CCRN - CCRN Exam Notes. Questions with Answers. Complete A+ Solutions Guide.
CCRN Exam Notes
Which of the following does not predispose the patient to
... [Show More] digitalis toxicity? Hyponatremia.
Remember that potassium, calcium, and magnesium affect cardiac contractility,
Which single lead is the most valuable for the diagnosis of ventricular tachycardia? V1
Cardio
Sites of MIs
Inferior MI - Right Coronary (RC), associated with papillary
muscle ruputure
Indicative Changes: II, III, aVF Reciprocal Changes: I, AVL
Anterior MI - Left Anterior Descending (LAD), associated with
ventricular septal ruputure (holosystic murmur)
Indicative Changes: V2, V3, V4 Reciprocal Changes: II, III, AVF
Septal Wall - Left Anterior Descending (LAD) Indicative Changes: V1 , sometimes V2 Reciprocal Changes: V5, V6
Lateral MI - Circumflex Artery Indicative Changes: I, AVL, V5, V6 Reciprocal Changes: II, III, AVF
Posterior Wall MI - Right coronary, if dominant Indicative Changes: V7, V8, V9
Reciprocal Changes: V1, V2, V3
**Remember posterior Wall MI has leads that are high numbers, post means after so associate these two
● murmur is loudest at the apex, and the clinical presentation is related to acute pulmonary edema.
Cardiac Values
Swanz gaz – measures pressure , cardiac output , and oxygen
PAOP 6-12mmHg (left atrial pressures =
end-diastolic pressure)(aka left
ventricular preload) PAWP (pulmonary artery wedge pressure) 4-12mmHG (in the pulmonary artery), inflate for 3-5 seconds and will have direct measurement of from back pressure.
PAOP or PAWP <4 = hypovolemic patient PAOP or PAWP >4 = hypervolemic patient
The PAd is normally 2 to 5 mm Hg higher than the PAOP. PAd may be more than 5 mm Hg higher than the PAOP in patients with pulmonary hypertension. If the PAOP is higher than the PAd, suspect that there is an occlusion in the catheter or that the catheter is not in the correct area of the pulmonary vasculature. The RAP is normally lower than the PAOP.
RAP/CVP 2-6mmHg or 1-8( right atrium pressure)
Optimal in Critical Care Can be up to 10mmHg
PAP (pulmonary artery pressure) – could be systolic and diastolic PAP systolic – 15-26 mmhG
PAD diastolic 5-15 mmHG
Cardiac tamponade would cause an increase in RAP, PAP, and PAOP.
SV02 –mixed venous saturation of oxygen.normal 60-80% It is basically the percentage of oxygen remaining in the venous blood returning to the right side of the heart. This is the oxygen left over in the blood after supplying all the parts of the body except the head.
Systolic – squeeze
Diastolic – relaxation and filing
CO 4-8 L/min
CI 2.5-4.3 L/min/m²
Stroke Volume 60-100 mL/beat Stroke Volume Index 35-60mL/m² Stroke Volume Variation 10-15%
SVmax-SVmin/SVmean x 100
LV Stroke Work Index 50-62gm-m/m²/beat
RV Stroke Work Index 5-10gm-m/m²/beat PVR (RV) <250 dynes/sec/cm⁻⁵
80 x (MPAP - PAOP)/CO
PVRI 255-285 dynes/sec⁻⁵/m² SVR (LV) 800-1200 dynes
80 x (MAP - RAP)/CO
SVRI 1970-3900 dynes/sec/cm⁻⁵/m²
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