Academicmaterials

A patient develops atrial fibrillation after abdominal surgery. Her blood pressure falls from 110/70 mm Hg to 92/68 mm Hg. The hypotension is related to which of the following? a. Decrease in ventricular contractility b. Hypovolemia c. Mural thrombi d. Decrease in ventricular filling - Correct answer: d Rationale: The contribution that atrial contraction makes to ventricular filling volume is approximately 15% to 30%. Atrial fibrillation results in quivering but not contracting atria. The...

One hemodynamic benefit of intra-aortic balloon therapy is: A) Balloon inflation prevents right to left shunt B) Balloon deflation increases coronary artery perfusion C) Balloon inflation optimizes aortic valve performance D) Balloon deflation decreases left ventricular afterload - D) Balloon deflation decreases left ventricular afterload Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors and antibiotic therapy? A) RAP 1, PAOP 4, SVR ...

How does COPD result in atrial fibrillation and predisposition to PEs? - COPD causes pulmonary hypertension, right ventricular hypertrophy, and right atrial enlargement. The right atrial enlargement causes stretching of the atrial tissue and frequently results in atrial dysrhythmias. SA blocks, second-degree AV block type I, and third-degree AV heart block at the level of the AV node would occur in _______________ occlusion - RCA (as seen in inferior wall MIs) There is (more/less) risk of b...

You have a pt you are admitting that suffered an assault from which an individual used a metal pipe. You assess your patient to have ecchymosis to his left flank. You determine that your pt most likely has which of the following? a) hypocalcemia b) a ruptured spleen c) hemorrhagic pancreatitis d)retroperitoneal bleeding - d) retroperitoneal bleeding --The flank ecchymosis is indicative of Grey Turner's sign in the setting of recent trauma, this may have lead to the retroperitoneal bleed...

Which of the following is considered to be an absolute contraindication for anticoagulation therapy in managing a VTE? A. Hypertensive patient B. Intracranial hemorrhage C. Postoperative patient D. Presence of epidural catheter - B Intracranial hemorrhage is an absolute contraindication to receiving anticoagulation or antithrombolytic therapy. Hypertension should be managed prior to initiation of anticoagulation therapy. Uncontrolled hypertension is a relative contraindication and can in...

Which clinical sign might patients with both systolic and diastolic heart failure have in common? a) Peripheral edema b) Enlarged heart size on chest radiograph c) Lung crackles d) Ejection fraction less than 40% - Answer: C Both a problem with ejection (systolic failure) and a problem with filling (diastolic failure) will increase left heart pressure and cause cardiogenic pulmonary edema (lung crackles). The remaining three choices are associated with systolic heart failure rather than d...

Aortic Regurg sx - -Head bobbing with pulse -wide pulse pressure > 40 -water hammer pulse Aortic regurgitation causes - -HTN rheumatic fever endocarditis marfan syndrome and VAD S3 heard sound - fluid overload s4 heart sound - artium contract into noncompliant ventricle LV failure. A split heart sound is heard best during ___ - inspiration Mitral Insufficiency is a ___ murmur located at the ____ ICS - systolic 5th A patient with mitral insufficiency is prone to which of the follo...

etiology of aneurysms - arteriosclerosis HTN smoking/obesity bacterial infections congenital defects Trauma Marfan's syndrome (connective tissue disorder) what other defect can cause systolic murmurs? - ventricular septal defect (heard on the left sternal border) relievers for Unstable angina? what do labs look like? ECG? - Nitroglycerin. Troponin negative. ST depression or T wave inversion. what does a decrease in systolic pressure mean if diastolic doesn't change? - This = narrowi...

Tx to decrease preload - -Diuretics -Dilators (nitrates, nitroprusside, morphine) Define preload - -Preload is the volume/pressure in the ventricle at the end of DIASTOLE after the AV valves close, just prior to ejection -As preload increases, SV and CO will increase up to a point -Too high of a preload may lead to heart failure -Preload will seldom be elevate if the heart is without disease and there are no metabolic abnormalities Cardiac output equation - CO = HR x SV Components of str...

IV Infiltration: Management - Prevention Early identification Stop the infusion Elevate warm or cool compress Monitor the site Unstageable pressure injury - Full-thickness tissue loss of unknown depth. The base of the wound is completely obscured by slough and eschar. Pressure Injury: Stage 3 - Full thickness skin loss Subcutaneous fat in wound bed No bone, tendon or muscle exposed The Skin - The largest organ system Comprises 10-15% of body weight receives 1/3 of circulating blood ...

Toddler w meningitis. Resistance when the lower legs are extended. She also cries when her legs are raised to change her diaper. Documents this as which of the following? a. Kernigs sign b. Brudinski sign c. Nuchal rigidity d. Battle sign - A. Kernig sign - back pain and resistance to lower leg extension is referred to as kernig sign. Brudinski's sign occurs when hips and knees flex in response to neck flexion. Nuchal rigidity is neck stiffness. Battle sign is basilar skull fracture. A...

Septic Shock Management Step Three - -Antibiotics (first 60 min) -Broad Spectrum antibiotics -Try to obtain culture first -Consider IM administration if hard to get IV access - Start with Gram Negative spectrum before Gram Positive Septic Shock Management Step One - - Recognition and Access: Diminished LOC, begin HFNC, if hypoxic intubate - Start IV access: peripheral or central What does SIRS stand for? - Systemic Inflammatory Response Syndrome Key characteristics of Endotheliopathy -...

What patients should not receive NS for fluid replacement? - Hypernatremic Renal failure (R/t risk of hyperchloremic acidosis) What are the goals of fluid resuscitation for patients in shock? - MAP >65 CVP ~6 mmHg Urine output 0.5 ml/kg/hr Hgb >7 Symptoms of hypovolemic shock - Decreased BP Decreased cardiac output Tachycardia Increased SVR What are the 3 stages of shock? - 1. Compensatory 2. Progressive 3. Refractory/Irreversible Compensatory stage of shock - Shock symptoms s...

Side effects of Positive Pressure ventilation - 1. Increased intrathoracic pressure leads to decreased venous return to the heart, decreasing stroke volume, and CO Two types of ventilators - 1. Negative pressure ventilators- i.e iron lung 2. Positive pressure ventilators: hospital bedside ventilators, use positive pressure to force air into the lungs by reversing normal breathing patterns. Stimulates both adrenergic and dopaminergic receptors, lower doses are mainly dopaminergic stimulatin...

benefits of IABP - increased coronary artery perfusion decreased O2 demand increased O2 supply decreased afterload Pt getting IABP. Hour after return from Cath lab, pt has had minimal UOP. What would be most appropriate action? A. get CXR to verify catheter placement B. give fluid bolus C. administer furosemide D. decreased frequency to 1:2 - A. get CXR to verify catheter placement Cardiogenic shock: A. BP 96/54, CI 1.8, PAP 54/26, PAOP 10 B. BP 84/52, CI 1.9, PAP 32/18, PAOP 12 C. ...

Vasopressin in esophageal varices - Reduces portal hypertension (ran at high doses of 0.4-1) -Watch with CAD patients!! What is the most common cause of acute hepatic failure? - DILI (drug-induced)- most commonly by acetaminophen Why would you watch for sepsis in a hepatic failure patient? - Bacteria can enter the blood stream from ascites/GI tract What is one of the key clinical differences between acute and chronic hepatic failure? - Acute there will not be portal hypertension Labs ind...

What value reflects right ventricular preload? - CVP or RA pressure In hypovolemic shock, does SVR increase or decrease? - increase CVP and PAOP are a measure of preload or after load? - preload Heart rate x stroke volume =? - cardiac output Stroke volume is dependent on what three concepts? - preload, contractility, and after load PAOP is a measure of which ventricle? - left SVR measures which ventricle? - left PVR measures which ventricle? - right PVR and SVR are a measure of preload o...

what are 3 treatments for DI? - 1) give ADH (pitressin, DDAVP), use cautiously in those with heart disease, may cause coronary artery ischemia 2) give fluids to replenish intravascular volume 3) monitor urinary output/specific gravity what is the pathophysiology of SIADH? (figure 10-1 pg 204) - too much ADH--> water retention--> decrease in serum Na+ (dilutional hyponatremia-CARDINAL SIGN); decreased urinary output; decreased osmolality (hypo-osmolality) measure of the number of par...

oculovestibular reflex assessment - the patient's eyes are held open while ice water is injected slowly into the ear canal and the eye response is observed (cold calorics) positive: eyes move toward the side of the ice water injection- positive is good) Wh brain herniation occurs when ____ - swelling within the brain becomes so severe that structures of the brain are squeezed to the point where blood cannot get up into the brain and death may occur at is the first sign of a neuro problem?...

Epithelial tissue - covers body surfae and lines cavities. Functions primarily as protection, secretion, absorption, excretion, filtration. All cells are exposed to the environment on one side and attached to a basement membrane on other. Proteins - monomeric unit is amino acid (peptide, polypeptide, protein). Functions- enzymes, antibodies, support, keratin, transport molecules, motion, hormones. Peptide bond. metabolism - all the chemical reactions that occur in cell. all biological must ...