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A&EII Exam 1 (1)
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Exam of 16 pages for the course ARRT CI Exam Study Guide at ARRT CI Exam Study Guide (A&EII Exam 1 (1))
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A&EII Exam 1Acute coronary syndrome - ANS-Not immediately reversible decreased O2 supply to
heart
Acute coronary syndrome ongoing management - ANS-Continuous ECG monitoring,
administration fo O2 if hypoxic, positioning, frequent vital signs, pain relief, rest, relieve
anxiety, glycemic control, prepare for transfer to next level of care
Aspiration pneumonia - ANS-Inhalation of oropharyngeal secretions or stomach
contents into lungs; inflammatory response to bacterial infection; patients at risk include
those with loss of protective airway reflexes, NG tube feedings, GI conditions (GERD),
and prolonged incubation; effects of aspiration depend on volume and character of
aspirated material but may include mechanical blockage, anaerobic bacterial aspiration,
and gastric juice aspiration
Aspiration prevention - ANS-Maintain head of bed at 30-45 degrees and use sedatives
sparingly, confirm placement of feeding tube before feeding, assess gastric residuals
and tube placement every 4 hours
Asystole causes - ANS-Hypoxia, hypothermia, acidosis, drug OD, severe hypoglycemia,
tension pneumothorax, tamponade, toxins, thrombosis
Asystole characteristics - ANS-Total absence of ventricular electrical activity, no
ventricular contraction, unresponsiveness, pulseless, apneic
Asystole interventions - ANS-Open the airway, intubate, obtain IV access, stabilize
airway (head tilt), CPR (100-120 compressions/min, 2 in deep, 30 compressions: 2
breaths), do not shock but bring crash cart to the room, assess in >1 ECG lead,
epinephrine 1 mg IV/IO (repeat q3-5 mins), lower patient and put on solid, flat surface, if
rhythm changes to pulseless v-tach or v-fib then defibrillate
Atelectasis - ANS-Collapse of alveoli or lobule or larger lung unit
Atelectasis Clinical Manifestations - ANS-Fever, marked dyspnea, cyanosis, pleural
pain, diminished breath sounds, shallow breathing, cough, tachypnea, hypoxia
Atelectasis Diagnosis - ANS-History and physical, chest x-ray
,Atelectasis etiology - ANS-Airway obstruction of bronchus impedes passage of air to
and from alveoli; air is trapped and absorbed into bloodstream; external
communications is blocked, replacement of air from outside is impossible; results from
exudates and secretions; usually seen postoperatively; complication is acute
pneumonia
Atelectasis management - ANS-Lungs that have collapsed because of an obstruction
should be re-expanded as rapidly as possible to avoid complications of pneumonia or
lung abscess, adequate pain management, mobilization/ambulation of post-operative
patients, deep breathing and coughing exercises, postural drainage/chest
physiotherapy, nebulizer treatments (albuterol), humidified oxygen, suctioning to
stimulate coughing, incentive spirometry
Atherosclerosis - ANS-Thickening of hardening fo artery walls
Atrial fibrillation characteristics - ANS-Associated with aging, atrial fibrosis and loss of
muscle mass; common in HTN, HR, CAD; 25-30% CO lost
Causes/risk factors: rheumatic heart disease, HF, cardiomyopathy, pericarditis, valvular
disease, electrolyte disturbance, caffeine use, thyrotoxicosis
Disorganized atrial electrical activity due to multiple ectopic foci resulting in loss of
effective atrial contraction
Less dangerous than V-fib because ventricle is still fully filling so you still get 70% CO
Atrial rate up to 300-600 bpm
P waves replaced by chaotic, fibrillatory waves
May be chronic or intermittent
Slow, moderate, ventricular response
Atrial flutter characteristics - ANS-P waves absent, referred to as F waves, saw-tooth
appearance on ECG
Rapid ventricular rate and loss of atrial "kick --> decreased CO --> HR
Atrial firing 250-400 BPM
Normal QRS but may be absent
Increased risk of stroke
Biomarkers for MI - ANS-Troponin is most sensitive and specific lab value, raised 3-4
hrs after onset of chest pain and remains elevated for 7-10 days
For 2nd MI in same week, troponin still high, look at CK-MB
Myoglobin is not specific to heart damage but absence can rule out MI
BNP is indicator of - ANS-Heart failure exacerbation (normal is <100)
, CABG equipment - ANS-IV access (central, peripheral), pacemaker (epicardial,
transcutaneous), defibrillator/crash cart, ventilator, suction (endotracheal, oral, NGT),
chest tubes (pericardial, lungs), urinary catheter
Cardiopulmonary bypass risks - ANS-Coagulopathy, heparinization, platelet injury, loss
of pulsatile flow, inflammatory response to artificial surfaces in bypass machines
Cardiopulmonary bypass system - ANS-Use K+ to stop the heart, use machine to
control blood flow/reoxygenate blood, cooling to lower cellular metabolism, bypass the
heart, introduce heparin and beta blockers to decrease cardiac workload and circulating
catecholamines
Chest tube for pneumothorax - ANS-Inserted 4th or 5th intercostal spaces at anterior
axillary line to remove air
CK-MB - ANS-Normal levels: 0-3 ng/mL
Time to initial elevation: 4-8 hours
Peak elevation: 15-24 hours
Return to baseline: 2-3 days
Clinical manifestations of MI - ANS-Chest pain (squeezing, choking, smothering) not
relieved by nitro, hypertension or hypotension, tachycardia or bradycardia, S3 or S4
heart sounds (early/late diastole), heart murmur, increased respirations, signs of heart
failure, nausea, vomiting, fever, restlessness, agitation, cool/pale/diaphoretic skin
Collaborative care for A-fib - ANS-Drugs to control ventricular rate and/or convert to
sinus rhythm (amiodarone, beta blockers, calcium channel blockers), electrical cardio
version, anticoagulation (heparin, warfarin for 3-4 weeks, >48 hrs before attempt at
cardio version), radiofrequency or catheter ablation or maze procedure, direct oral
anticoagulants (factor Xa inhibitors)
Collaborative management fo aspiration pneumonia - ANS-Clearing of obstructed
airway via foreign body removal, suction trachea/endotracheal tube to remove
particulate matter, bronchoscopy if patient has aspirated solid material, emergency or
elective mechanical ventilation, oxygen, fluids, antimicrobials, blood cultures,
antipyretics
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