CCRN Review: Comprehensive Guide to Critical Care Nursing, Exams of Cardiology

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CCRN Review

Heart rate (HR) - 60-100 beats/min Mean arterial pressure (MAP) - 70-105 mmHg Cardiac output (CO) - 4-5 L/min Cardiac index (CI) - 2.5-4.5 L/min/m Stroke volume (SV) - 50-100 ml/beat Stroke index (SI) - 35-60 ml/m2/beat Right arterial pressure (RAP) - 4-8 mmHg Pulmonary artery pressure (PAP) - Systolic 15-30 mmHg Diastolic 5-15 mmHg Pulmonary artery occlusive pressure (PAOP) - 8-12 mmHg Systemic vascular resistance (SVR) -

800-1200 dynes/sec/cm- Systemic vascular resistance index (SVRI) - 1970-2390 dynes/se/com-5/m Pulmonary vascular resistance (PVR) - 100-250 dynes/sec/cm- Pulmonary vascular resistance index (PVRI) - 255-285 dyens/sec/cim-5/m Arterial oxygen saturation (SaO2) - 95-100% Venous oxygen saturation (SvO2) - 60-80% Delivery of oxygen (DO2) - 550-650 ml/min/m Oxygen consumption (VO2) - 200-250 ml/min Inferior leads and artery - cardiac - Lead II, III, aVF - RCA Anterior septal leads and artery - cardiac - Lead V1, V2 - LM Anterior leads and artery - cardiac - Lead V3, V4 - LAD

Low lateral lead and artery - cardiac - Lead V5, V6 - LCX High lateral lead - cardiac - Lead I, aVL Symptoms of Left heart failure - Orthopnea, dyspnea, crackles, Low PaO2, SaO2 & SpO2, S3 & S4, Increased PAOP & PA pressures Symptoms of Right heart failure - JVD, Peripheral edema, Hepatomegaly, Increased CVP/RAP, S3 & S Symptoms of Systolic heart failure - Decreased stroke volume, decreased ejection fraction, S3 and enlarged heart Symptoms of Diastolic heart failure - Decreased stroke volume, normal ejection fraction, S4, normal heart size Laboratory signs of DIC - Decreased platelets Increased PT/INR Increased aPTT Decreased fibrinogen Increased FSP Increased D-Dimer Physical signs of DIC - Hypotension, Petechia, Purpura, Bruising, Bleeding in oral, GI/GU, or pulmonary

Chvostek's Sign - Facial muscle twitching when cheek is tapped - Hypocalcemia Trousseau's Sign - Spasming of the hand when the bp cuff is inflated beyong systolic pressure for >3 min - Hypocalcemia Grey Turner's Sign - Bruising of the flanks, appearing as a blue discoloration - retroperitoneal bleed Cullen's Sign - Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus - Intraperitoneal bleed Kehr's Sign - Acute pain in the tip of the shoulder when a person is lying down and the legs are elevated - splenic rupture Calculation of anion gap - (Na + K) - (CL + HCO3) *Cations - Anions Normal is < 15 PaO2/FiO2 Ratio (P/F ratio) - Measures the difference between oxygen content in PaO2 divided by the FiO2. Used to predict shunting and hypoxemia <300 = ALI <200 = ARDS Acute Respiratory Failure - PaO2 <60 mmHg PaCO2 >50 mmHg pH <7.

Acute Lung Injury & ARDS - Cxr - bilateral diffuse infiltrates with no cardiac enlargement (white-out or ground-glass appearance) P/F ratio: (<200 ARDS; <300 for ALI) PAOP <18mmHg Acute Pulmonary Embolism - For Massive PD: Acute right heart failure Shock and crushing chest pain Increased CVP with decreased CO Cyanosis and hemoptysis Status Asthmaticus - ABG revealing normalizing or increasing CO2 with no signs of improvement Little to no breath sounds auscultated Disappearance of wheezing Flail Chest - Paradoxical wall movement:

• On inspiration when chest wall should move outward, the fractured area will move inward
• On expiration when chest wall should move imward, the fractured area will move outward Tension Pneumothorax - Tracheal deviation and PMI move away from affected side High peak inspiratory pressure (if vented) Hypotension Cranial Nerve I - Olfactory - sense of smell

Cranial Nerve II - Optic - Central and peripheral vision Cranial Nerve III - Oculomotor - Eye and upper eyelid movement, pupil constriction Cranial Nerve IV - Trochlear - Down and inward eye movement Cranial Nerve V - Trigeminal - Touch, pain, temperature, jaw and eye muscle proprioception (sense of position), chewing Cranial Nerve VI - Abduncens - Lateral eye movement Cranial Nerve VII - Facial - Close eyelid, taste (anterior 2/3 of tongue), saliva and tears Cranial Nerve VIII - Acoustic - equalibrium and hearing Cranial Nerve IX - Glossopharyngeal - Gag reflex, swallowing, taste in posterior 1/3 of tongue Cranial Nerve X - Vagus - Salivary gland secretion, vagal control of heart, lungs and GI tract, gag reflex Cranial Nerve XI - Spinal accessory - Shoulder movement

Cranial Nerve XII - Hypoglossal - Tongue movement CPP - Map - ICU = CPP Normal is 60-100 mmHg ICP - Normal ICP is 5-15 mmHg Wernicke's area - Temporal lobe Broca's area - Frontal lobe Occipital lobe - Vision and color recognition Parietal lobe - Sensation and body awareness Temporal lobe - Receptive speech Frontal lobe - Understands what is said but is unable to express themselves appropriately Brudzinski's Sign -

Lay flat on back, flex the head down towards the chest and the knees pop up = meningeal irritation Kernig's sign - Lay flat on back, bend knee towards chest creates severe pain = meningial irritation Prerenal - Sodium <20 mEq/L BUN >25mg/dl FENa <1% *hypotension/hypo-perfusion Postrenal - Sodium >40 mEq/L BUN <25 mg/dl * only in postrenal *obstruction (tumors/stones) Antidote for acetaminophen - N-Acetrylcysteine (Mucomyst) Antidote for Opiates - Naloxone (Narcan) Antidote for benzodiapine - Flumazenil (Romazicon) Antidote for Digoxin - Digibind Antidote for Beta Blockers - Glucagon, Calcium Chloride

Antidote for Carbon monoxide - 100% FiO2 or hyperbaric chamber Antidote for Ethylene glycol and methanol - 10% ethanol infusion, dialysis Antidote for Tricyclic antidepressants - sodium bicarb Antidote for coumadin - Vitamin K Antidote for heparin - Protamine sulfate Antidote for amphetamines - benzodiazepines Antidote for calcium-channel blockers - Calcium chloride, glucagon Antidote for lithium - hemodialysis Antidote for nitrates - methylene blue Antidote for salicylates - sodium bicarb, hemodialysis

Dobutamine - Inotropic, chonotropic and vasodilator effects Treats heart failure Improves renal blood flow and u/o 2-20 mcg/kg/min Dopamine - Catacholamine raises bp refractory to fluid therapy treats heart failure corrects hemodynamic imbalances during shock

6mcg/kg/min Epinephrine - Catecholamine Incr CO by incr HR Incr cerebral and coronary blood flow Potent alpha receptor vasoconstrictor 1-10 mcg/min Levophed - Catecholamine Incr contractility to incr bp with mild effect to CO Used to treat hypotension and decr SVR 2-30 mcg/min Milrinone - Inotropic vasodilating agent with little chronotropic activity Incr CO without incr myocardial oxygen demand or HR 0.25-0.75 mcg/kg/min

Nitroglycerin - Venous vasodilator Decr preload and afterload in L ventricular failure Used for mycardial ischemia and dilator for coronary vasculature 20-40 mcg/min 50-250 mcg/min Nipride - Venous and arterial dilator Incr CO by decr L ventricular afterload Decr bp in hypertensive crises and decr pulmonary hypertension 0.5 - 10 mcg/kg/min Neosynephrine - Sympathetic adrenergic agent Constricts blood vessels and raises bp Stimulates baroreceptors to slow HR by incr vagal tone 100-180 mcg/min (can go up to 300 mcg/min) Vasopressin - Potent arterial vasoconstrictor Used for severe hypotension/shock unresponsive to catecholamine therapy, upper GI hemorrhages and ACLS protocol 0.01-0.4 units/min ABG Values - pH 7.35-7. PaCO2 35- PaO2 80- HCO3 22-

Normal CBC values - Hgb 13-18 M 12-16F Hct 40-52M 35-47F Normal Coag values - PT 12-15 sec aPTT 25-38 sec Platelet 150,000 - 400, Fibrinogen 200- Normal Chemistry values - Na 136 - 145 K 3.5 - 5. Ca 8 - 10. Phos 3 - 4. Mg 1.5 - 2. Chl 96 - 106 Normal Kidney Fxn Values - BUN 5 - 20 Creatinine 0.7 - 1. Anion Gap 5 - 15 Normal Liver/Pancrease Values - Alk Phos 30 - 85 Amylase 56 - 190 Lipase 0 - 15 ALT 5 - 36 AST 15 - 45 GGT 5 - 38

Normal Specific Gravity and Urine Osm values - Urine Specific Gravity 1.005 - 1. Urine Osmololity 50 - 1200