Exam 1 Review Complex PDF

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Exam # 1 Review TEACHER: GONZALEZ YEAR 2017...

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Complex Care of the Adult Exam 1 Review EXAM #1 Oxygenation Mechanical Ventilation - 10 Perfusion Myocardial Infarction – 10 Basic EKG -5 Dysrhythmias -5 Cardiac Treatments/Procedures - 10 Cardiac Valve Disorders -4 Cardiac Surgery - 4 Math Calculation - 2 Total 50 Types of Airways… Oropharyngeal: Prevents tongue from occluding the pharynx. Size specific (Tip of ear to corner of mouth….BOOK & Ms TB say corner of mouth to angle jawline), Prevents damage to orally inserted ET tubes, easiest to suction. Nasopharyngeal: Bypasses oral cavity to provide access via the nasopharynx. Size specific (Tip of ear to corner of nose). Laryngeal Mask Airway (LMA): Inserted orally to provide access to trachea; minimally invasive. Used in short stay surgeries and difficult ti intubate pts. Does allow ETT tube to be inserted once pt is stabilized. Endotracheal Tube: Is a invasive, secured airway. Inserted orally & sometime nasally. Tip of tube resides 1-2cm above carina. Balloon obstructs trachea to prevent flow of gases outside of ET tube. This can damage vocal cords. Must be properly secured. Tracheostomy Tube: Surgically inserted that bypasses larynx. Used when long term mech vent is required. Bypasses natural defenses so increased risk of respiratory infection. May aid in weaning pt from vent. LOW PRESSURE ALARM= Cuff deflation, TV set too low, Chest wounds/drains, Can’t build up pressure, pt disconnected it or there is a leak. HIGH PRESSURE ALARM= Block, secretions, pt biting/coughing/gagging on tube, Pmax too low, PEEP to high, mucous plugs, Pneumothorax, Air trapping, Bronchospasm, Tube in R-main bronchus. APNEA ALARM: Respiratory arrest. Over sedation. Change in pt condition. Loss of airway (total or partial extubation) LOW TIDAL VOLUME/MINUTE VENTILATION: Change in pt breathing efforts (rate & volume). Pt is disconnected, loose connection, or leak in circuit. ET tube/trach cuff leak (pt speaking, grunting). Insufficient gas flow HIGH TIDAL VOLUME/MINUTE VENTILATION/ OR RESPIRATON RATE: Pain, anxiety. Change in pt condition. Excess condensate in tubing (false reading) Quizlet: https://quizlet.com/40741004/mechanical-ventilation-alarms-causes-flash-cards/

Nasal Cannula

Venturi Mask

Non-rebreather

1-6 LPM

Simple Face Mask 5-10 LPM

Variable LPM

8-10LPM

24-44% FiO2 Humidity rates > 3 LPM

40-60% FiO2 Mouth or Nose Breathers

24-50% FiO2 Device will state O2 flow rate.

80-100% FiO2 Has 02 reservoir % one way valves

Must be able to breathe through noise

Uncomfortable, difficult to eat or drink.

Frequently used following extubation

For pt’s w/ severe hypoxia

Bag Valve Mask (Ambu) Minimum 10 LPM 100% FiO2 Self-inflates, Mask can be used w/ oro or nasalpharyngea l airways. Pts can be semi or unconscious. Built in O2 reservoir.

Invasive Mechanical Ventilators… NPP: Applied externally to the patient to the pt &  the atmospheric pressure surrounding the thorax to initiate inspiration. PPV: Use a mechanical drive to force air into the pt’s lungs through an ETT or trache tube.

Mechanics of Ventilators… -Ventilator must complete 4 phases of ventilation to ventilate pt: 1) Change from exhalation to inspiration 2) Inspiration 3) Change from inspiration to exhalation 4) exhalation Trigger: The phase variable that initiates the change from exhalation to inspiration. Pt Triggered: A breath that is triggered by the PT. (There can also be flow or pressure triggered) Flow Triggered: Depending on the sensitivity setting of the ventilator & pt’s inspiratory effort. Machine Triggered: Breath initiated by machine. Time Triggered: Breath initiated by machine after a preset of time. Cycles: The variable that ends respiration. Volume Cycled: Designed to deliver a breath until a preset volume is delivered. Pressure Cycled: Deliver a breath until a preset pressure is reached within the pt’s airways. Flow Cycled: Deliver a breath until a preset inspiratory flow rate is achieved. Time Cycled: Deliver a breath over a preset time interval. Combinations:….

*V-Tach, V-Fib, & Torsades are SHOCKABLE! Pulseless Electrical Activity (PEA) & Asystole are Non-Shockable Rhythms. *When you heat pt alarm go off the first thing you do is CHECK PT , not turn off alarm. *If a vent turns off You will Ambu-Bag pt. Cardiac Anatomy.... •Three layers: Epicardium>Myocardium>Endocardium •Four chambers: Left Atrium, Left Ventricle, Right Atrium, Right Ventricle •Heart valves: Tricuspid>Pulmonic>Mitral>Aortic Valve •Coronary arteries: The Right Coronary Artery, the Left Main Coronary, the Left Anterior Descending, and the Left Circumflex Artery.

•Cardiac Conduction System: Sinoatrial (SA) node, Atrioventricular (AV) node, Bundle HisPurkinje System. Angina… Stable (Responds to Ntg and rest), Unstable (Unrelieved by ntg, gets worse over time), and Variant (Occurs at rest w/ no precipitating factor d/t spasm (caused by anaerobic metabolism/lactic acid builds up) Myocardial Infarction… The death of myocardial tissue w/out blood flow due to an occlusion to a coronary artery. This is the end state where ischemia & followed by the injury occurred. 1- Ischemia (Evidence = T wave inverts; starving for oxygen and blood flow, tissue is pale and whitish) 2- Injury (Evidence = ST segment rises; ongoing starvation for blood flow and oxygen is evident, tissue is now bluish) 3- Infarction/Necrosis (Q wave present; necrosis and black color signal death and scar tissue is formed) *If angina is changing more than it was before you want pt to come in for check up. STEMI vs NON STEMI: ST-elevation myocardial infarction, or a STEMI heart attack, happens as a result of a complete blockage in a coronary artery. A STEMI attack carries a great risk of death and disability. When an artery is partially blocked and severely reducing blood flow, a nonSTEMI heart attack may occur. BIGGEST POINT IS ZONE OF ISCHEMIA. STEMI is more dangerous…Cell death irreversible 20-40 minutes Zone of Ischemia: Area of myocardium that was completely deprived of O2 resulting in cell death. T-Wave Inversion.

Zone of Hypoxic Injury: Immediately surrounding the area of infarction and will recover if blood flow is quickly restored.

Zone of Injury: What will your focused assessment include? Thrombolytics, Oxygen, Morphine, Nitro, Aspirin, Cath Lab(Crdiac Cath is a Dx tool & PERCUTANEOUS is a Surgical Procedure) Goes through groin , come back to PACU check for swelling, incision site, extremity for color/cap refill,pulses/temp, pain level(Duration, Location, What u were doing before, Relieving factors, does it radiate) Most common complication of MI is dysrhythmia, tissue death, HF, cardiogenic shock Different types of chest pain indicate differing pathophysiology’s.

Take 1 Nitro & Call 911(Activate Emergency Response) , Take another after 5, After 3, 15 min later, stop. Ta k eNi t r a t e , BB, ACE& CCB, ARB’ s , DI URETI CS CABG-x4me a nst h e r ewe r e4oc c l u s i ons . Mos tc ommo na r t e r i e sf orb y pa s s =s a p he no us , orma mmor y . Pwavei st hefi r s tshor tupwar dmov ementoft heECG t r ac i ng.I ti ndi c at est hatt heat r i aar ec ont r act i ng, pumpi ngbl oodi nt ot hev ent r i c l es . TheQRScompl ex,nor mal l ybegi nni ngwi t hadownwar ddefl ec t i on,Q;al ar gerupwar dsdefl ect i on,a peak( R) ;andt henadownwar dsSwav e.TheQRScompl exr epr es ent sv ent r i cul ardepol ar i z at i onand c ont r ac t i on. ThePRi nt er vali ndi c at est het r ansi tt i mef ort heel ect r i c als i gnal t ot r av el f r om t hes i nusnodet ot he v ent r i cl es . Twavei snor mal l yamodes tupwar dswav ef or mr epr es ent i ngv ent r i c ul arr epol ar i z at i on. MIev ol v esov ers ev er al hour sHy pox i aoft hehear tmus c l eduet oi s c hemi a,v as odi l at at i onofbl ood v es s el sandac i dos i sàK+,Mg+,Ca+i mbal ancesandac i dos i satt hecel l ul arl ev el ( anaer obi cmet abol i sm andl ac t i cac i df or mat i on)às uppr es sescont r ac t i l i t yandc onduct i onofi mpul ses Aut omat i ci t yandec t opyi nc r easesc at ec hol ami ne( epi &nor epi nephr i ner el eas ei nr es pons et oHy pox i a andpai nài nc r eas ehear tr at e,cont r ac t i l i t y ,andaf t er l oadài nc r eas eO2demands Ext entofZoneofi nf ar ct i ondemandsonàcol l at er al c i r c ul at i on,anaer obi cmet abol i s m,wor kl oad demandont hemy oc ar di um Effec t sal l 3l ay er sàTr ans mur al I nf ar c t i on6hour s ,8hour sài nf ar c t edt i ss uet ur nsgr eywi t hy el l ow s t r eak sàneut r ophi l si nv adet het i ss uet ophagoc y t es&r emov enecr ot i ct i s sue ,8t o10hour sgr anul at i on t i s suef or msar oundt heedgesoft henec r ot i car ea,2t o3mont hsnec r ot i car eaàshr i nk sf or msat hi nfi r m s caràt i s s uei sper manent l yc hangest hes i z eands hapeoft heL VàVent r i cul arRemodel i ngàdec r eas es L Vf unc t i onàhear tf ai l ur eài nc r eas esmor bi di t y&mor t al i t y

Cor onar yAr t er i es… Th eLe f ta nt e r i orde s c e n di n g( LAD)i sabr a n c ho fft h el e f tma i nc or o na r ya r t e r y .LADs up pl i e sb l oo dt ot he a n t e r i o rwa l lo ft h el e f tv e nt r i c l e .Ant e r i o rWa l lMI .RBB&LBBf e db yb l o ods up pl y . Th eCi r c umfle xa l s oab r a n c ho ft hel e f tma i nc o r on a r ya r t e r y , f e e d st h el a t e r a lwa l lo ft h el e f tv e nt r i c l e s .Si n c e t h eLAD&t h ec i r c umfle xc or on a r ya r t e r i e sb r a nc h e so fft h el e f tma i nc or o na r ya r t e r y ,b l oc ka g eo ft h el e f t ma i ni t s e l fwo ul dk no c ko utflo wt ob ot ht h e ebr a n c he s =HUGEHEARTATTACK( Wi d o wMa k e r ) . Ri g htCo r on a r yAr t e r y( RCA)f e e d st h er i g h tv e nt r i c l ea n dt h ei n f e r i o rwa l lo ft h el e f tv e nt r i c l e . Le f tMa i n:Sud de nDe a t h I fi t so nr i g hts i d ej u s tt hi nkt heS ANo dei st h e r es oi fi ts t a r t st og e td a ma g e dy o ul ls e ej u s taQRSont h e EKG. Ischemia: •Flattened ST segments •ST-T wave depression •T wave inversion •Abnormally tall, pointed T waves

•Inverted U waves Injury: •ST-T wave elevation Infarction: Pathological Q waves ( >0.03 sec and deeper than 2mm 24-60% Do Not have EKG changes indicative of MI on admission –Diagnosis based primarily on history ■

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Myoglobin is what shows the amount of oxygen stored in hemoglobin o2. Troponin: Should be 0.01ng/mL . Higher shows cardiac damage. CK-MB:

NSR:

PR Interval: 0.12-0.20secs QRS Interval:...