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NUR 470/NR 470 Exam 1 LATEST 2025 EXAM
GRADED A+ 100% ACCURATE SPRING-FALL
TERM
What kind of shape does an epidural hematoma have? what type of bleed it it? what is the most common type of bleed (artery) Biconvex shape (because it's between the skull and the fluid has no where to go), it is an arterial bleed, the most common type of bleed is from the middle meningeal artery at the temporoparietal where is the enthmoid artery frontal anterior where is the transverse sigmoid sinus occipital Where is the superior sagittal sinus? vertex what shape is a subdural hematoma? what type of bleed is it? what are s/s of subdural hematoma? what is it most likely caused from? Shape: cresent shape, venus bleed, headache, and confusion, most likely from bridging veins
What is a subarachnoid hematoma? What is it most likely caused from? who is more prone to getting it? what age? under the arachnoid and the dura mater. Caused by illicit drugs, genetics, drinking, smoking women are more prone. Age 30 - 40 years old what are intracerebral bleeds? what are they commonly from? bleeding anywhere from the brain, commonly from aneurysm or angioma what is Sheering? Sheering laceration and hemorrhage into the parenchyma. Jugular Venus O2 Sat. Normal value: What does it measure and indicate? Where do you want to place it? 55 - 75% Measures the supply and demand of cerebral O2, inidcates cerebral metabolism. Place at the side of injury if a patient has increased MAP, what does the body do to compensate? the body will vasoconstrictor so there isn't too much blood flow to the brain. What is normal MAP?
what are late late signs of increased ICP, hyperthermia, death, cushing's (bradycardia, wide BP, respiratory problems) What do you always need to administer dilatin with? and what is dilantin used for? NS; seizures what is lorazepam for? Seizures Mannintol is for what? Mannintol is an osmotic diuretic which decreases ICP within 1 hr by 30%. It decreases the blood viscosity (making it slippery), Bolus is better what organ does Mannintol affect? Kidney You can hyperventilate the patient if they have increase ICP (t/f) false An increase in peep decreases ICP (t/f)
false, it increases ICP so you don't want to do it Why is glucose related to brain injury Brain injury causes glutamate to be released--> this causes an increase in metabolic activity which increases the break down of glucose --> glycolysis is turned on --> resulting in lactic acid--
now you have increased acid and increased membrane permeability --> increased cerebral edema you want to use glucocorticoids in TBI (t/f) false, you don't want to. The only thing it is useful for is when the brain injury is with spinal cord injury because it reduces vasogenic edema. What does ventilation depend on? Airway diameter, muscle use, thorax, elasticity of the lung, nervous system What are the two types of alveoli? Type 1: prone to infection and damage (majority of alevioli) Type 2: surfactant; ease WOB, makes it slippery What is the monocyte role in alveoli it is the immune response to a micoorganism. The monocyte has a phagocytic role. The monocytes squirt hydrogen peroxide on the membranes and cause further damage, so it increases the permeability to the cells which result in edema.
if PaCo2 increased (H+) increased= increase ventilation what is respiratory distress? PaCo2, PaO2, pH PaCO2 > 50, PaO2 < 60 , pH < 7. For every 10% increase in FIo2, how much is increased for mmhg? 5 - 10 mmhg (driving pressure pAO2 : paO2. What are conditions that increase thickness for diffusion? ARDS, pulmonary edema, pulmonary fibrosis What measurement is more accurate when looking at O2?SpO2 or SaO2? SaO what do you look at for ventilation? what about oxygenation? Ventilation = Co2 and pH Oxygenation= spo2 and sao Respiratory acidosis is caused by hypoventilation, COPD, pneumonia, atelectasis, narcotics, neuromuscular dz, post- op
Metabolic acidosis is caused by ASA OD, DKA, shock, starvation, diarrhea Respiratory alkalosis is caused by Hyperventilation, fear, anxiety, head injury, ventilator (set respiratory breaths), pain Metabolic alkalosis is caused by vomiting, NG tube, diuretics, and, antacids. What is normal avleolar ventilation? 4L/min what is normal pulmonary capillary perfusion 5L/min what is normal VQ? 4: What does it mean if VQ is greater than .8?
what is dead space common with PE (pe occluded blood flow) NO gas exchange what is an anatomic shunt? blood moving from the right to left heart without going to the alveoli what are different types of anatomic shunt? cardiac septal defect, traumatic injury to pulmonary blood vessels. What is an intra Intrapulmonary shunt? normal blood flow past completely unventilated alveoli intrapulmonary shunt is also known as right to left shunt An intrapulmonary shunt usually requires mechanical ventilation; need to requit alveoli so you can have perfusion and ventilation Absolute shunt is anatomic shunt and capillary shunt
what is obstructive lung dz, give examples as to what kind of dz inability to exhale air, you're air trapping COPD, asthma, bronchiectasis, CF What is restrictive lung disease (give examples) inability to inhale air due to the restriction (stiffness) ARDS, interstitial lung disease, sarcoidosis, obesity, scoliosis NM disease What is an inflammatory syndrome marked by disruption of alveolar capillary membrane? ards what is the clinical definition of ARDS? Acute onset, both lungs affected, PAWP is < 18mmhg or no evidence of L ventricular failure. hypoxemia refractory to O2 tx (need 100% o2 but still not getting oxygenated). ALI v ARDS PaO2/ FiO2 ratio ALI < 300 ARDS <
injury to pulmonary vasculature ARDS pulmonary vasoconstriction, microemboli formation, pulmonary HTN, alveolar dead space, increased PVR, decreased CO, BP falling An increased in capillary membrane permeability, narrowing of the airway, and injury to pulmonary vasculature lead to (ARDS) increased WOB, alveolar hypoventilation, V/Q mismatch, intrapulmonary shunting ==> hypoxemia refractory to o2 therapy why do you want to give the lowest possible FiO2 for ARDS? don't want to have any oxygen damage You do not want to increase PEEP for ards (t/f) false, you want to promote diffusion For ARDS, what do you want to do to prevent baro/volutrauma? Low TV and increased RR What is the benefit of corticosteroids in ards? benefit in late ards because it breakdown inhibit fibrosis as well as decreased edema what are common causes of shunt like?
bronchospams, hypoventilation, and pooling of secretions. Poor ventilation what is normal CO 4 - 8 L/min What is normal CI 2.4-4. CO x BSA = CI What is normal SV 60 - 70ml/ each contraction PAWP is a measurement of... preload (left side of the heart) CVP is a measurement of preload right side of heart
diuretics, fluids, vasodilators (decreased BP and preload) What are factors that affect afterload volume, blood viscosity, vascular tone, aortic impendence (stenosis) what are the effects if you have increased afterload increased resistance so you can't push out a lot
- cool clamy hands, HTN, decreased urine output, slow cap refill what are the effects of decreased afterload warm flushed skin, increased CO , decreased BP what are s/s of increased contractility fatigue, SOB, dizziness, decreased urine output what are s/s of increased contractility increased BP what is the SV variation?? monitor SV, if you give fluids to a patient and they have a change in 15% up or down it is good. if they do not have a change within 15%, don't give them anymore fluids
CVP is the filling pressure on the side of the ventricl R What are non invasive methods for hemodynamic monitoring Doppler measures (CO, preload, afterload, and contractility) Impendence cardiography measures (SV, CO, SVR, and contraction ) What are invasive methods for hemodynamic monitoring? CVP : need a line access what is the formula for MAP [SBP + 2(DBP)] / 3 = MAP if MAP is > 60 what does that indicate organs are getting perfused well f What are disadvantages of Swan/ PA catheters? infection, insertion complication (pneumothorax, bleeding, damage to blood vessel or heart), air emboli, balloon rupture, pulmonary artery rupture
true If Left ventricular failure, you have an increased in PVR (t/f) false, it is increase SVR (afterload) you have weak heart sounds, decreased CO, and weak pulses in which sided ventricular failure (R/L)? Left A result of systolic heart failure is RHF, pulmonary congestion and pulmonary edema What is systolic HF caused by? CAD, dilated cardiomyopathy Hypertrophic and restrictive cardiomyopathy is an example of what type of HF? Diastolic If you have an increase LVEDP, you have a decrease in what Decrease in LVEDV, decreased CO, and EF)
What are s/s of acute HF? acute pulmonary edema, low CO, cardiogenic shock, s/s of palpitation, S3, SOB, cough pink frothy sputum. in chronic HF patients what do you see them typically have? Structural changes to the heart and they are hypervolemic. To compensate for a dilated cardiomyopathy what does the heart do? Increase HR bc blood isn't flowing and getting pushed out enough to fullfill what is needed for the body Dilated cardio is what type of problem contractile dysfunction what are s/s of dilated cardiomyopathy S4, murmur (regurgitation of aortic and mitral valve), emboli formation, L ventricular hypertrophy What is tx for dilated cardiomyopathy Diuretic (they are fluid overloaded), sodium restriction, inotrophic agents, anti-arythmias, ACE inhibitor, beta blocker to decrease HR and increase filling time
