Critical Care Cardiac/neuro

Front 1

what are some medical managements of angina?

Back 1

-increase coronary artery perfusion to myocardium
-prevent MI
-intervene in acute coronary syndromes

Front 2

when a pt goes into heart failure, what usually fails first?

Back 2

one chamber will fail first, then the other will follow. left side may go first and then right is next

Front 3

what type of chamber involvement do heart failure pts have?

Back 3

right and left ventricular failure

Front 4

if a pt is receiving too much beta blocker or calcium channel blocker, what can this cause?

Back 4

may put a pt into heart failure

Front 5

if a pt is on a heart medication, what is important to know if they are to start coming off of the med?

Back 5

wean the medication down. don't stop it abruptly

Front 6

what is systemic inflammation and what can it do to the heart?

Back 6

it is a form of sepsis where inflammatory mediators can depress cardiac function

Front 7

what are some precipitating causes of heart failure?

Back 7

-cessation of heart meds
-dysrhythmias
-systemic infection (sepsis)
-pulmonary embolism
-physical, environmental, and emotional stress

Front 8

what are left sided heart failure symptoms usually related to?

Back 8

associated with respiratory issues because the heart isn't able to pump the blood out as it should, therefore causing a back up of blood into the pulmonary vessels

Front 9

what is a hallmark sign of left sided heart failure?

Back 9

pink frothy sputum (blood tinged). backup of blood causes increased pressure in the capillaries, which eventually burst.

Front 10

what floor is CHF usually treated on? pulmonary edema?

Back 10

CHF is usually treated on the med-surg floor and pulmonary edema is usually treated on the ICU

Front 11

what is the mortality rate of someone who is in cardiogenic shock?

Back 11

90%

Front 12

why do most pts get tachypnic with heart failure?

Back 12

they are hypoxic and are trying to get in more oxygen

Front 13

if a pt has crackles and coughs and the crackles go away, what is the most likely cause of this?

Back 13

atelectasis

Front 14

if a pt has hypoxia, what happens to the pulmonary artery systolic pressure?

Back 14

it goes up (wedge pressure is increased)

Front 15

what is hemoptysis?

Back 15

blood tinged secretions

Front 16

what is paroxysmal nocturnal dyspnea?

Back 16

sudden onset of needing to cough or the feeling of choking

Front 17

what is the best way to establish a pt's overall fluid status?

Back 17

daily weights

Front 18

what are some causes for a pt to have mental changes?

Back 18

fluid overload (increased cranial pressure) or increased amounts of Na

Front 19

if a pt has right sided heart failure, what are some symptoms or other complications that can occur?

Back 19

-peripheral edema
-hepatomegaly
-splenomegaly
-hepatojugular reflux
-increased CVP
-JVD
-pulmonary HTN
-ascites

Front 20

with pulmonary HTN, the pressure in the vessels will be increased. Once the pressure increases to a certain point, what will happen?

Back 20

it will cause fluid to be pushed across the membranes and into the alveoli. As fluid accumulates in the alveoli, pulmonary edema will develop.

Front 21

in todays healthcare, right and left heart failure aren't hear of anymore. It is now called:

Back 21

biventricular heart failure

Front 22

what is the difference between systolic failure and diastolic failure?

Back 22

-systolic is a problem with afterload. The heart is having a difficult time getting the volume out of the ventricle. directly related to how vasoconstricted the pt is
-diastolic is a problem with preload. this is when the ventricles are having difficulty filling (stiff ventricle)

Front 23

what is backward failure?

Back 23

also known as diastolic failure. the blood isn't getting into the heart

Front 24

why do you not want to give a positive inotrope to a pt with systolic failure? what is a better choice for the pt?

Back 24

it can kill the pt when the ventricle is trying to contract harder. use a beta blocker or calcium channel blocker to decrease contractility

Front 25

if a pt has a dysrhythmia, what is the possible cause of it?

Back 25

fluid volume overload from electrolyte imbalances

Front 26

if a pt doesn't have reactive airway disease, what could it be?

Back 26

related to heart failure. diurese the pt and crackles should go away

Front 27

what are some symptoms of heart failure?

Back 27

shortness of breath (dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cardiac asthma), pulmonary edema

Front 28

what is one method of palliative care for a heart failure pt?

Back 28

give the pt morphine to help make them more comfortable

Front 29

aside from palliative care, what is another treatment for a heart failure pt?

Back 29

correct the problem if possible

Front 30

what should be done as soon as a patient is admitted into the hospital for a part of their plan of care?

Back 30

provide adequate nutrition. if they can't eat, try and get them on tube feeds

Front 31

what is important to try and do for the pt between every activity (including eating)?

Back 31

provide rest between each activity. this will help optimize cardiopulmonary function

Front 32

what are some important nursing managements that can be done with a pt in heart failure?

Back 32

-optimize cardiopulmonary function
-promote rest
-pharmacologic therapy
-nutrition
-skin integrity
-pt education

Front 33

how types of cardiomyopathy are there? what are they?

Back 33

3 types; hypertrophic, restrictive and dilated

Front 34

what is the most common cardiomyopathy?

Back 34

dilated cardiomyopathy, usually in pt's that have heart failure

Front 35

what is restrictive cardiomyopathy?

Back 35

causes scarring of the heart muscle and its capability of contracting like it should. this is different than athletes: athletes have hypertrophied hearts but chambers are getting bigger. pt's w/ restrictive cardiomyopathy have hypertrophied hearts, but chambers are getting smaller.

Front 36

what is dilated cardiomyopathy?

Back 36

all of the chambers are over dilated and aren't capable of getting the blood out like it should

Front 37

what are temporary pacemakers commonly used for?

Back 37

if patients have bradydysrhythmias or tachydysrhythmias. this will help speed up or slow down the HR

Front 38

bradydysrhythmias may include:

Back 38

-sinus bradycardia and sinus arrest
-sick sinus syndrome
-heart blocks

Front 39

tachydysrhythmias may include:

Back 39

-supraventricular
-ventricular

Front 40

if a pt is having bypass surgery, what is put into place for the surgery?

Back 40

pacing wires

Front 41

aside from bypass surgery, what is another reason for pacing wires to be put into place?

Back 41

electrophysiology studies (EPS)

Front 42

pacemakers are put into place like a standard central line. which chamber in the heart does it need to be in?

Back 42

right ventricle

Front 43

when does a pacemaker fire typically?

Back 43

on demand. if a pt has their own QRS, pacer won't fire, especially on the T-wave.

Front 44

what are the four routes for temporary pacemaker placement?

Back 44

-transcutaneous
-transthoracic
-epidural
-transvenous (endocardial)

Front 45

where is the transvenous pacemaker put in?

Back 45

through the superior vena cava into the right ventricle

Front 46

which pacemaker type is the safest for the patient?

Back 46

transvenous

Front 47

where is a transcutaneous pacemaker at?

Back 47

outside of the pt's body. do not hang from iv pole and wear rubber gloves!

Front 48

a pacemaker that is considered fixed is:

Back 48

asynchronous

Front 49

a pacemaker that is considered demand is:

Back 49

synchronous

Front 50

a pacemaker that is considered atrioventricular (AV) sequential is:

Back 50

dual chamber

Front 51

what are pacer spikes?

Back 51

when the pacemaker fires, it can be seen on the ekg strip, usually a different color than the regular spikes

Front 52

a pacemaker that fires on the p wave is considered:

Back 52

pacing for the atrium to preserve atrial kick

Front 53

a pacemaker that fires at the beginning of the QRS complex is:

Back 53

ventricular pacing

Front 54

a pacemaker that fires on the p wave and the beginning of the QRS complex is:

Back 54

atrial and ventricular pacing

Front 55

when a pt has an Implantable Cardioverter Defibrillator (ICD), how is this hooked up?

Back 55

put outside of the heart and hooked up to wires. It recognizes when a pt has a ventricular dysrhythmia and does something about it. ex. v-tach, defibrillator will shock the pt.

Front 56

what else can the ICD do aside from defib?

Back 56

it has a built-in pacemaker

Front 57

what is important for the family to know for a pt that has a severe heart condition?

Back 57

important for the family to learn CPR and become a part of some support groups

Front 58

what is the most common and 1st treatment to be done for heart pt's?

Back 58

angioplasty. if angio isn't available, use fibrinolytic medications

Front 59

how many cranial nerves are there and where are they located?

Back 59

12 cranial nerves, located in the brain and part of the peripheral nervous system

Front 60

nerves that are afferent (sensory fibers) are:

Back 60

going towards the brain

Front 61

nerves that are efferent (motor fibers) are:

Back 61

going away from the brain

Front 62

reflex does not involve:

Back 62

thinking

Front 63

what does a primitive reflex in babies look like?

Back 63

when you tickle the feet, the toes spread out. when you touch the face, the head will turn in that direction. anything opposite of these would be considered something wrong.

Front 64

should we have primitive reflexes all of our life?

Back 64

no. if we do, there is something wrong with our nervous system

Front 65

if there is an injury to the nervous system, what is something that you want to look for?

Back 65

recurring primitive reflexes

Front 66

if you ask a pt to grab your fingers, this is considered ______? asking them to let go or wave would be considered voluntary and takes what?

Back 66

primitive; this would indicate whether or not they have cognitive ability

Front 67

where are the ependymal cells located and what do they do?

Back 67

they line the ventricles of the brain and produce and release spinal fluid

Front 68

what is the purpose of cerbrospinal fluid (CSF)?

Back 68

to cushion the brain and transport glucose and oxygen throughout the brain

Front 69

the brain needs a continuous supply of what?

Back 69

oxygen and glucose

Front 70

what is the blood brain barrier and what does it do?

Back 70

the tight knit connections throughout the vessels in the brain that only lets lipid soluble items into the brain. this is a protective mechanism.

Front 71

what are the four things that the brain will allow to get in?

Back 71

water, glucose, oxygen, and lipid soluble items (medications)

Front 72

what is the one thing that is significant about astrocytes?

Back 72

they can form astrocytoma which is a glioblastoma multiform. This is an extremely agressive and fast growing tumor.

Front 73

why are glioblastomas considered so bad?

Back 73

they grow extremely quickly. tumors aren't usually detected until really large and it's too late. pt's that get them usually don't live longer than 9-12 months

Front 74

do primary brain tumors metastasize to other parts of the body?

Back 74

no, it's usually the other way around. other primary tumors (breast, liver, etc.) metastasize to the brain.

Front 75

within the skull, it doesn't matter if there is a tumor (benign or cancerous) or a bleed. what does matter is:

Back 75

the amount of pressure put on the brain from the tumor or bleed. this is what will cause complications

Front 76

what is the difference between myelinated and unmyelinated sheaths?

Back 76

myelinated sheaths will help with the speed of transmission for the information being sent back and forth

Front 77

if there is a synapse transmission problem, what kind of issue can this cause?

Back 77

it may cause issues with certain mediactions and how they are transferred across synapses.

Front 78

what is something that happens in guillen barre?

Back 78

it causes problems with the myelin sheaths that go to the peripheral muscles. This will usually go away.

Front 79

where does the central nervous system end?

Back 79

it goes down to the first synapse of the spinal cord

Front 80

what happens to the space between the brain and skull as we age? why would this be bad?

Back 80

the brain shrinks and the space increases. This can potentially be bad because if there is ever an injury, it is more open for accumulation of blood from a bleed.

Front 81

what is the space between the dura mater and skull, it sits just above the dura mater?

Back 81

epidural space

Front 82

where does the middle meningeal artery travel?

Back 82

in the epidural space

Front 83

what part of the brain are the cognitive skills located in?

Back 83

left side of the brain

Front 84

what lies between the dura mater and the arachnoid mater?

Back 84

the subdural space

Front 85

the network of vessels that are within the subdural space consist mainly of:

Back 85

a venous network

Front 86

if a bleed occurs within the subdural space, what type of bleed is it?

Back 86

this will typically be a venous bleed

Front 87

does it matter if a bleed is venous or arterial in the brain? why or why not?

Back 87

no, it only matters how fast the bleed is accumulating with the brain and what it is putting pressure on

Front 88

what is between the arachnoid space and pia mater?

Back 88

the subarachnoid space

Front 89

what is important about the subarachnoid space?

Back 89

within this space are the subarachnoid villi. these villi are important because they reabsorb CSF

Front 90

If a pt has a subarachnoid bleed, why is this significant?

Back 90

the bleed can get in the way of CSF reabsorption and cause the pt to develop hydrocephalus

Front 91

what does it mean if a pt has a low glucose in the CSF?

Back 91

there is most likely a bacterial infection in the meninges (meningitis). the reason there is a low amount of glucose is because the bacteria are feeding off of the glucose

Front 92

what is the most appropriate position for the intracranial pressure transducer?

Back 92

two finger widths above the ear

Front 93

what is the pool at the base of the brain called?

Back 93

cystern

Front 94

if there is an increase in intracranial pressure, where does the CSF get shunted to?

Back 94

the brain will shunt the CSF to the cystern

Front 95

how many ventricles are in the brain?

Back 95

four; lateral (2), third ventricle (1), fourth ventricle (1)

Front 96

what is an infection of the meninges called?

Back 96

meningitis

Front 97

what is an infection of the brain called?

Back 97

encephalitis

Front 98

what are the primary functions of the frontal lobe?

Back 98

-personality
-motor skills (voluntary movement and speech) Broca's area

Front 99

if a pt has an injury to the frontal lobe, what is one major characteristic that will be seen?

Back 99

speech problems

Front 100

what is the primary function of the parietal lobe?

Back 100

sensory stuff

Front 101

what is the primary function of the temporal lobe?

Back 101

-hearing
-smell
-short term memory

Front 102

what is anosmia?

Back 102

general loss of sense of smell

Front 103

what is the primary function of the occipital lobe?

Back 103

vision

Front 104

what is the limbic lobe?

Back 104

fibers in the deep part of the middle of the brain that deal with emotions and behaviors

Front 105

what is the amygdala responsible for?

Back 105

food gathering

Front 106

what is important about Wernicke's area?

Back 106

this area helps with speech understanding

Front 107

what is global dysphasia?

Back 107

when a person can't speak or understand something that being spoken to them.

Front 108

if a pt has global dysphasia, what is important about teaching them every day tasks?

Back 108

show/teach the pt how to do daily tasks one at a time. Also, it is important to teach them slowly so that they are able to understand clearly

Front 109

why is the basal ganglia important?

Back 109

it helps with allowing smooth coordinated movements

Front 110

where is the thermostat of the body located?

Back 110

hypothalamus

Front 111

if a patient has a neuro or central fever, what is the likely cause of this?

Back 111

their thermostat isn't working correctly. so, antipyretics won't work to bring the fever down. environmental things need to be used, such as a cooling blanket.

Front 112

aside from the thermostat, what else does the hypothalamus do?

Back 112

regulates food and water intake, regulates ADH from posterior pituitary, and ACTH from the anterior pituitary

Front 113

what are behavioral responses?

Back 113

responses to emotions

Front 114

what is proprioception?

Back 114

knowing where you are at in space

Front 115

what are the two components of consciousness?

Back 115

1. reticular activating system- being awake vs. being asleep
2. cerebral cortex- awareness

Front 116

what are the 2 primary arteries that carry blood to the brain?

Back 116

right and left carotids

Front 117

how many vertebral arteries are there that form the basilar arteries for the back 1/3 of the brain?

Back 117

two

Front 118

where is all of the blood flow ultimately connected within the brain?

Back 118

circle of willis (CoW)

Front 119

where do cerebral aneurysms typically occur?

Back 119

within the CoW

Front 120

what does the anterior circulation take care of?

Back 120

the top 2/3 of the brain

Front 121

what are the two veins that bring back to the heart from the brain?

Back 121

internal jugulars

Front 122

what is an important intervention for a pt that has a head injury with a bleed?

Back 122

keep their head midline. This will keep venous bloodflow coninuing and keep ICP from increasing

Front 123

what is posterior circulation responsible for?

Back 123

balance and vision

Front 124

what is the primary function of bones in the body?

Back 124

structure and support

Front 125

each spinal nerve _______ specific parts of the body?

Back 125

innervates

Front 126

if you know what dermatome is affected, what can this tell you?

Back 126

this will mostly tell you which spinal nerve is affected. Although, x-ray is needed for confirmation

Front 127

how many spinal nerves are there?

Back 127

31

Front 128

which nerve regulates the diaphragm?

Back 128

phrenic nerve

Front 129

why are dermatomes important?

Back 129

there are specific dermatomes for specific parts of the body. This will help tell where there might be injury occurring