Where Did the Fluid Go?
A patient has ascites and edema but is hypotensive. The fluid is trapped where it cannot adequately support circulation.
What is third spacing?
This electrolyte should make you immediately think neurological assessment.
What is sodium? (135-145)
This cardiac biomarker rises when myocardial cells are damaged.
What is troponin?
This implanted device provides electrical stimulation when the heart rate is inadequate.
What is a pacemaker?
This is the first action when a transfusion reaction is suspected.
Stop the transfusion.
Heart failure increases this pressure, pushing fluid out of the vessels and contributing to edema.
What is hydrostatic pressure?
A potassium level of 6.2 plus tall, peaked T waves indicates this condition.
What is hyperkalemia?
A patient receives one SL nitroglycerin tablet for chest pain. Before giving the next dose 5 minutes later, assess this first.
What is blood pressure?
A pacemaker spike appears on the ECG, but there is no QRS after the spike. Name the malfunction.
What is failure to capture?
This is the only IV fluid routinely compatible with packed RBC administration.
What is 0.9% normal saline?
Liver failure causes low albumin. Loss of this pressure allows fluid to leave the vascular space and contribute to ascites.
What is oncotic pressure?
A dehydrated patient's serum osmolarity, hematocrit, and urine specific gravity would generally trend in this direction.
They generally increase/become concentrated.
After coronary stent placement, aspirin should normally be paired with how many of these: Plavix, Brilinta, or Effient?
One. Aspirin + ONE P2Y12 inhibitor, such as Plavix, Brilinta, or Effient.
The pacemaker fires even though the patient's intrinsic heartbeat should have prevented it from firing. Name the malfunction.
What is failure to sense?
A patient with thrombocytopenia is at greatest risk for this complication.
What is bleeding?
A patient after abdominal surgery has increasing HR, decreasing BP, abdominal distention, edema, and falling urine output. Despite appearing fluid overloaded, what fluid problem should you suspect?
What is third spacing with intravascular volume depletion/hypovolemia?
A dehydrated patient's serum osmolarity, hematocrit, and urine specific gravity would generally trend in this direction.
What are hypotonic fluids?
After a femoral cardiac cath, HR rises from 82 to 116 while BP falls from 128/76 to 92/54. What complication is the priority concern?
What is post-cath bleeding/hemorrhage?
This central-access device is accessed with a noncoring Huber needle.
What is an implanted port?
This disorder causes excessive RBC production and increases the patient's risk for DVT, PE, and other thrombotic events.
What is polycythemia vera?
A patient has massive edema, low albumin, BP 86/48, and low urine output. Which is the better reasoning: immediately give a large dose of diuretic, or first evaluate/support the circulating volume—and why?
Evaluate/support intravascular volume first. The edema does not mean the usable circulating volume is adequate; aggressive diuresis could worsen hypotension and perfusion.
Low circulating volume activates RAAS and ADH. What overall effect are these systems attempting to produce?
Retain sodium and water, vasoconstrict, and increase circulating volume/BP.
A patient reports chest discomfort shortly after PCI. What question best helps distinguish expected reperfusion discomfort from recurrent coronary ischemia?
“Does this feel like the pain that brought you in?” Same pain is more concerning for recurrent ischemia/reocclusion.
A patient has a lethal ventricular rhythm. Which implanted device is designed to recognize the rhythm and deliver a shock?
What is an ICD?
Blood was picked up from the blood bank at 1000. By what time must the transfusion be completed at the latest?
1400 / 2:00 PM — blood must be completed within 4 hours.