Practice Questions .....

Questions:

1.      Death from status epilepticus is due to:

a.       Cerebral hypermetabolism

b.      V-fib

c.       Metabolic alkalosis

d.      Cerebral hemorrhage

2.      The priority action for patient who is having a grandmal seizure is:

a.       Volume status

b.      Safety

c.       Antibiotics

d.      Restraints

3.      A VP shunt was recently placed, pt is admitted with positive Kernig’s sign and positive brudzinski’s sign. What is this indicative of?

a.       CNS infection

b.      Blockage in shunt

c.       Non-communicating hydrocephalus

d.      Peritonitis

4.      What type of Meningitis : CSF WBC is 400- 500, protein is 400 and glucose is 10

a.       Bacteria                

b.      viral

c.       Fungal                  

d.      none of the above

5.      A CXR is obtained and a ground glass like appearance is reported. On auscultation the lungs reveal bibasilar crackles. The patient is developing:

a.       A pulmonary embolus

b.      A bacterial pneumonia

c.       COPD

d.      ARDS

6.      Patient was admitted following an MVA. The patient is SOB and RR of 40/min. Breath sounds are greatly diminished on the right with hyperresonance. The patient has:

a.       Flail chest

b.      Pneumothorax

c.       Pulmonary embolus

d.      Hemothorax

7.      Hypoventilation is defined as:

a.       A RR of less than 10

b.      A pCO2 greater than 45

c.       A pO2 less than 75

d.      A pH of greater than 7.35

8.      Arterial hypoxemia from pulmonary embolism is due to:

a.       Diffusion defect

b.      Anatomic shunting

c.       Ventilation perfusion mismatch

d.      Narrowed A-a gradient

9.      Respiratory acidosis and fever will result in changes in the oxyhemoglobin dissociation curve:

a.       A shift to the left

b.      A shift to the right

c.       No change

d.      Both a and b

10.  Which of the following is a correct statement about a shift of the oxyhemoglobin curve to the right?

a.       Increase in blood pH

b.      Increase in body temp.

c.       Less oxygen is being unloaded for a given O2

d.      100% saturation of hemoglobin

11.  Which of the following ABG indicates Acute Respiratory Failure?

   ph                 pCO2              pO2        HCO3

a.       7.18           70                    43            26

b.      7.18           80                    63            42

c.       7.26           55                    54            24

d.      7.34           45                    65            23

12.  Clinical feature of DKA:

a.        Hyperphosphatamia

b.       Hypokalemia

c.        Decreased Anion gap

d.    None of the above

13.  Patient with history of Type I is admitted with flu. Has had flu for a week. Patient’s LOC is decreased, skin dry with poor skin turgor.

a.        Hyponatremia                 

b.       Ketosis

c.        Hyperthermia                  

d.       Hypovolemia

Answers:

1. a
2. b
3. a
4. d
5. d
6. b
7. b
8. c
9. b
10. b
11. c
12. b
13. d

Oxyhemoglobin Dissociation Curve

Questions:

1. Which of the following is a correct statement about a shift of the oxyhemoglobin dissociation curve to the right?

a. It can result from an increase in blood ph.
b. It can result from an increase in body temperature.
c. It results in less oxygen being unloaded for a given pO2.
d. It results in 100% saturation of hemoglobin

2. Respiratory acidosis and a fever would result in which of the following changes in the oxyhemoglobin dissociation curve?

a. A shift to the right and increased saturation
b. A shift to the left and increased saturation
c. A shift to the left and decreased saturation
d. A shift to the right and decreased saturation

3. Which of the following factors would decrease the release of oxygen from hemoglobin at the tissue level?

a. core body temperature of 102.2 degrees fahr
b. arterial pH of 7.32
c. massive transfusion of stored banked blood
d. increased levels of 2,3 - DPG


Facts about the oxyhemoglobin dissociation curve. It explains the affinity of the oxygen to the hemoglobin.

A shift to the right results in unloading of oxygen to the tissues. Oxygen unbinds from the hemoglobin.

The four factors that shifts the oxyhemoglobin dissociation curve to the Right are:

a. increase temperature
b. metabolic acidosis
c. increase in pCO2
d. increase 2,3-DPG

A shift to the left results in oxygen binding tightly with the hemoglobin therefore oxygen does not get to the tissues.

The four factors that shifts the oxyhemoglobin dissociation curve to the Left are:

a. decrease temperature
b. metabolic alkalosis
c. decrease in pCO2
d. decrease 2,3 - DPG

What is 2,3 DPG - it is a metabolite called diphosphateglycerate. It is an adaptive mechanism, made in the red blood cell that controls movement of the oxygen from the red blood cells to the tissue. Increase in this substance shifts the curve to the right and unloads the oxygen into the tissues.

Answers:
1. b
2. a
3. c

STROKE - The First Three Letters ---- S..T..R..

STROKE: Remember The 1st Three Letters... S.T..R ... My friend sent this to me and encouraged me to post it and spread the word. I agree. If everyone can remember something this simple, we could save some folks. STROKE IDENTIFICATION: During a party, a friend stumbled and took a little fall - she assured everyone that she was fine and just tripped over a brick because of her new shoes. (they offered to call ambulance) They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm , Ingrid passed away.) She had suffered a stroke at the party . Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die. They end up in a helpless, hopeless condition instead. It only takes a minute to read this... STROKE IDENTIFICATION: A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough. RECOGNIZING A STROKE Remember the '3' steps, STR . Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions : S * Ask the individual to SMILE .. T * = TALK. Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (eg 'It is sunny out today'). R * Ask him or her to RAISE BOTH ARMS . If he or she has trouble with ANY ONE of these tasks, call the ambulance and describe the symptoms to the dispatcher. NOTE : Another 'sign' of a stroke is 1. Ask the person to 'stick' out their tongue. 2. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. A prominent cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved. And it could be your own. Share · September 30 This was taken from a Facebook Posting!!!

12 Lead EKG Interpretation

Answer:

ST elevations on V1, 2, 3 and 4

LAD

AnteroSeptal MI

Ventricular Arrythmias/High degree heart blocks

Cardiogenic shock

Antoarrythmic agents, pressors, dilators, IABP

12 Lead Interpretation

Questions:

1. The ST elevations are in what leads?

2. What kind of MI?

3. What coronary artery is affected?

4. What possible arrythmias will the patient have?

5. What are the interventions related to the arrythmias?

6. In this kind of MI, what do we want to make sure we rule out? How do we do that?

7. What would be the treatment for that?

The Answers:

1. Leads II, III and aVF

2. Inferior Wall MI

3. Right Coronary Artery

4. brady arrythmias, low degree heart blocks

5. Pacemaker, atropine when symptomatic

6. Right Ventricular Infarct. 18 lead EKG.

7. Volume, volume, volume

Blood Gas

What is your interpretation of the blood gas?

a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic alkalosis
d. Metabolic acidosis


What is the reason and how do you want to treat that?

Any changes on the ventilator settings?

Metabolic Acidosis.

The reason is due to hypoperfusion. When there is hypoperfusion, lactic acid production occurs, anaerobic metabolism ensues and that results into metabolic acidosis.

No changes on the ventilator settings. Give sodium bicarbonate as a temporary fix, treat the hypoperfusion as far as the definitive treatment.

Additional information:

What is the patient's Anion Gap?

The Anion Gap is 21. How did we do that? Add sodium and potasium, minus chloride and CO2.

An Anion gap of less than 15 is normal - that means the metabolic acidosis is due to a base loss.

An anion gap of greater than 15 means that the metabolic acidosis is an acid gain. In this case the hypoperfusion causing lactic acidosis is an acid gain.

Here is another DYK (Did You Know)

Anion gap is not useful when the patient is not on metabolic acidosis!!!

ABG
ph - 7.30
pCO2 - 40
HCO3 - 18
Base Excess - -4

Happy reading!!!

Post Ventricular Septal Rupture Repair

Immediate Post-Op

HR - 122/min
BP - 88/60 mmhg
Temp. - 35.8
PCWP - 13 mmhg
CVP - 12 mmhg
PAP - 42/14 mmhg
SVO2 - 42 mmhg
CI - 1.9
SVR - 2860
Vent settings:
VT - 600
AC - 16
FI02 - 90%


ABG
ph - 7.30
pCO2 - 40
HCO3 - 18
Base Excess - -4

Electrolytes
Na - 138
K - 3.0
Cl - 112
CO2 - 8

Hemoglobin 12
Hct - 32
WBC - 9800

IABP - 1:1 frequency
Aug - 80mmhg
MAP - 45 mmhg
Assisted Aoedp - 50
Unassisted Aoedp - 50
Assisted Systole - 80
Unassisted 81

Mediastinal tube - 60 ml
Pleural CT - no air leaks

Patient is intubated and sedated (on propofol)
Dopamine at 6 mcg/kg/min
Nipride is at 1 mcg/kg/min

Based on hemodynamic parameters, what is the most emergent situation the nurse has to do?

a. Cardiogenic Shock
b. Tension pneumothorax
c. Cardiac Tamponade
d. Septic Shock

The answer to this is cardiac tamponade because there is equalization of pressures between PAD, PCWP and CVP.

What this is?

Hello Everyone,

I want to welcome everyone to my critical care essentials blog. This blog site is more than that. It will be a place to share my thoughts, information and the funny and the sad part of being a nurse. It will be a journey for me and for you. You will get to know me, maybe like me, maybe not like me, you may agree or disagree, I maybe politically incorrect and all my entrees are not a representation of who I work for. These are my thoughts and thus I alone am responisble for it.

The other part of this blog is to share some questions with each others and try to help each other find the correct answers that can all help us out with the certification exams. I will post some questions and have you all look into it. You can post some questions as well.

The last point I want to make is that, I will be posting some thoughts from my iphone and with that said, I maybe posting things that are not grammmatically correct. I will try my very best not to do that.

So let's begin our journey!!!!

Hello