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Care Management IV Exam 2 Questions And 100% Correct Answers Latest Update
Hemodynamics - ANSWER bloods ability to create pressure flow and deliver O2;measurement of pressure, flow, & oxygenation in CV system; measures power of heart to pump blood to body parts invasive measuring devices - ANSWER arterial line, triple/double lumen, PA catheter arterial line measures. - ANSWER continuous read out of BP triple/double lumen measures. - ANSWER CVP PA catheter measures. - ANSWER CVP, PCWP, CO, SVR noninvasive measuring devices - ANSWER NIBP, pulse oximetry/ SaO2, SvO why use hemodynamics - ANSWER used as a diagnostic tool and gives us a better totalpicture of pt and helps us control more of their care
hemodynamics shows - ANSWER heart function, fluid status, baseline, early detection ofpressure changes, and can compare trends cardiac output - ANSWER volume of blood pumped by the left ventricle in 1 min formula for cardiac output - ANS CO = HR x SV normal range for cardiac output - ANS 4-8 L/min
cardiac index - ANS cardiac output based on body surface area formula for cardiac index - ANS CI = CO/BSA normal ranges of CI - ANS 2.2-4 L/ min/ m2stroke volume - ANS volume of blood ejected from the L ventricle with each contraction/ beat normal range of stroke volume - ANSWER 60-150 mL/ beat (usually 50% of total ventriclevolume)
preload volume - ANSWER amount of volume or fiber stretch in hearts ventricle at end ofdiastole (just before systole), volume in is volume out
frank starlings law - ANSWER "the greater the stretch, the greater the push" compliance is - ANSWER the stiffness or thickness of hearts walls volume of the right ventricle - ANSWER low-pressure system, thin wall, no valve,pumped to the lungs
PVR (Pulmonary vascular resistance)- ANSWER Resistance of the blood flow by thepulmonary vessels.
left ventricular volume - ANSWER high-pressure system, thick wall, pumpedsystemically
SVR - Systemic vascular resistance- ANSWER the resistance of blood flow by thesystemic vessels.
CVP - Central Venous Pressure- ANSWER pressure of right atrium
ejection fraction ("the pump") - ANSWER >50-65% ventricle volume pumped, measuredby heart cath and echo
positive inotropes - ANSWER increase contraction via beta 1 stimulation, decreasesheartrate
negative inotropes - ANSWER decrease contraction/ myocardial O2 demand, increasesheartrate *never give to a dry heart
arterial pressure - ANSWER measure of the pressure exerted by the blood against thewalls of the arterial system
MAP - ANSWER MAP= 2/3 diastolic + 1/3 systolic complications of art lines - ANSWER bleeding (dislodged catheter, disconnect line)infection, culture tip, change site/line thrombus formation, Allen test distal circulation, pulses, skin color, numbness central lines - ANSWER used to obtain measurements of pressure, CVP, PCWP, CO andto give volume
complications of central lines - ANSWER infection, air embolus, thrombus, arrhythmias,bleeding, pulmonary rupture, PA cath, balloon rupture, PA cath
pulmonary artery catheter - ANSWER central line terminating in the pulmonary artery,used to determine heart function and volume status, can be advanced to pulmonary capillary to get wedge pressure CVP normal range - ANSWER 2-8 mmHg
PWCP normal range - ANSWER 6-12 mmHg nursing responsibilities for hemodynamics - ANSWER patient & family teaching,informed consent, setup preparation/assist, hemodynamic monitoring (pressures, waveforms, alarms, re-zero) intra-aortic balloon pump/ ventricular arterial device - ANSWER decreases leftventricular workload, increases myocardial perfusion, augments circulation
acute kidney injury - ANSWER rapid onset, can be reversible chronic kidney disease - ANSWER develops over time, not reversible but is manageable,treat with dialysis or transplant
phases of renal failure - ANSWER 1. azotemia
- uremia azotemia - ANSWER increased nitrogen wastes products (increased BUN and CR), UOP<400 mL/day, no s/sx
Uremia - ANSWER symptomatic azotemia, causes ischemia, hypovolemia, nephrotoxicagents
Prerenal AKI - ANSWER 70% of AKIs, external to kidney Causes of prerenal AKI - ANSWER intravascular volume depletion, decreased CO,altered vascular resistance
Intrarenal AKI - ANSWER 25% of AKIs, direct damage to renal tissue d/t ischemia ornephrotoxic agents
disorders clinical manifestations of oliguria - ANSWER altered mental status, hyperreflexia,anorexia, N/V, reduced/absent bowel sounds, uremic syndrome, cardiac dysrhythmias
recovery phase - ANSWER diuresis!! gradual renal recovery as evidenced by a slowdecrease in BUN and CR and increase in GFR
why is diuresis dangerous - ANS can cause hypovolemia, hyponatremia, andhypokalemia diagnostic tests for AKIs - ANS urinalysis, BUN, Cr, electrolytes, CBC, ABGs, renal US,angiogram, IVP, CT, MRI, renal biopsy goals for AKI - ANS CATCH IT EARLY! no permanent kidney function loss, I&O balance, electrolytes WNL, pt understandsdisease process
interventions for AKI - ANS treat cause, fluid management, hyperkalemia tx, infection,nutrition, respiratory, skin
cause treatment for AKI- ANSWER hypovolemia? give fluidsdecressed CO? give vasopressors arrhythmias? electrolyte balance fluid management for AKI- ANSWER daily weights, I&Os, fluid replacement/ restriction hyperkalemia tx for AKI- ANSWER hemodialysis, insulin drip (fast but temp), kayexalate,calcium gluconate IV, bicarb, diet restriction
infection tx for AKI- ANSWER antibiotics, be careful tho bc some drugs are hard onkidneys
nutritional tx for AKI - ANSWER low protein, low K, low Na, CHO, fats, TPN/lipids withsupplements, tube feedings
respiratory tx for AKI - ANSWER monitor for pulmonary edema skin care for AKI - ANSWER q2 turn, mouth care, ROM q chronic kidney disease (CKD) - ANSWER can progress from AKI, progressive,irreversible, destruction of nephrons & scar tissue, effects every organ in body
causes of CKD - ANS HTN, diabetes, chronic kidney infection/ disease, connectivetissue disorders goals for CKD - ANS identify s/sx of stages of CRF, comply with therapeutic regimen,participate in decision marking, establish effective coping mechanisms CKD pts are at risk for - ANS hyperkalemia, fluid volume excess, neurotoxicity, HTN,renal osteodystrophy, anemia, complications of drug therapy, and nutrition problems
interventions for fluid volume excess (CKD) - ANSWER daily weight, monitor labs,monitor BP, fluid/ diet restrictions, administer diuretics
interventions for neurotoxicity (CKD) - ANSWER sedatives, anticonvulsants interventions for HTN (CKD) - ANSWER VS, fluid/ diet restrictions, low Na PO4 and K,CCBs, ACE inhibitors, monitor edema
interventions for renal osteodystrophy - ANSWER prevent acidosis, increase calciumand decrease phosphate
nutrition interventions for CKD - ANSWER restrict protein, limit K PO4 and Na
external AV shunt - ANSWER consists of a cannula w/ a rubber septum through which aneedle may be inserted for drawing blood, dangerous bc infection, long term
internal AV shunt - ANSWER blended artery and vein, need to wait to use -needs tomature-, long term
complications of HD - ANSWER hypotension, infection/sepsis, muscle cramps, bloodloss, hepatitis
continuous renal replacement therapy - ANSWER 24/7, for pts who can't tolerate HD,exchange is slower, removes less volume/hr than HD, done in ICU setting, strict I&Os, adjust machine every hr to get off what you need
