Normal Central Venous Pressure (CVP) range
2-8 mmHg
Normal Pulmonary Artery Occlusion Pressure (PAOP) range
6-12 mmHg
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Normal Pulmonary Artery Systolic (PAS) range
20-30 mmHg
Normal Pulmonary Artery Diastolic (PAD) range
5-15 mmHg
Normal Pulmonary Artery Mean (PAM)
11-20 mmHg
Normal Systemic Vascular Resistance (SVR) range
800-1200 mmHg
Preload
volume left in the left ventricle at the end of diastole
What is preload affected by?
venous return to the heart, atrial kick, total volume, and ventricular compliance
What drugs can affect preload?
Furosemide and nitroglycerin
Afterload
Amount of pressure heart has to overcome to pump blood out
What drugs may affect afterload?
Vasoconstricters and vasodilators
Contractility
the contractile force of the heart, how much will it take to move the preload out against the afterload
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What is the appropriate hold time after pulling an arterial line?
5-10 min
What part of the heart does the PAOP affect?
Left ventricle
What part of the heart does the CVP affect?
Right ventricle
What does it mean when the PAOP is elevated?
Increased left ventricular end diastolic pressure that could be indicative of left ventricular dysfunction or failure
What does it mean if CVP is elevated?
Fluid overload or decreased compliance (such as with ARDS and COPD)
Difference between stable and unstable angina
Stable angina: pain happens with certain activities but then goes away with rest.
Unstable angina: chest pain can occur at rest, becomes more sever or frequent, or lasts longer
ECG changes with an acute MI?
ST elevation or depression
ECG changes with hyperkalemia
Peaked T waves
What conditions may cause elevated cardiac enzymes?
Trauma, acute MI, CABG, and pericarditis
What is the goal of treatment with cariogenic shock?
to increase cardiac output
What are the effects of nitroprusside (Nipride) and dobutamine (Dobutrex) on preload, afterload, and contractility?
They both increase cardiac output, heart rate, and contractility
Special precautions of Nipride
It can cause severe hypotension and cyanide toxicity
Where to listen to assess with a murmur associated with aortic stenosis
right upper sternal border
What is the most important thing to watch for when administering tPa?
mental status changes
Anti-clotting medications
Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), warfarin (Coumadin), heparin, apixaban (Eliquis), and enoxaparin (Lovenox)
Heart rate controlling medications
Beta blockers (-lol), calcium channel blockers (-ipine), Digoxin
Heart rhythm controlling medications
Na+ channel blockers (lidocaine) and K+ channel blockers (amiodarone)
R on T phenomenon
When pacing, a strong ventricular stimulus occurring on top of the T wave that can initiate a sustained ventricular tachyarrythmia
Normal PR interval
0.12-0.20 seconds
What can a long PR interval (>0.20 seconds) indicate?
1st degree heart block, hypokalemia, acute rheumatic fever, or carditis associated with Lyme disease
Normal QRS complex
0.12 seconds or less
What could a wide QRS complex (>0.12 seconds) indicate?
Right or left BBB, pacemaker, hyperkalemia, or ventricular pre-excitation associated with Wolf-Parkinson-White pattern
Normal QT interval
Less than or equal to 0.04 seconds
What could a long QT interval (>0.04 seconds) indicate?
Antibiotic use or hyperkalemia
What to watch out for with Dopamine administration in regards to skin
Reflex erythema, central blanching, and piloerection
Heparin antidote
protamine sulfate
Coumadin antidote
Vitamin K
Antidote for Coumadin
Vitamin K
ACLS drug and dose for symptomatic sinus bradycardia
Atropine 0.5 mg repeated up to a total dose of 3 mg
Signs and symptoms of digitalis toxicity
Loss of appetite, nausea, vomiting, diarrhea, tachycardia, and vision changes including blind spots, blurred vision, seeing spots, and changes in how colors look
Causes of low volume ventilator alarm
Tube disconnection
Causes of high pressure ventilator alarm
Biting on ETT, coughing, mucus plug, bronchospasm, mucus or water in the tube, or kinked tubing
How much is too much output in chest tube over one hour following surgery?
>150 mL
Appropriate pressure for suctioning is
120 mmHg
Causes of decreased breath sounds
Pneumonia, heart failure, pleural effusion, and increased chest wall thickness
Nursing action to check for proper ETT placement
Listen to bilateral breath sounds
Most common reason for development of PE following trauma with multiple long bone fractures
Fat emboli
What is the most important nursing action in relation to cervical spine injury?
Respiratory impairment is the most common complication of CSI, so need to protect airway, maintain adequate respirations, and keep spine straight
Earliest sign of increased ICP
Headache and vomiting
Drug frequently used to decrease ICP
Mannitol
How many hours can lapse between onset of stroke symptoms and administration of tPA?
Up to 4.5 hours
Most important part of neurological assessment
Evaluation of LOC
Signs of diabetes insipidus in a post operative craniotomy patient
Extreme thirst and urine output >1000 mL
What anti-seizure medication should never be mixed with D5W and why?
Dilantin because it causes crystallization
Signs and symptoms of DKA
Frequent urination, extreme thirst, elevated glucose, elevated urine ketones, nausea and/or vomiting, abdominal pain, confusion, and fruity-smelling breath
Signs and symptoms of hypoglycemia
Shakiness, dizziness, hunger, irritability, anxiety, and headache
Treatment for DKA
IV fluids and correction of potassium of [Show Less]
