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166 Cards in this Set
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Beta 1
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increases HR and contractility
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Beta 2
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causes lung vasodilation
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Med used to treat refractory vasodilatory shock; acts on B! and B2 receptors
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vasopressin
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actually an anti-diuretic
no titration on or off |
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Body's response to Beta 1
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increase HR and contractility
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body's response to stimiulation of alpha 1 receptor
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vasoconstriction
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Inhibits platelet aggregation class of drugs
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Glycoprotein 2b/3a
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makes platelets slippery
po version- plavix IV version- Integrelin |
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Dopamine works as an inotrope at this dose
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5-10 mcg/kg/min
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2-5 mcg--renal
has to be fluid volume based |
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this class of drugs are used to slow down cardiac conduction
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BB, CCB, Antiarrhythmics
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arterial vasoconstrictor; acts only on alpha receptors and started at 20mcg/min
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neosynephrine
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can titrate up to 300 mcg/min
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potent arterial and venous vasodilator
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nitroprusside
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instant no matter what dose
only on for up to 48 hours never hang without an a-line |
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class of drugs that relaxes vascular smooth muscle and is effective in the treatment of hypertension
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vasodilator
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receptor found in vasculature
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Alpha 1
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bronchodilate and vasoconstrict
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this drug stimulates beta receptors 50% and alpha 50%
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epi
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up to 150 is vasodilator, greater than 150 becomes arterial
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Nitro
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This class of drugs increase MAP, SVR, and BP
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vasopressor
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monitor what closely with IV diltiiazem
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hypotension
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use this with caution in pts with asthma and COPD
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non-selective BB
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works on beta 1 and 2
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selective beta blocker
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metoprolol
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non-selective
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lebatalol
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This class of drugs helps heart beat stronger and more effectively. acts on beta 1 receptors
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inotrope
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positive inotrope
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stimulates beta
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dobutamine
dopamine 5-10 milranone levo |
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negative inotropes
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slows down beta
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CCB, BB, antiarrhythmics
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what do you need to give with esmolol
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lost of volume
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what is the 2nd stage of MI
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myocardial infarction
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faint but immediately audible
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grade 2
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most common complication of MI
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dysrhythmia
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2 factors that make up CO?
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HR x SV
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physiology of s1 sound
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closing of AV valve
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Right side of heart
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Inferior wall
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hyper-acute
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ST elevation
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this heart sound is always pathalogical
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?
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what do you do for failure to capture
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turn up voltage
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20% od CO is generated here
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atrial kick
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ECG finding that is most conclusive of old MI
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30% Q wave
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what drug should you test for cyanide toxicity that is a vasodilator
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nitroprusside
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non-invasive emergency temporary pacing for complete Heart block
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transcutaneous pacing
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most accurate test for NSTEMI
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troponins
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>0.04?
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if Nitro is given at > 120 mcg/min, what should you look for
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hypotension
chest pain becomes an arterial vasodilator |
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if dopamine is given over 10 mcg, what does it become
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vasopressor
works on alpha 1 |
5-10 is inotrope
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What are the vasopressors
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Levo
neosynephrine dopamine 5-10 Epi |
increase SVR, BP, and MAP
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If giving a Beta 2 for pulmonary vasodilation (beta blocker), what should you watch for
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if they have COPD or Asthma, watch for bronchospasm
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What BB should you not give to COPD or Asthma
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(non-selective)-Esmolol
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Metoprolol is selective to Beta 1
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What does Levo do?
What receptor does it act on? What is the dose range? |
vasoconstricts
acts on alpha 1 2-30 mcg/min |
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what med is a potent arterial and vaso dilator
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Nitroprusside/ Nipride
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never hang without an a-line
short-term (no longer than 48 hrs) cyanide toxicity causes shunting |
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name 2 vasodilators
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nitro and nipride
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why give vasopressin
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ADH
given in addition to to pressors to increase circulatng volume |
don't titrate...on/off
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What are you at risk for with epi
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tachycardia
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beta 50% alpha 50%
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what do negative inotropes do
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slow conduction
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BB, CCB, antiarrhythmics
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2 anti-platelet aggregates
glycoprotein 2b/3a Dosages |
IV Integrelin (1-2 mcg/kg/min)
PO Plavix (6 mos to 1 year) |
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what is neosynephrine
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arterial vasoconstrictor
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acts on alpha 1
started at 20 up to 300 mcg/min |
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NS should inintially be primed under this type of pressure in presssure tuning
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none/gravity
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this is done to routinely verify accuracy of the waveform
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square test
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nursing action that clears transducer of atmospheric pressure
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zeroing
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mechanical impulse that translates to electrical signal
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transducer
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if low SVR, low preload, and high CO, what does this indicate
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Septic shock
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only one with decreaed SVR because body has vasodilation
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When is preload hight
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cardiogenic shock
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what type of shock presents with increased SVR, low CO
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hypovolemic shock
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increased preload, decreased CO, and increased SVR is this shock
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cardiogenic
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most appropriate tx for PAWP of 17
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vasodilate or diurese
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3 types of distributive shock
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septic, anaphalyctic, neurogenic
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most deadly threat of pulmonary artery catheter?
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PA infarct, rupture
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When wedging, what does a long curve mean?
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low C.O.
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this waveform would be the correct waveform to pull back a swan in the event that it has migrated
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RA wave
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continuous CO monitoring also continuously monitors this
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SVO2
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the process for wave and number selection in CO monitoring?
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average of 3 waves within 10%
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Measurement of L sided preload?
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PAWP and PAD
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PAWP-not reflective of pulmonary HTN
PAD-only in absence of lung disease |
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If fluid resuscitated, what to do for afterload?
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vasodilate
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inotrope will only affect contractility if volume status is normal. What if dry?
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HR will go up
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what are inotropes titrated to
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cardiac index
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R sided preload is made up of this?
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CVP
RAP |
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L side preload is made up of this?
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PAD
PAWP |
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What are vasodilators and pressors titrated to?
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MAP
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Equivalent to end diastolic volume?
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Preload
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Afterload is made up of this?
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SVR
PVR MAP |
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Normal range for SVO2
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60-80%
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INterventions to increase contractility?
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inotropes
Dopamine 5-10 Dobutamine |
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Primary treatment for RAP/CVP of 2?
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fluid
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Normal PAP?
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25-15/15-8
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this hemodynamic value is the force the ventricles must pump against
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afterload
made of SVR and PVR |
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During DKA, the infusion continues until this occurs?
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AG closes
<12 |
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hypotension, hypothermia, lethargy, RR of 5 are s/s of this life-threatening disease?
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myxedema coma
resp and metabolic acidosis |
profound hypothyroid; always on synthroid because they prob had a thyroidectomy and forgot to take
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Calculate AG from these values?
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Na- (Cl + CO2)
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the difference of positives and negatives
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DI causes this electrolyte disorder
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hypernatremia
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profound ADH--lose tons of volume
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do this with caution when treating HHS
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administration of NS; if osmolality in periphery in increased too fast, the fluid follows Na and results in cerebral eddema
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bolus 2L, then gtt @ 100-200 mg/hr
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s/s: thirst, nausea, polyuria, glucose 654, potassium 6.3?
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DKA
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Anion gap > 12 differentiates hyperglycemia from DKA
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s/s: hot, dry, lethargic, increased Na, increased osmolality, and hyperglycemia, no sweet breath?
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HHS
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What to give in critical care situation for adrenal insufficiency?
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hydrocortisone
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this allows cortical and catecholamines to work which will allow pressors to work
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if you give cosytropin to stimulate cortisone and there is no increase, this means?
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adrenal insufficiency
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This is referred to as a Stem test
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Stem Test?
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if not acidotic and pressors arent working
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you have adrenal insufficiency and need to give cosytropin
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polydipsia and excretion of large amount of dilute urine in absence of hyperglycemia, you have this endocrine disorder?
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DI
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DI--lack of ADH so serum osmolality is increassed, urine osmolality is decreased, and glucose is not elevated
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What does a serum osmolality of .350 mean?
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dehydration; anything over 250 is considered dehydration
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osmolality should be Na x 2
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Difference of type 1 and type 2 diabetes
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type 1--no insulin
type 2--resistant to insulin |
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Ketones in urine indicate this?
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DKA
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post-op thyroidectomy is at risk for this imbalance?
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hypocalcemia
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monitor this closely with DKA IV insulin therapy
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potassium
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a patient treated for DKA drops glucose from 800 to 500, K is 3.5, and Na is 147. AG is 16. WHat now?
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IV insulin gtt
K replace and D5 0.45 NS |
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increased ADH and decreased serum osmolality disorder
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SIADH
more water than sodium |
if awake-give Na tab
fluid resuscitate hypertonic fluid |
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these IV meds are effective in lowering potassium?
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insulin and dextrose
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give calcium gluconate to protect heart from K;
Kayelelate not IV given and is long-term |
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water in the absence of edema and accompanied with hyponatremia is indicative of this disorder?
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SIADH
tons of weight gain but no edema |
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dehydration, met acidosis, cardiac dysrhythmias and heart failure all describe this disorder?
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Thyroid Storm
hyperthyroidism |
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MUDPILES
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M-methanol (grain alcohol)
U-uremia D-DKA P-paraldahyde I-INH, isopropyl alcohol L-lactate E-ethylene glycol (anti-freeze) S-ASA |
all of these cause extra acid and eventually DKA
so...if metabolic acidosis and AG> 12, then DKA |
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this occurs when renal blood flow is constant despite change in MAP
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intra-renal autoregulation
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average amount of urine produced in a 24 hour period
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800 mL
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if increased myoglobin, what condition
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rhabdomylisis
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movement of substances out of the blood into infiltrate
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glomerular filtration
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2 assessments are key to monitor pt in ARF and CRF
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I and O
daily weights |
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this fluid compartment contains plasma and holds 33% of total body water
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extracellular
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this structure releases urine
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collecting tubule
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theses tiny blood vessels deliver blood to the glomeruli. they constrict and dilate to control intra renal BP
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Afferent
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in anuric phase of RF, the elevation of these electrolytes need to be closely monitored
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potassium and phosphorus
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mechanical obstruction can cause this type of renal failure
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post-renal
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these renal protective enzymes dilate the afferent arterioles during ischemic insult and has no systemic effect
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prostoglandins
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ventricular force that help maintain GFR by creating this type of pressure
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hydrostatic
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this value is recognized as normal GFR
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125 ml/min or
180 L/day |
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dilation and constriction of the afferent and efferent arterioles help to maintain this nephron function
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GFR
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this phase has lots of urine output
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diuretic
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this reflection of GFR is the most accurate indicator of renal failure
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creatinine
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this is produced in the kidney to stimulat4 an increase in hematocrit
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erythropoietin
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these electrolytes are key in electrical conduction and acid base balance
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potassium and sodium
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the are the tuft of capillaries that sit within the Bowman's capsule
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glomerulus
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the most common type intra-renal ARF/AKI
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ATN
acute tubular necrosis |
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what are you at risk for if you pee in the lake
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post-renal failure
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a patient with DCHF is at risk for this type of failure
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pre-renal
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functional unit of the kidney
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nephron
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reason for acute mental status change during ARF
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Uremia
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these are the clinical phases for ARF/AKI
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1-initial
2-oliguria/anuria 3-diuresis 4-recovery |
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What are the vent settings in ARDS?
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PCV, IR, APRV
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order of sepsis continum
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SIRS, sepsis, severe sepsis, septic shock, mods
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in EGDT for sepsis, theses are the standards for hemodynamic monitoring
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CVP 8-12
MAP > 65 SVO2 >70% UO > 0.5 ml/kg/hr |
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selective pulmonary vasodilator for ARDS?
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Nitric Oxide, Flowvan
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Drug for Hepatic Encepalopathy
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Lactulose
clears ammonia to gut to shit out |
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this lab value used to triage the severity of illness in a pt on sepsis continum?
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lactate (normal 1-2)
if > 4 ...bad news bears |
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Criteria for SIRS
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HR > 90
RR > 20 Temp > 30 or < 36 WBC > 12000 or < 4000 |
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determine celcius
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(celcius x 1.8) + 32
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2 drugs useful for UGI bleed
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PPI
Octreotide |
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value defining intra-abdominal HTN
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> 25 mmHg
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Intra-abdominal compartment >40
normal 0-5 mmHg |
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what enzymes are elevated in pancreatitis?
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Lipase (long-lasting)
Amalyse (short-acting |
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normal amylase
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60-160
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normal lipase
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< 160
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ALT
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10-35
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AST
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<35
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albumin
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3.5 - 5
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bilirubin total
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0.3 -1
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bilirubin-direct
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0.1 -0.3
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protein
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6 - 8.4
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DIC
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thrombosis and hemorrhage
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definition of ITP?
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platelets - 20,000
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type of blood in acute UGI bleed
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bright red
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if perforated ulcer
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coffee ground emesis, slow bleed
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4 most abnormal values seen in liver failure
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AST, ALT, Bilirubin, Amonia, Coags, Albumin
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Ammonia
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15-45
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Sepsis
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SIRS plus 1 infection
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ARDS ensues as a result of this
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exaggerated inflammation response
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presents with new LLL Pneumonia; Labs are:
HR 98 BP 100/60 SPO2 90% Temp 102 What labs should be drawn? |
lactate
Pan cultures (UA, blood, foley, lines, etc.) ABG CBC Coags CMP-metabolic panel |
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severe sepsis and hypoperfusion despite fluid resuscitation
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septic shock
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Labs indicating HIT
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Platelets < 50% before heparin started
platelets < 100,000 |
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Assessment findings in abdomen?
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GreyTurner
Cullen's |
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a PaO2/FiO2 ratio of < 200 and pulmonary edema from ards is not what?
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cardiogenic
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this drug for septic shock because of anti-inflammatory?
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hydrocortisone
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A platelet count of < 50,000 would cause theses 2 assessment findings on inspection?
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petechiae
purpura (lesion like) |
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most difinitive in defining septic shock
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SVR (normal 800-1200)
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2 week old bowel resection in septic shock. What needs to be done within the first hour?
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isotonic fluids
antibiotics levo and dopamine dobutamine if Hct < 30...transfuse |
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Med treatment for DIC
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cryoprecipitate
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EGDT therapy for sepsis is second action for increasing circulating volume
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#1--fluids
#2--pressors (levo and dopamine) |
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what is auto-digestion
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acute pancreatitis--result of prematurely activated digestive enzymes
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What labs to use for thrombocytopenia?
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decreased platelets
coags normal normal PT/PTT (because clotting cascade is normal) prolonged bleeding time |
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