioning" "things that decrease ICP - CORRECT ANSWER -mannitol -hypothermia -quiet room -good body alignment/posturing -CSF draining" "decorticate posturing - CORRECT ANSWER characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex" "deceribrate posturing - CORRECT ANSWER WORSE!! arms and legs extended. ominous sign of cerebral hemispheric or brain stem injury" "ischemic stroke - CORRECT ANSWER a type of stroke that occurs when the flow of blood to the brain is blocked, by thrombus or embolus" "hemorrhagic stroke - CORRECT ANSWER occurs when a blood vessel in the brain leaks or ruptures aneurysm or vessel rupture or hypertensive crisis" "stroke interventions - CORRECT ANSWER -assess/monitor ABCs -call stroke team -monitor sats -obtain CT/MRI -position head in midline -elevate HOB 30 degrees if no symptoms of shock/injury -seizure precautions -anticipate thrombolytic therapy for ischemic stroke -keep NPO until swallow reflex is evaluated" "stroke s/s - CORRECT ANSWER -unilateral numbness, weakness, paralysis of face, arm, or leg -difficulty speaking or understanding others -blurred or decreased vision or sudden double vision -dizziness, loss of coordination -severe headache" "brain death - CORRECT ANSWER irreversible loss of all brain function" "seizing pts interventions - CORRECT ANSWER -airway -no tongue blades -bed flat remove objects -keep safe but do not restrain -suction and oxygen available -provide privacy -keep calm, observe type, duration and characteristics, time of onset, precipitating events" "amioadarone - CORRECT ANSWER antiarrhythmic v fib, vtach, a-fib, a-flutter monitor for hypotension in stable pt with pulse, give 150mg bolus over 10 minutes, then 1mg/min for 6 hours, then 0.5mg/min for 18 hours or until tolerating PO in unstable pulseless pts, give 300mg IV push, if unsuccessful then 150mg IV push" "failure to rescue - CORRECT ANSWER the inability to recognize a patient's negative change in status in a timely manner in order to prevent patient complications and to prevent major disability or death" "bedside handoff - CORRECT ANSWER -introduce yourself, update white board -safety check, look at room equipment, verify settings and orders, fall hazards, turn on bed alarm, make sure pt has call light -review vital sign trends, evaluate pain and last med given -review abnormal areas of assessment -review care goals for next shift with patient and family members -provide time when you will be back to see patient" "what to do when pt starts deteriorating - CORRECT ANSWER call when concerned. give providers a clear picture of what is going on. use communication tools to communicate your concern" "CUS - CORRECT ANSWER I am Concerned I am Uncomfortable This is a Safety issue" "pH - CORRECT ANSWER 7.35-7.45" "reading ABGs - CORRECT ANSWER 1. evaluate pH to identify acidosis or alkalosis 2. match CO2 or HCO3 with pH state using ROME to determine respiratory or metabolic 3. assess whether CO2 or HCO3 state is opposite of pH to determine if it is uncompensated, partially compensated, fully compensated, or corrected" "non-invasive ventilation - CORRECT ANSWER CPAP/BiPAP" "CPAP - CORRECT ANSWER continuous positive airway pressure; provides inspiratory pressure" "BiPAP - CORRECT ANSWER bilevel positive airway pressure; provides inspiratory and expiratory pressure" "intubation - CORRECT ANSWER insertion of ETT into trachea" "RSI - CORRECT ANSWER administration of induction agent and neuromuscular blockade agent simultaneously" "intubation kit medications - CORRECT ANSWER premeds - versed and fentanyl sedatives - propofol, etomidate, ketamine paralytics - succinylcholine, rocuronium pressor - phenylephrine" "intubation preparation - CORRECT ANSWER -notify RT and pharmacist -discuss need for intubation and obtain consent, ensure pt does not have DNI order. -evaluate whether pt has difficult airway -verify equipment and PPE -assure functioning IV access -position pt -ensure verbalization of procedural pause -preoxygenate" "RN role during intubation - CORRECT ANSWER monitor pt vital signs especially O2 sats, administer medications, monitor time of intubation attempts, suctioning as needed" "intubation process - CORRECT ANSWER -following sedation, bag mask ventilate the pt -physician visualize ETT passing through cords -anesthesia backup will be notified after 10 minutes or 2 attempts to secure the airway" "post intubation care - CORRECT ANSWER -portable chest x-ray, ABGs -obtain sedation and analgesia orders -hourly RASS observation -monitor for hemodynamic changes" "ventilator settings - CORRECT ANSWER FiO2 Tidal Volume Respiratory Rate PEEP Mode" "FiO2 - CORRECT ANSWER fraction of inspired oxygen; the concentration of oxygen in the air we breathe RA is 21%, maximum is 100% lung protection FiO2 goal: maintain SpO2 target with FiO2 <60%" "PEEP - CORRECT ANSWER positive end-expiratory pressure, provides positive pressure to airways during expiration and helps keep alveoli open common mechanical ventilator setting in which airway pressure is maintained above atmospheric pressure disadvantages: increased thoracic pressure decreases venous return to the heart. high levels can cause barotrauma, tension pneumo" "respiratory rate - CORRECT ANSWER minimum number of breaths per minute the vent will ensure your pt takes increase the rate to blow off CO2, decrease rate to retain" "tidal volume - CORRECT ANSWER amount of air that moves in and out of the lungs during a breath. calculated based on predicted body weight (height and gender) 6mL/kg is ideal" "spontaneous (CPAP) - CORRECT ANSWER used to strengthen respiratory muscles and evaluate readiness to extubate" "ASV - CORRECT ANSWER Adaptive support ventilation, adjusts ventilation breath by breath depending on pts lung mechanics. If pt does not initiate breath, vent will deliver pressure control breath. if pt does take a breath, ASV will give however much pressure support is needed to meet VT" "vent alarms - CORRECT ANSWER Happens when there is too much or too little pressure. Low pressure=vent came out, apnea, disconnection, cuff leak High pressure=pt coughs, mucous plug in the resp tract you as the nurse want to suction the pt Make sure you perform good oral hygiene to prevent VAP" "ETT suctioning - CORRECT ANSWER preoxygenate prior to each pass, use sterile catheter, wear PPE, watch for hemodynamic changes, assess lung sounds" "nursing care of intubated patient - CORRECT ANSWER -sedation vacation -oral cares q2h -GI prophylaxis -increase HOB -check placement of tube frequently -move oral tubes from one side of the mouth to the other" "ICU liberation bundle - CORRECT ANSWER Assess and manage pain - IV opioids Breathing/awakening trials - determine extubation readiness Choice of analgesia and sedation - sedate to RASS goal, treat pain prior to administering analgesia Delirium prevention - CAM screening, reorientation, avoid benzos Family engagement - family presence, involvement in making decisions Goals of care - honor pt wishes" "weaning criteria - CORRECT ANSWER FiO2 50% or less PEEP 10 or less LOC acceptable stable hemodynamics ABGs WDL" "primary pulmonary function review - CORRECT ANSWER exchange of gases between ambient air and the blood relatively dry alveoli and adequately perfused capillaries = healthy lungs overall goal is to exhale CO2 and ensure proper oxygenation" "ventilation - CORRECT ANSWER movement of air in and out of the lungs" "pneumonia - CORRECT ANSWER inflammation of the lungs due to presence of infection. alveoli fill with sludge, leading to poor ventilation and oxygenation" "types of pneumonia - CORRECT ANSWER -Community Acquired: onset in the community -Hospital Acquired: 48 hrs or longer after hospital admission -Ventilator associated: within 48-72 hrs of intubation -Aspiration: breathing in food or liquid" "pneumonia s/s - CORRECT ANSWER -cough, likely productive -fatigue -fever/chills -chest pain with respirations -SOB" "pneumonia treatment - CORRECT ANSWER -antibiotic therapy based on culprit organism (sputum sample) -respiratory cares (cough/deep breathe, incentive spirometry, mobilization) -respiratory assessments (lung sounds, pulse ox, how do they look) -symptom management (fever reducers, nebs, cough medicine, pain relief)" "does your pt need to be intubated? - CORRECT ANSWER clinical signs: tachypnea, accessory muscle use, anxiety, air hunger, inability to clear seretions, labored breathing labs: low PaO2, elevated or low CO2" "COPD - CORRECT ANSWER bronchitis and emphysema progressive disease, most commonly caused by cigarette smoke less air flows in and out of airways because: alveoli lose their elasticity, lining of airways becomes thick and inflamed, excess mucous is produced" "COPD exacerbation s/s - CORRECT ANSWER productive cough, SOB, wheezing, chest tightness tachypnea, dyspnea, orthopneic, barrel chest" "COPD exacerbation treatment - CORRECT ANSWER -bronchodilators (open airway) -steroids (decrease inflammation of airways) -antibiotics (if needed depending on cause of exacerbation) -CPAP or BiPAP (positive pressure ventilation)" "steroids nursing considerations - CORRECT ANSWER hyperglycemia, adrenal function, hypokalemia" "pneumothorax - CORRECT ANSWER accumulation of air in the pleural space can be caused by trauma, surgery, or idiopathic" "spontaneous pneumothorax - CORRECT ANSWER pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space" "tension pneumothorax - CORRECT ANSWER a type of pneumothorax in which air that enters the chest cavity is prevented from escaping" "hemothorax - CORRECT ANSWER blood in the pleural cavity" "pneumothorax s/s - CORRECT ANSWER -dyspnea -tachypnea -pleuritic chest pain -tachycardia -restlessness -decreased chest wall movement -progressive cyanosis -absent breath sounds unilaterally" "pneumothorax treatment - CORRECT ANSWER -supplemental O2 -evacuation of the air from the pleural space w/ large bore needle decompression -chest tube insertion 2nd intercostal space, mid-clavicular line. placed to chest drainage system that provides water-seal and suction" "ARDS treatment - CORRECT ANSWER -treat underlying cause -prevent progression of lung injury -promote gas exchange -high pressure ventilation (PEEP) -high level O2 therapy to keep PaO2 >60 -support tissue oxygenation -prevent complications" "ARDS management strategies - CORRECT ANSWER -low tidal volume ventilation -recruit PEEP -monitor plateau pressure -pulmonary vasodilatos -neuromuscular blockers -proning -ECMO" "low tidal volume ventilation - CORRECT ANSWER goal is <6mL/kg to prevent over distending alveoli. helps sustain surfactant production" "recruiting PEEP - CORRECT ANSWER keeps alveoli open, improving oxygenation using lower FiO2. this however can drop pt's BP due to decreased venous return and can also cause barotrauma" "plateau pressure - CORRECT ANSWER the pressure exerted on small airways and alveoli during mechanical ventilation. measures compliance of the entire lung. keep below 30 to prevent over distention of alveoli" "pulmonary vasodilators - CORRECT ANSWER specifically dilate pulmonary blood vessels ex: -epoprostenol (continuous infusion) -alprostadil (inhaled) -nitric oxide (inhaled)" "neuromuscular blockers - CORRECT ANSWER to paralyze our pt, which decreases O2 consumption" "proning - CORRECT ANSWER optimizes ventilation and perfusion to lungs. improves gas exchange, reduces pleural pressure, improves secretion removal. prone for 16hrs then supine for 8 risks: hemodynamic instability, skin breakdown, facial edema, emesis, unintentional extubation" "ECMO - CORRECT ANSWER extracorporeal membrane oxygenation. large-bore catheters are inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body" "peripheral nerve stimulator - CORRECT ANSWER a battery-operated device used to assess the level of neuromuscular blockade by causing muscle contractions" "neuromuscular blockade - CORRECT ANSWER acute muscle paralysis and apnea, reserved for pts with severe, refractory, or life threatening hypoxemia who are not responsive to other sedatives or analgesics classified as depolarizing or non-depolarizing goal is to deliver minimum amount of medication to achieve desired effect" "NMB agents indications - CORRECT ANSWER -facilitate short procedures -facilitate mechanical ventilation -reduce muscle oxygen consumption -prevent respiratory or other movements -treat increased muscle activity" "neuromuscular junction - CORRECT ANSWER point of contact between a motor neuron and a skeletal muscle cell -impulse travels down motor axon resulting in influx of calcium -calcium generates release of ACh -ACh crosses into synaptic cleft and binds to receptors -membrane permeability increases, allowing for exchange of Na and K -this initiates depolarization and an action potential, which produces muscle contraction" "NMB risks - CORRECT ANSWER -disconnection from ventilator -failure to cough -generalized deconditioning -skin breakdown -DVT -awake and paralyzed" "NMB nursing care - CORRECT ANSWER -alarms on -monitor ABG and pulse ox -hemodynamics -frequent skin care and assessment, turn and rub, specialty bed/mattress -monitor for physical signs of pain -analgesia and sedation -prophylactic eye care -VTW prophylaxis -TOF with assessments -explain all procedures to pt" "NMB reversal - CORRECT ANSWER used to decrease incidence of residual NMB to prevent awake paralyzed pt. administer acetylcholinesterase inhibitor and anticholinergic meds during reversal process." "neostigmine - CORRECT ANSWER most common NMB reversal agent, onset 5-10 mins, physician must be present. atropine is antidote, must have at bedside give with glycopyrrolate" "pyridostigmine - CORRECT ANSWER NMB reversal agent, onset 2-5 mins, give with glycopyrrolate" "sugammadex - CORRECT ANSWER NMB reversal agent of roc and vec" "preload - CORRECT ANSWER amount of fluid filling the heart, how wet or dry the pt is since veins hold venous blood returning to heart, dilation and constriction affect preload" "CVP - CORRECT ANSWER preload of right heart" "PAWP - CORRECT ANSWER preload of the left heart 6-12 is normal snapshot in time, not a continuous measurement. swan ganz is advanced and balloon is inflated and pressure is recorded. risk of rupturing vessels, minimize how often we measure this" "Frank-Starling Law - CORRECT ANSWER the greater the stretch, the stronger is the heart's contraction giving fluid increases preload, and therefore increases cardiac output however if you give too much fluid, you will stretch the heart too much and it won't be able to contract, which will decrease cardiac output" "how to fix preload - CORRECT ANSWER if preload is low, give crystalloids, colloids, or blood to increase volume if preload is high, give diuretics, vasodilators, or dialysis" "how to help right heart deliver to left - CORRECT ANSWER decrease right heart afterload - dilate pulmonary arteries" "afterload - CORRECT ANSWER the amount of resistance to ejection of blood from the ventricle, how dilated or clamped down the pt is" "high afterload treatment - CORRECT ANSWER treat cause decrease SVR with ACE inhibitors, ARBs, hydralazine decrease PVR with milrinone, isuprel, nitric oxide, sildenafil" "milrinone - CORRECT ANSWER pulmonary vasodilator, decreases PVR while increasing CO and contractility good for R side HF" "low afterload treatment - CORRECT ANSWER constrict arteries with dopamine, norepinephrine, phenylephrine" "SaO2 - CORRECT ANSWER oxygen saturation of hemoglobin in arterial blood, obtained through an ABG" "hypovolemic shock - CORRECT ANSWER shock resulting from blood or fluid loss. dehydrated, veins dilated, arteries clamped down. decreased CO because dry. preload will be low. SNS and RAAS are good because they help maintain perfusion of vital organs" "hypovolemic shock s/s - CORRECT ANSWER cool and clamped down, tachycardic, low UOP, thirsty, dry mucous membranes" "hypovolemic shock treatment - CORRECT ANSWER give fluid or blood, control any bleeding" "cardiogenic shock - CORRECT ANSWER shock caused by inadequate function of the heart, or pump failure. poor contractility. SNS and RAAS are bad because they will cause an increase in resistance and fluid retention, making the situation worse." "distributive shock s/s - CORRECT ANSWER flushed, peripherally dilated, tachycardic, concentrated urine, hypotensive, high temp" "distributive shock treatment - CORRECT ANSWER fill tank first by giving fluid, then clamp down with vasopressors, add inotrope if needed, treat infection if there is one" "distributive shock - CORRECT ANSWER A condition that occurs when there is widespread dilation. low BP, low afterload, low preload. SNS and RAAS are good but cannot vasoconstrict this includes septic shock" "cardiogenic shock s/s - CORRECT ANSWER cool and clamped down, mottled, crackles, peripheral edema" "cardiogenic shock treatment - CORRECT ANSWER block SNS and RAAS, decrease preload in L failure, decrease afterload by dilating arteries, increase contractility with inotropes" "sepsis - CORRECT ANSWER life threatening inflammatory response to infection which can lead to tissue damage, organ failure, and death" "sepsis risk factors - CORRECT ANSWER critically ill, very old and very young, infection, malignancy and cytotoxic drugs, invasive lines and procedures, chronic diseases, compromised immune status" "pathophys of sepsis - CORRECT ANSWER infection, sepsis, septic shock, ischemia, death" "gram negative - CORRECT ANSWER -worse prognosis -pseudomonas, klebsiella, hemophilus influenzae -higher mortality" "gram positive - CORRECT ANSWER -around 50% of infections -enterococci, strep pneumoniae, hemolytic streptococcus -frequently hospital acquired -lower mortality" "fungemia - CORRECT ANSWER fungal infection that spreads throughout the body by way of the bloodstream aspergillus, candida, histoplasmosis" "virema - CORRECT ANSWER viruses in the blood CMV, EBV, HSV, VZV" "hemodynamics of early sepsis - CORRECT ANSWER hyperdynamic state characterized by decreased PVR, vasodilation, decreased preload, decreased MAP, increased HR, decreased BP, elevated SvO2 because they are unable to utilize oxygen" "early sepsis s/s - CORRECT ANSWER high HR, fever, tachypnea, anaerobic metabolism so lactate is released" "hemodynamics of late sepsis - CORRECT ANSWER hypodynamic state, decreased cardiac output, hypoperfusion, myocardial depression, low preload, SvO2 drops as lactic acidosis increases and organs fail" "late sepsis s/s - CORRECT ANSWER temp <35, cold and clammy" "septic shock - CORRECT ANSWER sepsis induced hypotension persisting despite adequate fluid resuscitation require pressors to maintain MAP >65 lactate >4" "SOFA - CORRECT ANSWER Sequential Organ Failure Assessment mortality prediction score that is based on the degree of dysfunction of 6 organ systems" "qSOFA - CORRECT ANSWER quick sepsis related organ failure assessment for timeliness and ease of use. positive if they have 2 or more of these criteria: -resp rate >22 -altered mentation -systolic <100 if positive, draw lactate and contact primary service" "MODS - CORRECT ANSWER progressive dysfunction of two or more organ systems" "treatment of sepsis - CORRECT ANSWER sepsis bundles focused on early goal directed therapy. first 3 hours - CALF first 6 hours- PAL" "CALF - CORRECT ANSWER Cultures Antibiotics Lactate Fluid" "PAL - CORRECT ANSWER Pressors Assess volume status Lactate repeated" "Surviving sepsis campaign - CORRECT ANSWER -restore perfusion -antimicrobial therapy -source control -glycemic control" "restore perfusion - CORRECT ANSWER -increase preload w/ fluid boluses -optimize afterload after fluid resuscitation, use pressors -increase contractility using inotropes" "antimicrobial therapy - CORRECT ANSWER from onset of hypotension due to sepsis, every hour counts. antibiotics during first hour = 80% survival" "source control - CORRECT ANSWER goal for identification and control within 12 hours. debride wound or remove line" "glycemic control - CORRECT ANSWER glucose will be elevated from stress and pressors. utilize insulin infusions per area protocol" "Swan-Ganz catheter - CORRECT ANSWER a cardiac catheter with a balloon at the tip that is used to measure pulmonary arterial pressure; it is flow guided through a vein into the right side of the heart and then into the pulmonary artery inserted under sterile technique by provider. IJ, sublavian, or femoral" "pulmonary arterial pressure - CORRECT ANSWER 15-30/8-15"