(answered) Test 1 CCRN (Pass CCRN)
What is vasogenic cerebral edema?
Vasogenic cerebral edema is an increase in extracellular fluid caused by a breakdown
of the blood-brain barrier with the resultant increase in vascular permeability. This
cerebral edema begins locally and becomes more generalized. Common causes are
trauma (including surgical trauma), tumors, hemorrhage, and abscesses
What ventilator parameter indicates fluid volume excess?
An A:a gradient greater than 10 mm Hg is a reflection of a diffusion defect. Note that the
process of diffusion is between A (alveolus) and (a) arterial blood. An increase in
intraalveolar fluid dilutes and inactivates surfactant, causing alveolar collapse
(decreasing vital capacity) and decreases lung compliance. Peak inspiratory pressure
increases reflect a decrease in lung compliance
What does autonomy refer to?
The patient's right to make decisions for themselves
What does beneficence mean?
Obligation to do good
What does nonmaleficence mean?
Obligation to do no harm
What does fidelity mean?
the obligation to abide by agreements and responsibilities
What does veracity mean?
The obligation to tell the truth
What are Diagnosis-Related groups?
DRGs constitute a prospective payment program for Medicare patients. Payment is
based on primary and secondary diagnosis, primary and secondary procedures, age,
and length of hospitalization
BNP is secreted in response to?
Ventricular wall stretch
What are omnious signs in a patient with status asthmaticus?
A normalization or increase in the PaCO2. This patient is still tachypneic, and if
ventilation is normal, PaCO2 should be decreased. The other ominous sign in this
patient would be absence of wheezing or rhonchi, because they would indicate that
ventilation is insufficient to cause these noises.
What problems arise from losses from the GI tract?
Any loss results in hypokalemia. Vomiting results in loss of acidic contents, whereas
losses below the pylorus result is alkalitic losses leading to metabolic acidosis. Fluid is
sequestered in the intestine leading to hypovolemia, which could cause hypovolemic
shock.
Actual problems are worse than potential problems!!
...
How can you differentiate the cause of jaundice?
An increase in direct bilirubin is associated with biliary obstruction because direct
bilirubin is conjugated. An increase in indirect bilirubin is associated with hepatic
disease or excessive hemolysis because indirect bilirubin is unconjugated
, What antihypertensive meds work best in African american patients?
African-Americans do not respond well to angiotensin-converting enzyme inhibitors
(e.g., captopril [Capoten]), but they do respond well to an angiotensin II blocker
(valsartan [Diovan]). Of the beta-blockers, labetalol works best. Of the calcium channel
blockers, diltiazem works best
What lab values define acute respiratory failure?
50-50!
PaO2<50 and/or PaCO2>50
Hyperkalemia can cause what?
Diarrhea-increases gastric motility
Flaccid paralysis- partially depolarizes muscle cells, prevents further depolarization
Every 1 inch increase in abdominal girth equates to how much blood accumulation in
the abdomen
500-1000mL
What pacing method would be used in a patient in atrial fib?
VVI- you don't want to sense or pace the atria.
1st letter-paced chamber
2nd letter-chamber sensed
What is the difference between an anaphylactic and anaphylactoid reaction?
Anaphylactoid reaction is clinically indistinguishable from anaphylactic reaction but does
not require previous exposure to the antigen. Anaphylactoid reaction is not IgE
mediated, and direct activation and degranulation of mast cells are thought to be
triggered by the complement system. Anaphylactic reaction requires previous exposure
to the antigen and is IgE mediated
Mitral stenosis is associated with what?
Pinkish discoloration of the cheeks. It is a diastolic murmur
What murmur is associated with widened pulse pressure?
Aortic regurg
What murmur is associated with narrowed pulse pressure?
Mitral regurg
What lead changes are associated with left ventricle hyperthrophy?
Strain pattern in V5 and V6 (asymmetric T wave inversion)
When the depth of the S wave in lead V1 or V2 plus the height of the R wave in lead V5
or V6 is 35 mm or greater, this constitutes voltage
What lead changes are associated with right ventricle hypertrophy?
strain pattern in V1 and V2. Prominent R wave in V1 reverse progression of the R wave
across the precordium.
What organ system is the most common to fail in severe sepsis?
Hematologic- coagulopathies are common in severe sepsis
What are the early signs of hypoglycemia?
The early signs of hypoglycemia are mediated by the sympathetic nervous system,
which acts to mobilize glucose stores (tachycardia, tachypnea, diaphoresis). Later signs
of hypoglycemia are related to low glucose levels in the brain (neuroglycopenia)
**Early signs can be masked in pts taking beta-blockers
What is vasogenic cerebral edema?
Vasogenic cerebral edema is an increase in extracellular fluid caused by a breakdown
of the blood-brain barrier with the resultant increase in vascular permeability. This
cerebral edema begins locally and becomes more generalized. Common causes are
trauma (including surgical trauma), tumors, hemorrhage, and abscesses
What ventilator parameter indicates fluid volume excess?
An A:a gradient greater than 10 mm Hg is a reflection of a diffusion defect. Note that the
process of diffusion is between A (alveolus) and (a) arterial blood. An increase in
intraalveolar fluid dilutes and inactivates surfactant, causing alveolar collapse
(decreasing vital capacity) and decreases lung compliance. Peak inspiratory pressure
increases reflect a decrease in lung compliance
What does autonomy refer to?
The patient's right to make decisions for themselves
What does beneficence mean?
Obligation to do good
What does nonmaleficence mean?
Obligation to do no harm
What does fidelity mean?
the obligation to abide by agreements and responsibilities
What does veracity mean?
The obligation to tell the truth
What are Diagnosis-Related groups?
DRGs constitute a prospective payment program for Medicare patients. Payment is
based on primary and secondary diagnosis, primary and secondary procedures, age,
and length of hospitalization
BNP is secreted in response to?
Ventricular wall stretch
What are omnious signs in a patient with status asthmaticus?
A normalization or increase in the PaCO2. This patient is still tachypneic, and if
ventilation is normal, PaCO2 should be decreased. The other ominous sign in this
patient would be absence of wheezing or rhonchi, because they would indicate that
ventilation is insufficient to cause these noises.
What problems arise from losses from the GI tract?
Any loss results in hypokalemia. Vomiting results in loss of acidic contents, whereas
losses below the pylorus result is alkalitic losses leading to metabolic acidosis. Fluid is
sequestered in the intestine leading to hypovolemia, which could cause hypovolemic
shock.
Actual problems are worse than potential problems!!
...
How can you differentiate the cause of jaundice?
An increase in direct bilirubin is associated with biliary obstruction because direct
bilirubin is conjugated. An increase in indirect bilirubin is associated with hepatic
disease or excessive hemolysis because indirect bilirubin is unconjugated
, What antihypertensive meds work best in African american patients?
African-Americans do not respond well to angiotensin-converting enzyme inhibitors
(e.g., captopril [Capoten]), but they do respond well to an angiotensin II blocker
(valsartan [Diovan]). Of the beta-blockers, labetalol works best. Of the calcium channel
blockers, diltiazem works best
What lab values define acute respiratory failure?
50-50!
PaO2<50 and/or PaCO2>50
Hyperkalemia can cause what?
Diarrhea-increases gastric motility
Flaccid paralysis- partially depolarizes muscle cells, prevents further depolarization
Every 1 inch increase in abdominal girth equates to how much blood accumulation in
the abdomen
500-1000mL
What pacing method would be used in a patient in atrial fib?
VVI- you don't want to sense or pace the atria.
1st letter-paced chamber
2nd letter-chamber sensed
What is the difference between an anaphylactic and anaphylactoid reaction?
Anaphylactoid reaction is clinically indistinguishable from anaphylactic reaction but does
not require previous exposure to the antigen. Anaphylactoid reaction is not IgE
mediated, and direct activation and degranulation of mast cells are thought to be
triggered by the complement system. Anaphylactic reaction requires previous exposure
to the antigen and is IgE mediated
Mitral stenosis is associated with what?
Pinkish discoloration of the cheeks. It is a diastolic murmur
What murmur is associated with widened pulse pressure?
Aortic regurg
What murmur is associated with narrowed pulse pressure?
Mitral regurg
What lead changes are associated with left ventricle hyperthrophy?
Strain pattern in V5 and V6 (asymmetric T wave inversion)
When the depth of the S wave in lead V1 or V2 plus the height of the R wave in lead V5
or V6 is 35 mm or greater, this constitutes voltage
What lead changes are associated with right ventricle hypertrophy?
strain pattern in V1 and V2. Prominent R wave in V1 reverse progression of the R wave
across the precordium.
What organ system is the most common to fail in severe sepsis?
Hematologic- coagulopathies are common in severe sepsis
What are the early signs of hypoglycemia?
The early signs of hypoglycemia are mediated by the sympathetic nervous system,
which acts to mobilize glucose stores (tachycardia, tachypnea, diaphoresis). Later signs
of hypoglycemia are related to low glucose levels in the brain (neuroglycopenia)
**Early signs can be masked in pts taking beta-blockers
