Tuesday, February 28, 2012
Test #2 today - Cardiac
Test #2 today at 8am. A little over 3 hours away! Hope this goes well!!! I have studied and I am PREPARED! God has not given us a spirit of fear, but of power, love, and a sound mind. 2 Timothy 1:7
Thursday, February 16, 2012
REFERENCE RANGES to know for Test #2 (Cardiac)
PT
PTT
INR
Hgb
Hct
Platelets
Electrolytes:
---------------
Sodium
Potassium
Calcium
Magnesium
-----------------------
Answers:
PT ::: 9.5 to 12
PTT ::: 20-39
INR ::: 1, 2-3 therapeutic range
Hgb ::: 15, 12-18
Hct ::: 45, 35 to 52
Platelets ::: 150,000 to 450,000
Electrolytes:
---------------
Sodium ::: 135 to 145
Potassium ::: 3.5 to 5.0
Calcium ::: 8.5 to 10.5
Magnesium ::: 1.8 to 2.2 - crucial to cardiac function. Low levels are seen in torsades de pointe and alcoholism.
------------------
CO = HR x SV
SV is affected by preload, afterload, and contractility
---------------
HR is increased with sympathetic response (due to norepinephrine)
HR is decreased with parasympathetic response (due to acetylcholine)
---------------
PTT
INR
Hgb
Hct
Platelets
Electrolytes:
---------------
Sodium
Potassium
Calcium
Magnesium
-----------------------
Answers:
PT ::: 9.5 to 12
PTT ::: 20-39
INR ::: 1, 2-3 therapeutic range
Hgb ::: 15, 12-18
Hct ::: 45, 35 to 52
Platelets ::: 150,000 to 450,000
Electrolytes:
---------------
Sodium ::: 135 to 145
Potassium ::: 3.5 to 5.0
Calcium ::: 8.5 to 10.5
Magnesium ::: 1.8 to 2.2 - crucial to cardiac function. Low levels are seen in torsades de pointe and alcoholism.
------------------
CO = HR x SV
SV is affected by preload, afterload, and contractility
---------------
HR is increased with sympathetic response (due to norepinephrine)
HR is decreased with parasympathetic response (due to acetylcholine)
---------------
H's and T's
Pulseless Electrical Activity:
--------------------------
Hypothermia
Hypoxia
Hypo/Hyper kalemia
Hypovolemia
H+ ions (acidosis)
Thrombosis (coronary)
Thrombosis (pulmonary)
Tension pneumothorax
Tamponade
Tablets (overdose)
----------------------------
First degree heart block:
Long PR Interval, > .20
Second degree heart block Type I:
Wenkebach: longer, longer, drop
PR interval gets longer and longer until a beat is dropped.
Second degree heart block Mobitz type II:
AV node is the problem; caused by disease or ischemia
May progress to 3rd degree heart block. PR interval is consistent - but beat is sometimes dropped. Consider a pacemaker (CO is decreased)
Third degree heart block:
AV node not conducting rhythm - P wave and QRS complex are totally disconnected. Pt needs a pacemaker. Impacts the Cardiac output.
-----------------------------
--------------------------
Hypothermia
Hypoxia
Hypo/Hyper kalemia
Hypovolemia
H+ ions (acidosis)
Thrombosis (coronary)
Thrombosis (pulmonary)
Tension pneumothorax
Tamponade
Tablets (overdose)
----------------------------
First degree heart block:
Long PR Interval, > .20
Second degree heart block Type I:
Wenkebach: longer, longer, drop
PR interval gets longer and longer until a beat is dropped.
Second degree heart block Mobitz type II:
AV node is the problem; caused by disease or ischemia
May progress to 3rd degree heart block. PR interval is consistent - but beat is sometimes dropped. Consider a pacemaker (CO is decreased)
Third degree heart block:
AV node not conducting rhythm - P wave and QRS complex are totally disconnected. Pt needs a pacemaker. Impacts the Cardiac output.
-----------------------------
Wednesday, February 15, 2012
Heart sounds, S1, S2, S3, S4, gallops, murmurs
S1: the AV valves closing
S2: the semilunar valves closing
S3: resistance during ventricular filling; heard early in diastole; most commonly due to heart failure (fluid overload)
S4: resistance during atrial contraction, heard late in diastole; most commonly due to hypertrophy of the ventricle.
murmur: turbulent blood flow
gallop: tachycardia, s3 and s4 sound.
------------------
S2: the semilunar valves closing
S3: resistance during ventricular filling; heard early in diastole; most commonly due to heart failure (fluid overload)
S4: resistance during atrial contraction, heard late in diastole; most commonly due to hypertrophy of the ventricle.
murmur: turbulent blood flow
gallop: tachycardia, s3 and s4 sound.
------------------
Tuesday, February 14, 2012
Pink top
If a patient comes in pregnant and bleeding, pull a pink top. The pink top blood tube is for the blood bank. If the patient has an ectopic pregnancy, or needs to go to surgery for any reason - then the blood will have already been drawn (won't have to stick the patient again - and saves time).
Monday, February 13, 2012
UTI's in children - pediatrics
Yesterday at work I learned that sometimes a UTI (urinary tract infection) in children can manifest itself as nausea and vomiting. The urine sample sent to the lab may or may not pick up on bacteria in a child's urine - so if the sample is iffy (picks up a small amount of bacteria but not enough to be classified as a UTI), the child may still have a urinary tract infection.
Wednesday, February 8, 2012
Yesterday's test
There was so little on the test yesterday about vents! I had studied the modes of ventilation so much, and there was not much at all on the test about it - except a bit on weaning!!! ay yi yi!!! I dislike when what I spend the most time on, does not end up being on the test!
Rigorous studying
Really, I just like the word "rigorous."
Continuing on from my notetaking yesterday:
18) Right atrial pressure (RAP): This is the same as CVP, central venous pressure. The pressure in the right atrium. Should be 2-6. used interchangeably with CVP.
19) PAOP: pulmonary artery occlusive pressure. This is the same as the "wedge" pressure. PAWP. The Swan-Ganz goes into the patient (The potential sites for insertion of Swan-Ganz catheters include the internal jugular vein, the subclavian vein, the femoral vein and the right or left brachial veins.) http://www.helium.com/items/1740513-swan-ganz-pa-catheter-compare-insertion-sites
http://en.wikipedia.org/wiki/Pulmonary_wedge_pressure
Wedge pressure (PAOP pressure) should be between 8 to 12. >20 is an indicator of acute pulmonary edema.
20) SVR: systemic vascular resistance. Resistance that the left ventricle must overcome to eject a volume of blood.
http://en.wikipedia.org/wiki/Systemic_vascular_resistance
The flow is equal to the driving pressure divided by the resistance.
21) PVR: pulmonary vascular resistance. Resistance the right ventricle must overcome to eject a volume of blood.
22) RVEDV/RVEDP: right ventricular end diastolic volume or pressure. Diastole is relaxation (filling). This is the highest pressure or volume in the right ventricle (since it is when the ventricle is filled to the max, right before ejection). Normally 100 to 160. Measures the R ventricular preload (the stretch).
23) LVEDV/LVEDP: left ventricular end diastolic volume or pressure.
24) SvO2: mixed venous oxygen saturation: 60 to 75%
25) ScvO2: central venous oxygen saturation: 65% to 80%
26) five major components of hemodynamic monitoring: This is the Swan-Ganz catheter that goes in through the IJ (or subclavian, or wherever) (a) invasive catheter (b) non compliant pressure tubing (c) transducer and stopcocks (d) pressurized flush system (e) bedside monitoring system.
27) the zeroing stopcock: stopcock attached to the transducer.
Continuing on from my notetaking yesterday:
18) Right atrial pressure (RAP): This is the same as CVP, central venous pressure. The pressure in the right atrium. Should be 2-6. used interchangeably with CVP.
19) PAOP: pulmonary artery occlusive pressure. This is the same as the "wedge" pressure. PAWP. The Swan-Ganz goes into the patient (The potential sites for insertion of Swan-Ganz catheters include the internal jugular vein, the subclavian vein, the femoral vein and the right or left brachial veins.) http://www.helium.com/items/1740513-swan-ganz-pa-catheter-compare-insertion-sites
http://en.wikipedia.org/wiki/Pulmonary_wedge_pressure
Wedge pressure (PAOP pressure) should be between 8 to 12. >20 is an indicator of acute pulmonary edema.
20) SVR: systemic vascular resistance. Resistance that the left ventricle must overcome to eject a volume of blood.
http://en.wikipedia.org/wiki/Systemic_vascular_resistance
The flow is equal to the driving pressure divided by the resistance.
21) PVR: pulmonary vascular resistance. Resistance the right ventricle must overcome to eject a volume of blood.
22) RVEDV/RVEDP: right ventricular end diastolic volume or pressure. Diastole is relaxation (filling). This is the highest pressure or volume in the right ventricle (since it is when the ventricle is filled to the max, right before ejection). Normally 100 to 160. Measures the R ventricular preload (the stretch).
23) LVEDV/LVEDP: left ventricular end diastolic volume or pressure.
24) SvO2: mixed venous oxygen saturation: 60 to 75%
25) ScvO2: central venous oxygen saturation: 65% to 80%
26) five major components of hemodynamic monitoring: This is the Swan-Ganz catheter that goes in through the IJ (or subclavian, or wherever) (a) invasive catheter (b) non compliant pressure tubing (c) transducer and stopcocks (d) pressurized flush system (e) bedside monitoring system.
27) the zeroing stopcock: stopcock attached to the transducer.
Tuesday, February 7, 2012
4th Semester Respiratory
Got an 86.3% on my respiratory exam today. Happy with my score! This semester, students must score an average of 79% or higher on our exams to pass. So this gives me 7 positive points. Glad for that!
I will not miss the stress of testing. Nursing school is terribly stressful.
We are now moving on to our cardiac/circulation section. Next exam is the end of this month - I believe February 28th, 2012 is the next exam. Our lecture today was about hemodynamics and measurements of different pressures.
1) Cardiac output = stroke volume x heart rate.
2) stroke volume is affected by preload, afterload, and contractility.
3) systole is pumping.
4) diastole is relaxation.
5) AV valves are tricuspid and the bicuspid (mitral). The bicuspid (mitral) is on the left side of the heart. It has two leaflets, whereas the tricuspid has three leaflets. It is called the mitral valve because of the resemblance to a Bishop's mitre hat in the Roman Catholic church.
6) The semilunar valves are the pulmonic and aortic. The pulmonary artery arises from the right ventricle and the aorta arises from the left ventricle.
7) Preload is the stretch - it is the amount of blood in the ventricle prior to ejection (systole).
8) Frank-Starling law: states that the more stretch there is - the more cardiac output there will be (within physiological limits).
9) How does preload affect cardiac output? back to the Frank Starling law here - the more preload there is - the more CO there will be.
10) afterload - resistance. it is the resistance the ventricle must work against when pumping blood into the pulmonary artery or the aorta.
11) contractility: stretchability of the heart. This can be affected by increased intrathoracic pressure (we learned in our respiratory section how PEEP can affect CO). If the heart can't stretch, it can't get as good of a PUMP going. Cardiac tamponade is another good example of this. In cardiac tamponade, fluid or blood builds up in between the myocardium and the pericardium. The heart can't stretch out against the fluid to pump as well. Cardiac tamponade = decreased CO. Another thing to remember about cardiac tamponade is that the blood pressure may fall on inspiration. On inspiration, intrathoracic pressure increases - and cardiac output decreases. When CO decreases, BP decreases.
12) Three ways of non-invasive hemodynamic monitoring: (a) NIBP - non invasive blood pressure (b) jugular vein distention (gives an idea of central venous pressure). Since the jugular is connected to the superior vena cava which goes right into the right atrium - there is a way to occlude the jugular briefly and measure the distention to get an idea of the right atrial pressure (synonymous with central venous pressure). (c) lactate - this lab will give us an idea of anaerobic metabolism.
13) 2 reasons why the CVP may be elevated: excess fluid or right ventricular dysfunction.
14) high serum lactate levels are noted in patients with hypoperfusion, such as in shock states.
15) range for cardiac output = 5 to 8 L per minute.
16) cardiac index = this is the CO / the patient's body surface area. Usually 2.5 to 4.2.
17) central venous pressure - same as right atrial pressure. usually 2 to 6. It is used to guide assessment of fluid balance and responsiveness.
I will not miss the stress of testing. Nursing school is terribly stressful.
We are now moving on to our cardiac/circulation section. Next exam is the end of this month - I believe February 28th, 2012 is the next exam. Our lecture today was about hemodynamics and measurements of different pressures.
1) Cardiac output = stroke volume x heart rate.
2) stroke volume is affected by preload, afterload, and contractility.
3) systole is pumping.
4) diastole is relaxation.
5) AV valves are tricuspid and the bicuspid (mitral). The bicuspid (mitral) is on the left side of the heart. It has two leaflets, whereas the tricuspid has three leaflets. It is called the mitral valve because of the resemblance to a Bishop's mitre hat in the Roman Catholic church.
6) The semilunar valves are the pulmonic and aortic. The pulmonary artery arises from the right ventricle and the aorta arises from the left ventricle.
7) Preload is the stretch - it is the amount of blood in the ventricle prior to ejection (systole).
8) Frank-Starling law: states that the more stretch there is - the more cardiac output there will be (within physiological limits).
9) How does preload affect cardiac output? back to the Frank Starling law here - the more preload there is - the more CO there will be.
10) afterload - resistance. it is the resistance the ventricle must work against when pumping blood into the pulmonary artery or the aorta.
11) contractility: stretchability of the heart. This can be affected by increased intrathoracic pressure (we learned in our respiratory section how PEEP can affect CO). If the heart can't stretch, it can't get as good of a PUMP going. Cardiac tamponade is another good example of this. In cardiac tamponade, fluid or blood builds up in between the myocardium and the pericardium. The heart can't stretch out against the fluid to pump as well. Cardiac tamponade = decreased CO. Another thing to remember about cardiac tamponade is that the blood pressure may fall on inspiration. On inspiration, intrathoracic pressure increases - and cardiac output decreases. When CO decreases, BP decreases.
12) Three ways of non-invasive hemodynamic monitoring: (a) NIBP - non invasive blood pressure (b) jugular vein distention (gives an idea of central venous pressure). Since the jugular is connected to the superior vena cava which goes right into the right atrium - there is a way to occlude the jugular briefly and measure the distention to get an idea of the right atrial pressure (synonymous with central venous pressure). (c) lactate - this lab will give us an idea of anaerobic metabolism.
13) 2 reasons why the CVP may be elevated: excess fluid or right ventricular dysfunction.
14) high serum lactate levels are noted in patients with hypoperfusion, such as in shock states.
15) range for cardiac output = 5 to 8 L per minute.
16) cardiac index = this is the CO / the patient's body surface area. Usually 2.5 to 4.2.
17) central venous pressure - same as right atrial pressure. usually 2 to 6. It is used to guide assessment of fluid balance and responsiveness.
Monday, January 16, 2012
ACLS
How soon after I get my "license in the mail" (thank you, Hurst Review) ... can I take the ACLS course?
Vasopressin, vasopressor and lopressor
Somehow I seem to get vasopressin, vasopressor and lopressor confused! Vasopressin is another term for anti-diuretic hormone (ADH). I try to keep this straight by thinking of my niece. She was born with an underdeveloped pituitary gland, so she has to take DDAVP. DDAVP (desmopressin) replaces the vasopressin - and helps my niece with diabetes insipidus.
A vasopressor causes vasoconstriction, such as levophed. Levophed is something we use in the ER. It is norepinephrine. Norepinephrine is a catecholamine (along with epinephrine and dopamine) that comes from the adrenal medulla. The therapeutic effects of giving a vasopressor are that it will increase blood pressure and increase cardiac output. It may be used in the treatment of severe hypotension and shock.
Lopressor is another name for metoprolol. By the "lol" at the end, you can tell it is a beta blocker. Beta blockers lower the heartbeat. Lopressor/metoprolol can be used to treat tachycardia.
A vasopressor causes vasoconstriction, such as levophed. Levophed is something we use in the ER. It is norepinephrine. Norepinephrine is a catecholamine (along with epinephrine and dopamine) that comes from the adrenal medulla. The therapeutic effects of giving a vasopressor are that it will increase blood pressure and increase cardiac output. It may be used in the treatment of severe hypotension and shock.
Lopressor is another name for metoprolol. By the "lol" at the end, you can tell it is a beta blocker. Beta blockers lower the heartbeat. Lopressor/metoprolol can be used to treat tachycardia.
Sunday, January 15, 2012
Arterial Line
I watched an arterial line being placed on a patient in the ER yesterday. I am a nursing student going in to my 4th and final semester of nursing, and have not learned much about arterial lines. Here is what I learned - but I still have many questions about art lines. I am hoping to start a discussion, to learn more about art lines, and to get some of my questions answered.
What is the difference between an arterial line and a central line?
As I understand it, an art line is placed by a doctor and it is the most accurate measurement of blood pressure. Why would lidocaine make the insertion of an art line more difficult?
In the case of this patient, I believe the indication for placement of the art line was because of frequent blood gas monitoring. The respiratory therapist was having difficulty getting the blood gases - and blood gases were ordered ... I believe it was Q2H. This particular patient had anasarca and very low albumin. The resident doctor was attempting to place the arterial line in the femoral artery x3 attempts with no success.
What are the nursing responsibilities during placement of an arterial line?
What is the difference between an arterial line and a central line?
As I understand it, an art line is placed by a doctor and it is the most accurate measurement of blood pressure. Why would lidocaine make the insertion of an art line more difficult?
In the case of this patient, I believe the indication for placement of the art line was because of frequent blood gas monitoring. The respiratory therapist was having difficulty getting the blood gases - and blood gases were ordered ... I believe it was Q2H. This particular patient had anasarca and very low albumin. The resident doctor was attempting to place the arterial line in the femoral artery x3 attempts with no success.
What are the nursing responsibilities during placement of an arterial line?