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ANCC Adult Gerontology Acute Care
Study Guide Solutions
Cardiac Index - ANSWER✔✔-2-4
SVR/Afterload - ANSWER✔✔-800-1200
MAP - ANSWER✔✔-mean CVx80/CO
PA pressure - ANSWER✔✔-15-30
Wedge PCWP pressure - ANSWER✔✔-6-12
Hypovolemic Shock Parameters - ANSWER✔✔-Preload CVP decreased, SVR afterload increased, CI
decreased, Oxygen delivery Decreased, Venous Oxygen saturation increased
Types of hypovolemic shock - ANSWER✔✔-Hemorrhage, burns, pancreatitis
Cardiogenic shock parameters - ANSWER✔✔-CVP preload increased, SVR afterload increased, CI
decreased, oxygen delivery decreased, SV02 decreased
Types of cardiogenic shock - ANSWER✔✔-Post mi, malignant dysrhythmia, acute myocarditis
Obstructive shock parameters - ANSWER✔✔-Preload either, SVR increased, CI decreased, oxygen
delivery decreased, SV02 decreased
Types of obstructive shock - ANSWER✔✔-Tension pneumo, cardiac tamponade, PE
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Distributive shock parameters - ANSWER✔✔-Preload CVP decreased, afterload SVR decreased, CI
increased, SV02 decreased, oxygen delivery increased
Types of distributive shock - ANSWER✔✔-Septic shock, anaphylaxis, neurogenic shock
CVP Preload - ANSWER✔✔-2-8
Cardiac Output - ANSWER✔✔-4-8
MAP - ANSWER✔✔-70-90
Fractional Excretion of NA <1% - ANSWER✔✔-Prerenal state of kidney dysfunction (i.e. dehydration)
Fractional Excretion of NA >2% - ANSWER✔✔-ATN (acute tubular necrosis)
CPP equation - ANSWER✔✔-MAP-ICP
SIADH Hyposmolar hyponatremia "inappropriate water retention" - ANSWER✔✔-serum sodium low,
serum osmo low <280, urine osmo high >100, no dehydration, tx restrict fluids
if neuro symptoms give 3%NS
DI Hyperosmolar hypernatremia dry - ANSWER✔✔-Serum sodium high, serum osmo high >290, urine
osmo low <100, urine spec grave 1.005 (urine is like water), urine sodium >20, dehydration, if serum Na
>150 give D5W to replace ½ volume deficit in 12-24 hours, avoid rapid lowering of Na, DDAVP for acute
situations
Serum Osmo - ANSWER✔✔-280
Urine Osmo - ANSWER✔✔-300-800
Sodium - ANSWER✔✔-~140
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Total cholesterol - ANSWER✔✔-<200
Triglycerides - ANSWER✔✔-<150
HDL - ANSWER✔✔->40
LDL - ANSWER✔✔-<100
Management of pulm edema - ANSWER✔✔-02, sitting up, morphine 2-4mg, Lasix 40, another Lasix 40 if
needed
Left heart failure - ANSWER✔✔-LUNGS, dyspnea at rest, rales, wheezing, generally healthy except acute
event, S3, murmur of mitral regurg
Right heart failure - ANSWER✔✔-JVD, hepatomegaly, peripheral edema
MR ASS - ANSWER✔✔-Mitral regurg, aortic stenosis, systolic murmurs
MS ARD - ANSWER✔✔-Mitral Stenosis, aortic regurg, diastolic
Mitral murmur locations - ANSWER✔✔-5th ICS, apex
Aortic murmur locations - ANSWER✔✔-2nd or 3rd ICS, base
S1 - ANSWER✔✔-AV valves closed, SL open
S2 - ANSWER✔✔-SL closed, AV open
Cardiac blood flow - ANSWER✔✔-SVC,RA, tricuspid, RV, pulmonic valve, pulmonary artery, lungs,
pulmonary veins, LA, mitral, LV, Aortic valve, aorta, body
Cushing's - ANSWER✔✔-Moon face, buffalo hump, hypertension, HYPERglycemia, HYPERnatremia,
HYPOkalemia, tx depends on cause (stop meds, tumor)
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Addison's ADRENOcorticoid deficiency - ANSWER✔✔-Remember: SEX, SALT, and SUGAR
Deficient cortisol, androgens, and aldosterone, hyperpigmentation in buccal mucosa, tanning,
HYPOtension, scant hair, HYPOglycemia, HYPOnatremia, HYPERkalemia, cosyntropin is the rule out for
addison's, manage: referral, glucorticoid, hydrocortisone, fludrocortisone inpatient: hydrocortisone and
fluids
HYPERthyroidism/Grave's - ANSWER✔✔-TSH LOW, T3 High, Grave's Disease, bulgy eyes, weight loss, fine
thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
Thyroid crisis - ANSWER✔✔-PTU or Methimazole with adjunct within 1 hour Lugol's propranolol,
hydrocortisone
No ASA
Hypothyroidism - ANSWER✔✔-(TSH assay most sensitive test) TSH ELEVATED, T4 LOW
hasimototo's most common, LOW AND SLOW, cold intolerance, weight fain, brittle nails, brady,
hypoactive BS, Levothyroxine 50-100mcg
Myxedema Coma - ANSWER✔✔-AIRWAY, fluid replacement PRN, levothyroxine 400mcgIVx1
Subacute thyroiditis - ANSWER✔✔-Treated symptomatically with propanonlol
Pheocromocytoma - ANSWER✔✔-Labile hypertension, TSH normal, postural hypotension, plama-free
metanephrines to rule out, CT to confirm, surgical removal, postop: hypotension, adrenal insufficiency,
hemorrhage
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