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Who set the critical care competency criteria?
AACN
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What 2 heart sounds are heard in heart failure?
S3 & S4
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Describe S3
- Lubb-dubba
- Ken-Tuk-Y
- Heard after S2
- Overfilled heart
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Describe S4
- Heard before S1
- Tee-Lubb-Dubb
- Te-ne-see
- Force atrial contractions, too much volume
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Describe CAD
- Progressive narrowing of 1+ Coronary arteries by plaque
- Inflammatory Process from endothelial injury
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Toponin
Means_____
Normal Level
Onset
Peak
- Cardiac specific
- < 0.5
- Several hours
- 2 weeks
-
Myoglobin
Means _______
Normal levels
Onset
- Muscle dying, non-specific
- < 100
- Onset before all others
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Normal CSF secretion rate
- 400 mL/day
- or
- 18-24 mL/hour
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What happens if MAP gets to low?
Ischemia - infarction if not corrected
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How to calculate CPP
CPP= MAP-ICP
-
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Brain needs glucose
< _____= confusion
< _____ = coma
- < 70 for confusion
- < 20 for coma
-
Define autoregulation
- Used by brain to maintain
- BF reguarless of MAP, vessels dilate/constrict)
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Causes of false low bp in interal measurements
(8)
- Airbubbles
- didn't zero transducer
- blood in cath system
- clot at end of cath
- bent tubing
- iv tubing instead of pressure tubing
- too many stopcocks
- improper cuff size/placemnt for external
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Is there a difference between periphal and internal bp readings?
- yes, internal is 5-20 mmHg higher
- internal more accurate
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Spinal Cord Injury
C1-C2
Vent dependant?
yes
-
Spinal shock vs Severed cord/lesion
- Spinal shock mimics but will get better
- Severed cord is permenant
-
3 Causes of stroke
- Clot in cerebral arteries
- Traveled clot
- Hemorrhage
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Complications of an A Line
(4)
- -Thrombosis
- -Embolism
- -Blood loss
- -Infection
-
Common ND for the need for invasive hemodynamic monitoring
- Ineffective/impaired __________ tissue perfusion
- Decfreased cardiac output
- FVD or FVE
-
What protects the brain form harm/disease and what can cross?
- Blood brain barrier
- Fat soluble (glucose)
-
Which cells create CSF?
glial
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Complications from central line
(5)
- -Infection
- -Pneumo/hemothorax
- -Carotid puncture
- -Dysrhythmias
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Nursing interventions for central line
(6)
- -zero transducer
- -monitor waveform (no notch)
- -vent-increase PEEP will show false decrease CO
- -hob 0-60 degrees
- -complications (pneumo/hemothorax)
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nursing interventions for A-line
(8)
- Set alarms
- Document assessment q 2hours while inserted
- Monitor wave form
- Keep wristh in neutral position
- Compare values with non-invasive
- When removed
- -pressure for 5-20 min
- -achieve hemostasis
- -assess/document removal
- Maintain pressure system
- Check site/circulation
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What do you assess after A-line removal?
(6)
- Cap Refill
- Skin Temp
- Pulses
- Sensations
- Fine Motor check (touch finger to thumbs)
- Did whole cath come out
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PA lumens - Temp Probe
- No fluids
- monitors temp of diff between injected fluid and pt body temp, CO through amount of time it takes for fluid to pass
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Nursing implication for inflating the balloon
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