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Questions and Answers

What is the primary consequence of hypovolemia on kidney function?

  • Enhanced erythropoietin production
  • Damage due to insufficient blood volume (correct)
  • Decreased potassium levels
  • Increased glomerular filtration rate (GFR)

Which medication is potassium-sparing and requires monitoring for hyperkalemia?

  • Spironolactone (correct)
  • Hydrochlorothiazide
  • Furosemide
  • Atenolol

At what GFR level is chronic kidney disease stage 5 indicated?

  • 15 or lower (correct)
  • Between 30-59
  • Above 60
  • 90 or higher

Which of the following is correct regarding the management of acute kidney injury (AKI)?

<p>Aim for a minimum urine output of 30 mL per hour (B)</p> Signup and view all the answers

How should a dialysis fistula be monitored post-operation?

<p>Listen for a bruit using a stethoscope (C)</p> Signup and view all the answers

Which electrolyte channels do procainamide primarily affect during rapid depolarization?

<p>Sodium and Calcium (C)</p> Signup and view all the answers

What is the major function of Diltiazem in treating coronary artery conditions?

<p>Dilate coronary arteries (D)</p> Signup and view all the answers

What should be prioritized when administering whole blood in cases of severe blood loss?

<p>Prime with normal saline only (B)</p> Signup and view all the answers

Which factor can indicate a possible blood transfusion reaction during administration?

<p>Temperature increase of 1 degree (A)</p> Signup and view all the answers

What is the primary effect of administering antiarrhythmics like procainamide in a clinical setting?

<p>Managing life-threatening dysrhythmias (B)</p> Signup and view all the answers

What is the minimum mean arterial pressure (MAP) considered acceptable to ensure adequate kidney perfusion?

<p>65 mmHg (D)</p> Signup and view all the answers

Which condition may result in reduced production of erythropoietin after severe damage to the kidneys?

<p>Chronic kidney disease (A)</p> Signup and view all the answers

Which of the following medications is associated with monitoring potassium levels due to the risk of hyperkalemia?

<p>Spironolactone (A)</p> Signup and view all the answers

In chronic kidney disease stages 1-3, what symptom may patients typically not notice?

<p>Elevated potassium levels (C)</p> Signup and view all the answers

What is the preferred GFR level for optimal kidney function?

<p>90 or above (A)</p> Signup and view all the answers

Which drug is commonly used to treat fluid overload due to its potency compared to hydrochlorothiazide?

<p>Furosemide (D)</p> Signup and view all the answers

What is the desired output of urine in volume per day for proper kidney function?

<p>2 liters (A)</p> Signup and view all the answers

Which dietary restriction should individuals taking spironolactone observe due to its potassium-sparing effect?

<p>Avoid high-potassium foods (C)</p> Signup and view all the answers

In the case of a fistula created for dialysis access, what assessment should be made to ensure the fistula is functioning properly?

<p>Listen for a bruit (D)</p> Signup and view all the answers

For managing unstable angina, which class of medication is essential?

<p>Calcium channel blockers (D)</p> Signup and view all the answers

What is the primary action of procainamide in emergency situations?

<p>Blocking sodium and calcium channels (A)</p> Signup and view all the answers

What effect does administering Diltiazem have on the cardiovascular system?

<p>Causes vasodilation of coronary arteries (A), Decreases myocardial oxygen demand (B)</p> Signup and view all the answers

Which observation is crucial when monitoring a patient receiving a blood transfusion?

<p>Vital signs should be recorded at the beginning and end (C)</p> Signup and view all the answers

Which of the following factors indicates a possible transfusion reaction during blood administration?

<p>A rise of more than 1 degree in temperature (B)</p> Signup and view all the answers

When using vasopressors in hypovolemic shock, which is essential to monitor?

<p>Mean arterial pressure (MAP) (A)</p> Signup and view all the answers

What describes the role of cranberries in urinary health?

<p>They make urine more acidic, helping to prevent infections (B)</p> Signup and view all the answers

Which of the following is a characteristic of hypovolemic shock?

<p>Decreased urine output and low MAP (D)</p> Signup and view all the answers

Which of the following describes the anatomy of PQRST waves in an ECG?

<p>T wave corresponds to ventricular repolarization (D)</p> Signup and view all the answers

In acute treatment regimens, ambioterone is specifically indicated for which condition?

<p>Managing lung congestion (B)</p> Signup and view all the answers

What potential side effects should be monitored with Diltiazem administration?

<p>Hypotension and bradycardia (C)</p> Signup and view all the answers

What is the primary function of antiarrhythmic medications like procainamide during critical care?

<p>Stabilize cardiac rhythm by blocking sodium channels (B)</p> Signup and view all the answers

Which physiological change occurs during depolarization in cardiac muscle cells?

<p>Sodium ions enter the cells (B)</p> Signup and view all the answers

What monitoring sign may indicate a possible blood transfusion reaction during whole blood administration?

<p>Slight elevation in temperature (A)</p> Signup and view all the answers

Which therapeutic effect is associated with the administration of Diltiazem?

<p>Causes significant peripheral vasodilation (C)</p> Signup and view all the answers

In cases of hypovolemic shock, which of the following is a consequence of potent vasoconstriction?

<p>Diminished blood flow to skin and extremities (D)</p> Signup and view all the answers

What is the role of cranberries in urinary health as mentioned?

<p>Make urine highly acidic, contributing to bactericidal properties (C)</p> Signup and view all the answers

During whole blood transfusion, why is it important to prime the blood products with normal saline only?

<p>To avoid compatibility issues with other fluids (A)</p> Signup and view all the answers

What indicates effective treatment in patients receiving antiarrhythmic agents for life-threatening dysrhythmias?

<p>Stabilization of heart rhythm without new arrhythmias (A)</p> Signup and view all the answers

In monitoring a patient on vasopressors for hypovolemic shock, what is crucial to ensure adequate perfusion?

<p>Maintaining mean arterial pressure (MAP) at a specific level (A)</p> Signup and view all the answers

What potentially dangerous side effect should be monitored with the use of Diltiazem?

<p>Bradycardia and hypotension (A)</p> Signup and view all the answers

How does chronic kidney disease (CKD) primarily affect fluid balance in the body?

<p>Severe edema and swelling due to fluid retention (D)</p> Signup and view all the answers

What are the potential consequences of a GFR dropping below 15?

<p>Severe kidney damage and need for dialysis (C)</p> Signup and view all the answers

When caring for patients with acute kidney injury (AKI), what should be closely monitored aside from urine output?

<p>Mean arterial pressure (MAP) (C)</p> Signup and view all the answers

What is the recommended action if a nurse hears a bruit over a dialysis fistula?

<p>Document and ignore, as this is expected (B)</p> Signup and view all the answers

In patients undergoing treatment with spironolactone, which dietary factor must be considered?

<p>Reduce potassium-rich foods to prevent hyperkalemia (A)</p> Signup and view all the answers

What effect does severe hypovolemia have on kidney function?

<p>Reduced blood flow leading to potential damage (B)</p> Signup and view all the answers

Which medication is most potent for managing fluid overload in patients with renal impairment?

<p>Furosemide (D)</p> Signup and view all the answers

What is the primary purpose of calcium channel blockers in the context of unstable angina?

<p>To relax coronary arteries and reduce heart workload (D)</p> Signup and view all the answers

What defines the distinction between stable and unstable angina?

<p>Stable angina is predictable, while unstable is unpredictable and possibly severe. (B)</p> Signup and view all the answers

What should be assessed to understand fluid status in a patient with acute kidney injury?

<p>Strict intake and output measurements (B)</p> Signup and view all the answers

Flashcards

Kidney Perfusion

Blood flow to the kidneys; crucial for kidney function

Hypovolemia Kidney Damage

Low blood volume, reducing kidney blood flow, potentially causing damage.

Prerenal Kidney Failure

Kidney damage caused by insufficient blood flow before the kidneys.

Sepsis Kidney Damage

Kidney damage caused by a severe infection.

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GFR (Glomerular Filtration Rate)

A measurement of how well the kidneys filter blood.

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GFR >90

Good kidney function—higher is better (optimal is >90)

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Erythropoietin

Hormone made by kidneys that helps make red blood cells.

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CKD Stages

Stages 1-5 describe the progression of Chronic Kidney Disease, ranked according to declining kidney function.

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Stage 5 CKD

Severe kidney failure, GFR <15.

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Dialysis Fistula

Surgical connection for dialysis access.

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AKI (Acute Kidney Injury)

Sudden loss of kidney function.

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MAP (Mean Arterial Pressure)

Average blood pressure throughout the cardiac cycle.

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Potassium-Sparing Diuretics

Drugs preventing potassium loss in urine.

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Spironolactone

Potassium-sparing diuretic; watch for hyperkalemia.

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Hydrochlorothiazide

Diuretic used for high blood pressure and fluid retention.

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Furosemide

Loop diuretic used to treat fluid retention and edema.

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Stable Angina

Predictable chest pain, often with strenuous activity.

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Unstable Angina

Chest pain that changes or worsens, potentially a heart attack.

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Prinzmetal Angina

Chest pain caused by spasm in coronary arteries.

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STEMI

ST-elevation myocardial infarction—a heart attack.

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NSTEMI

Non-ST-elevation myocardial infarction, sometimes heart attack.

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Calcium Channel Blockers

Used in angina, including unstable angina and Prinzmetal angina.

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Troponin Levels

Blood test to diagnose heart damage (usually from a heart attack).

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MONA

Treatment protocol for suspected heart attack (Morphine, Oxygen, Nitroglycerin, Aspirin).

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Ambioterone

A drug used to treat lung congestion, but toxic to the lungs.

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Antidysrhythmics

Medications to restore a normal heart rhythm.

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Sodium Channel Blocker (Example: Procainamide)

Medication that inhibits sodium channels in heart cells to treat life-threatening arrhythmias.

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Diltiazem

A calcium channel blocker that dilates coronary arteries, lowering blood pressure and heart rate.

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Cranberries

Complementary therapy that makes the urine acidic, inhibiting some bacteria, but there's debate.

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Depolarization

Electrical response that causes muscle contraction in the heart.

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Repolarization

Recharging or resting phase after the electrical impulse of muscle contraction.

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PQRST Waves

Electrical activity of the heart on an ECG tracing.

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P Wave

ECG wave representing atrial depolarization.

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QRS Complex

ECG complex representing ventricular depolarization.

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T Wave

ECG wave representing ventricular repolarization.

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Hypovolemic Shock

Shock caused by significant blood loss.

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MAP (Mean Arterial Pressure)

Average blood pressure during one cardiac cycle.

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Whole Blood Transfusion

Administration of complete blood in severe cases of blood loss.

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Blood Administration

Procedure for safely administering blood products, including consent, matching, and monitoring.

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Blood Admin. Prime

Blood products must be infused using normal saline to prevent clogging.

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Blood Type Matching

Checking compatibility of donor and recipient blood types to prevent reactions.

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Blood Transfusion Reaction Monitoring

Observing patient for signs of a reaction during or after a blood product transfusion.

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Neutropenia

Low neutrophil count, increasing the risk of infection.

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Filgrastim

Medication given to increase neutrophil count.

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Low Platelets

Low platelet count.

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Kidney Perfusion

Blood flow to the kidneys, essential for kidney function, and damage from low perfusion can cause kidney damage.

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Hypovolemia & Kidneys

Low blood volume (hypovolemia) reduces blood flow to the kidneys, potentially damaging them.

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Pre-renal Kidney Damage

Kidney damage caused by reduced blood flow before reaching the kidneys.

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Sepsis & Kidney Damage

Severe infections (sepsis) can damage the kidneys due to their effect on blood flow and body-wide inflammation.

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GFR > 90

Good kidney function; a glomerular filtration rate (GFR) above 90 is optimal.

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Erythropoietin (EPO)

Hormone made by kidneys to stimulate red blood cell production.

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CKD Stages

Stages 1-5 describe the progression of chronic kidney disease, reflecting declining kidney function.

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Stage 5 CKD

Severe kidney failure, marked by a drastically reduced glomerular filtration rate (GFR).

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Dialysis Fistula

Surgical connection for dialysis access; Assess carefully; avoid BP/IVs on that side.

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AKI (Acute Kidney Injury)

Sudden loss of kidney function.

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MAP ≥ 65

To adequately perfuse organs, including the kidneys; a minimum target, lower may indicate poor perfusion

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Potassium-Sparing Diuretics

Drugs preventing potassium loss in urine (e.g., spironolactone).

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Spironolactone

Potassium-sparing diuretic. Watch for potassium buildup (hyperkalemia).

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Hydrochlorothiazide

Diuretic; early distal tubule effect; take in the morning; watch K+ level.

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Furosemide

Loop diuretic. Monitor potassium levels. More potent.

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Stable Angina

Predictable chest pain often triggered by activity; often managed with beta-blockers.

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Unstable Angina

Chest pain that changes or worsens, potentially a warning sign of a heart attack; Beta-blocker and nitroglycerin

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Prinzmetal Angina

Chest pain caused by coronary artery spasm, often treated with calcium channel blockers.

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STEMI

Heart attack (myocardial infarction) characterized by ST-segment elevation on ECG.

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NSTEMI

Heart attack (myocardial infarction) with no ST-segment elevation on ECG; possible heart attack but less severe.

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Calcium Channel Blockers

Medications used for angina (including unstable and Prinzmetal) to help control chest pain and lower blood pressure.

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SL Nitro

Sublingual nitroglycerin used for chest pain; call 911; monitor

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Troponin Levels

Blood test to check for heart damage, often a sign of a heart attack.

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MONA

Treatment protocol for suspected heart attack: Morphine, Oxygen, Nitroglycerin, Aspirin.

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INCR lung congestion

Increased fluid in the lungs, potentially a medical emergency.

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Ambioterone

Drug used to treat lung congestion, but toxic to the lungs.

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Antidysrhythmics

Medications used to correct abnormal heart rhythms.

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Sodium Channel Blocker (e.g., Procainamide)

Medication that blocks sodium channels, often for life-threatening heart rhythm problems.

Signup and view all the flashcards

Diltiazem

Calcium channel blocker that dilates coronary arteries, lowers blood pressure and heart rate.

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Cranberries

Complementary therapy that makes urine acidic, potentially affecting some bacteria.

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Depolarization

Electrical event in the heart that leads to muscle contraction.

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Repolarization

Electrical event in the heart that causes muscle relaxation.

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PQRST Waves

ECG waves representing the heart's electrical activity.

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P Wave

ECG wave indicating atrial contraction/depolarization.

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QRS Complex

ECG complex representing ventricular contraction/depolarization.

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T Wave

ECG wave indicating ventricular relaxation/repolarization.

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Hypovolemic Shock

Shock caused by significant blood loss.

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MAP

Average blood pressure during one cardiac cycle.

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Whole Blood Transfusion

Giving complete blood in severe cases with significant blood loss

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Blood Administration

Procedure for safely administering blood products.

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Blood Admin. Prime

Blood products given with normal saline only

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Blood Matching

Checking for compatibility between donor and recipient blood types.

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Blood Transfusion Reaction Monitoring

Observing for signs of a reaction during or after a blood transfusion.

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Neutropenia

Low neutrophil count, increasing risk of infection.

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Filgrastim

Medication to increase neutrophil count.

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Low Platelets

Low platelet count.

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Kidney Perfusion

Blood flow to the kidneys; crucial for kidney function.

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Hypovolemia Kidney Impact

Low blood volume reduces kidney blood flow, potentially causing damage.

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Prerenal Kidney Failure

Kidney damage from insufficient blood flow before reaching the kidneys.

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Sepsis Kidney Damage

Kidney damage caused by severe infection (sepsis).

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GFR (Glomerular Filtration Rate)

Measurement of kidney's blood filtering ability.

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GFR > 90

Good kidney function; higher is better.

Signup and view all the flashcards

Erythropoietin (EPO)

Kidney-produced hormone for red blood cell production.

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CKD Stages

Stages 1-5 show CKD progression, worsening kidney function.

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Stage 5 CKD

Severe kidney failure; low GFR (<15).

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Dialysis Fistula

Surgical connection for dialysis access.

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AKI (Acute Kidney Injury)

Sudden kidney function loss.

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MAP ≥ 65

Minimum blood pressure to adequately perfuse organs; kidneys included.

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Potassium-Sparing Diuretics

Prevent potassium loss in urine.

Signup and view all the flashcards

Spironolactone

Potassium-sparing diuretic; watch for hyperkalemia.

Signup and view all the flashcards

Hydrochlorothiazide

Diuretic that affects the distal tubule, morning dose.

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Furosemide

Loop diuretic, more potent than HCTZ, for lung crackles.

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Stable Angina

Predictable chest pain, often with activity.

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Unstable Angina

Changing/worsening chest pain; possible heart attack.

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Prinzmetal Angina

Chest pain from coronary artery spasm.

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STEMI

Heart attack; ST-segment elevation on ECG.

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NSTEMI

Heart attack; no ST-segment elevation on ECG.

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Calcium Channel Blockers

Used for angina, including unstable and Prinzmetal's.

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Troponin Levels

Blood test to check for heart damage, often associated with a heart attack.

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MONA

Treatment protocol for suspected heart attack: Morphine, Oxygen, Nitroglycerin, Aspirin.

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INCR lung congestion

Increased fluid in the lungs.

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Ambioterone

Drug for lung congestion, but toxic to the lungs.

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Antidysrhythmics

Medications to correct abnormal heart rhythms.

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Sodium Channel Blocker (e.g., Procainamide)

Medication for life-threatening heart rhythms, block sodium.

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Diltiazem

Calcium channel blocker, dilates coronary arteries, lowers blood pressure & heart rate.

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Cranberries

Complementary therapy that makes urine acidic.

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Depolarization

Electrical event in the heart leading to muscle contraction.

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Repolarization

Electrical event making the heart muscle relax.

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PQRST Waves

ECG waves representing heart's electrical activity.

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P Wave

ECG wave showing atrial contraction/depolarization.

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QRS Complex

ECG complex showing ventricular contraction/depolarization.

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T Wave

ECG wave showing ventricular relaxation/repolarization.

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Hypovolemic Shock

Shock caused by significant blood loss.

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MAP

Average blood pressure during one cardiac cycle.

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Whole Blood Transfusion

Giving complete blood in severe cases with significant blood loss.

Signup and view all the flashcards

Blood Administration

Procedure for safely administering blood products.

Signup and view all the flashcards

Blood Admin. Prime

Blood products given with normal saline only

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Blood Matching

Checking compatibility between donor and recipient blood types.

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Blood Transfusion Reaction Monitoring

Observing for signs of a reaction during or after a blood transfusion.

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Neutropenia

Low neutrophil count, increasing risk of infection.

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Filgrastim

Medication to increase neutrophil count.

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Low Platelets

Low platelet count.

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Study Notes

Kidney Perfusion and Function

  • Hypovolemia: Low blood volume negatively impacts kidney function, potentially causing damage. Pre-renal conditions can harm the kidneys.
  • Sepsis: Kidney damage can result from sepsis.
  • GFR (Glomerular Filtration Rate): A crucial indicator of kidney function. Maintaining a GFR above 90 is desirable.
  • Peripheral Shunts: Constant assessment is necessary.
  • Erythropoietin: Kidney injury impairs the production of erythropoietin, a hormone essential for red blood cell production.
  • Chronic Kidney Disease (CKD): Characterized by edema or swelling. Higher potassium (hyperkalemia) is a common complication due to kidney impairment.
  • Potassium-Sparing Diuretics: Spironolactone retains potassium in the body, so potassium-rich foods like spinach, tomatoes, bananas, and potatoes should be moderate or avoided.
  • Hydrochlorothiazide: This diuretic acts on the early distal tubule. Take it in the morning. Monitor potassium levels closely.
  • Furosemide: A more potent diuretic acting on the loop of Henle. Given if lung crackles are present. Monitor potassium levels.
  • CKD Stages: Stages range from 1-5. Stages 1-3 may be asymptomatic. Stage 5 shows severely low GFR (around 15). Aim for a GFR above 60 (ideally above 90).
  • Kidney Transplant Considerations: If waitlisted, don't take blood pressure or insert IVs on the dialysis fistula side. Listen for bruits using a bell.
  • Acute Kidney Injury (AKI): Maintaining a mean arterial pressure (MAP) of 65 or higher is key. Monitor fluid balance (Strict I&O).
  • Lethargy (in AKI): A sign of inadequate perfusion; blood flow preferentially going to heart & lungs.

Cardiovascular Issues

  • Angina: Chest pain.
    • Stable: Often activity-related; Treat with beta-blockers (atenolol).
    • Unstable: Urgent; Treat with beta-blocker (atenolol) plus sublingual nitroglycerin PRN.
    • Prinzmetal: Requires calcium channel blockers (e.g., diltiazem).
  • Myocardial Infarction (MI): Heart attack.
    • STEMI: Full-blown heart attack.
    • NSTEMI: Possible heart attack; Check troponin levels.
  • MONA: Treatment protocol for heart attacks: Morphine, Oxygen, Nitroglycerin, Aspirin.
  • Congestive Heart Failure: Pulmonary edema treated with ambuterone, which is toxic to the lungs.
  • Antiarrhythmics: Medications to treat abnormal heart rhythms.
    • Sodium Channel Blockers: Procainamide. Works on both Na and some Ca channels; use only as needed.
    • Calcium Channel Blockers: Diltiazem dilates coronary arteries and can cause hypotension and bradycardia. Be aware of patient position changes.
  • Heart Action Potentials: Depolarization = contraction; Repolarization = resting. The PQRST waves represent different phases of the heartbeat.
    • P Wave - atrial contraction/depolarization
    • QRS Complex - ventricular contraction/repolarization
    • T Wave - ventricular repolarization

Cardiovascular Shock

  • Shock: Conditions impacting blood pressure and blood flow.
  • Hypovolemic Shock: Blood loss reduces blood volume, leading to low MAP (mean arterial pressure), fatigue, and decreased urine output. Treats with potent vasoconstrictors (norepinephrine, Vasopressin).
    • Norepinephrine may be used as initial treatment for shock.
    • If no results or undesirable effects then alternative medicine is petolomine injection
  • Severe Cases of Hypovolemic Shock: Expect whole blood transfusions to be administered.

Blood Products and Transfusions

  • Blood Administration: Prime with normal saline only. MUST obtain consent. Ensure ABO/Rh matching and double-check RN information. Monitor vital signs (temperature, blood pressure, heart rate) at beginning and end of transfusion, and during administration. Observe for signs of reaction(single degree rise).
  • Blood Reaction Window: Administration takes 30 minutes, watch for reactions within that window. Whole blood is used for severe losses, and is given for 50% blood loss.

Other Topics

  • Urinary System: Cranberries are acidic and make urine bacteriocidal (to a certain degree).
  • Neutropenia: Filgrastim for low neutrophils.
  • Low Platelets:

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