What is Cardiac Output (CO)
What is Stroke Volume (SV)
CO - The product of the heartbeat per minute X the SV
SV = Each ventricular contraction (60 - 70 ml of blood) *477
What is Hypoxia
Inadequate tissue oxygenation at a cellular level.
PH - 7.27
PaCO2 - 18
HCO3 - 17
What am I?
Causes?
PH low and HCO3 low - Metabolic Acidosis
DKA
Salicylate Overdose
Rental failure
Shock
Severe diarrhea
Bubbles in this _____________________ chamber indicates?_______________________
Water Seal
Air Leak
What Am I?
Life threatening
Cause cardiac dysrhythmias
HYPOXIA
Describe the electrical conduction of the cardiac system.
SA node - intraatrial & internodal pathways - AV node - Bundle of His - R & L bundle branch - Purkinjie fibers - ventricles. * 914
What causes Hypoxia
?????????????????????????????
Decreased hemoglobin level
Lower oxygen carrying capacity of blood
Diminished concentration of FiO2
Shock - poor tissue perfusion
Impaired ventilation - Fx ribs
* 917
Major role in BP control
What am I?
RAAS -Describe this system *1152
Name the three chambers of a water seal container
Drainage
Water seal
Pressure (suction)
18 year old Michael returned from surgery - S/P Fx femur. AAO x 2, C/O's of "worse pain ever", pushes the PCA button never releasing it. 10 minutes later , on rounds, Michael is pale, resps. 8, will not arouse, cold, and pulse radial - 52.
What is the first action:
Call rapid response - code team
Ventilate with BVM:
Airway?
How many liters?
What is the FiO2?
Administer Narcan
Delegate what cares?
What am I?
Troponin I
Protein found in the muscle of the heart. I am a marker for a cardiac injury such as AMI.
Normal levels: 0 - 0.4ng/ml
I have respirations of 34, pale, sweating, can't talk. I have been sick for 24 hours with a cough. The nurse needs to apply supplemental O2,,,Which O2 delivery system do you apply and what liter do you set?
A non-rebreather rate at 15 Liters
Catheter-associated urinary tract infections (CAUTI)
Name preventable causes:
Avoid Foley catheter insertions
Increase fluids
Empty foley bag frequently
Keep bag off the floor
Secure with sure STAT
Measure I & O
Monitor for change in smell, color, volume
Strict Foley cath care
I ate:
8 oz of jello
3 oz of broth
1/2 of the 200 cc of ice chips
3 - 100 ml of NS with 10 KCL
1/2 of an 8 oz bowl of oatmeal
1/2 of 90 ml of yogurt
How many ml do I need to record for intake?
730 ml/cc need to be entered for intake
56 year old Bill C/O's of fatigue. You are looking across the room and notice:
Bill looks "fluffier" than usual
Ankles are swollen
Neck veins are distended
Initial Hypothesis?
*918
Heart Failure:
Right or Left???????????
Draw the flow of blood in the heart.
PH - 7.53
PaCO2 - 42
HCO3 - 28
What am I?
Causes?
Metabolic Alkalosis
Loss of gastric secretions
Over use of bicarbonates - tums
Diuretics
Ph- 5.0
Protein - zero
Glucose - Moderate
Ketones - Moderate
specific gravity - 1.030
What is the first action?
Assessment of the patient
Areas of concern - Name them and why
Vital signs
Intake vs Output
I usually am 135 - 145
Live in the ECF
Neuromuscular pump
Responsible for osmolality of vascular fluid
Regulate acid-base balance
A 63 yr old female presents to the urgent care. C/O's:
acute chest pain
Dyspnea
tachypnea
Trachea deviated
Hypotension - 80/50
Hypothesis??????????
A Tension Pneumothorax
I am not the cell (pacemaker of the heart) but I am in charge
I am wide, P wave is not always present, and I alter cardiac output.
Ventricular Tachycardia
What is your first action:
Metabolic Alkalosis
What is my patients symptoms?
Increase of PH and Increase in HCO3
Confusion
Dizzy
Irritability
N, V, D
Compensatory hypoventilation
Dysrhythmias - tachycardia - low K+
Muscle cramps - low serum Ca++
I am a cluster of capillaries which filter water, glucose, amino acids, urea, uric aid, creatinine, and major electrolytes - what am I?
* 1150
Glomerulus
Hyponatremia Causes:
Drinking excessive free water
Bulimia
Addison
V/D
Burns
Heart Failure
Medications
V-Fib.......
What are you going to do?