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CP Test 4 > B4-008 CBCL Hemodynamic Shock > Flashcards

B4-008 CBCL Hemodynamic Shock Flashcards

1
Q

TBW calculation as a percent of body weight

A

TBW = 60% of BW

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2
Q

calculation of TBW as a percent of lean body mass

A

LBM = BW - Fat weight
TBW= 72% of LBM

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3
Q

most accurate method of calculating TBW

A

using lean body mass

fat cells contain less water

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4
Q

water movement between ECF and ICF is driven by

A

osmotically active solutes

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5
Q

water movement within the ECF depends on

A

hydrostatic and oncotic pressure

starling forces

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6
Q

water follows

A

solute

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7
Q

water will move from [..] to […] osmotic pressure compartments

A

low to high

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8
Q

gives you information about the number of molecules dissolved in the solution, but may not allow you to predict how cells will respond

A

osmolarity

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9
Q

defines the effect a solution has on the steady state volume of a cell

A

tonicity

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10
Q

causes cell volume to increase

A

hypotonic

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11
Q

does not change initial cell volume

A

isotonic

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12
Q

causes cell volume to decrease

A

hypertonic

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13
Q

body fluid disturbance arise from changes in

2 things

A
  1. osmolarity (tonicity)
  2. volume (expansion/contraction)
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14
Q

hypotonic, isotonic, hypertonic indicate change in

2 things

A
  1. osmolarity
  2. ICF volume
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14
Q

hypotonic, isotonic, hypertonic indicate change in

2 things

A
  1. osmolarity
  2. ICF volume
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15
Q

expansion, contraction
indicate a change in

A

ECF volume

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16
Q

increase in ECF/plasma volume (expansion) will increase venous return, preload, SV and CO. As a result […] will increase

A

MAP

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17
Q

a decrease in ECF/plasma volume (contraction) will reduce venous return, preload, SV and CO. As a result, this will decrease […]

A

MAP

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18
Q

excessive H2O intake is an example of

tonicity/volume

A

hypotonic expansion

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19
Q

how does hypotonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: decrease
ECF volume: increase
ICF osmolality: decrease
ICF volume: increase

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20
Q

how does hypotonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: decrease
ECF volume: decrease
ICF osmolality: decrease
ICF volume: increase

[loss of NaCl]

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21
Q

how does isotonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: no change
ECF volume: increase
ICF osmolality: no change
ICF volume: no change

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22
Q

how does isotonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: no change
ECF volume: decrease
ICF osmolality: no change
ICF volume: no change

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23
Q

how does hypertonic expansion effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: increase
ECF volume: increase
ICF osmolality: increase
ICF volume: decrease

[gain of NaCl]

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24
Q

how does hypertonic contraction effect:
ECF osmolality:
ECF volume:
ICF osmolality:
ICF volume:

A

ECF osmolality: increase
ECF volume: decrease
ICF osmolality: increase
ICF volume: decrease

[loss of water]

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25
Q

salt loss is an example of

tonicity/volume

A

hypotonic contraction

[loss of NaCl]

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26
Q

IV infusion of .9% saline is an example of

tonicity/volume

A

isotonic expansion

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27
Q

hemorrhage is an example of

tonicity/volume

A

isotonic contraction

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28
Q

IV infusion of hypertonic saline is an example of

tonicity/volume

A

hypertonic expansion

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29
Q

dehydration/severe sweating is an example of

tonicity/volume

A

hypertonic contraction

[water loss]

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30
Q

hemorrhage, burns and excessive fluid loss cause what kind of shock?

A

hypovolemic

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31
Q

septic, anaphylactic, and neurogenic cause what kind of shock?

A

distributive

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32
Q

cardiac tamponade, heart failure, MI cause what kind of shock?

A

cardiogenic

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33
Q

all types of shock cause decreased MAP and

A

inadequate tissue perfusion

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34
Q
  • inadequate CO
  • cold/clammy skin
  • low central venous pressure
A

hypovolemic shock

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35
Q
  • systemic vasodilation (decreased TPR)
  • normal blood volume
  • skin feels warm
A

distributive shock

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36
Q

caused by low blood volume

A

hypovolemic shock

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37
Q

caused by arteriolar problem

decreased TPR

A

distributive shock

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38
Q
  • inadequate CO by diseased/impaired heart
  • venous pressure increased
  • skin cold/clammy
A

cardiogenic shock

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39
Q

caused by a pump problem

A

cardiogenic shock

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40
Q

decreased venous return lowers EDV, SV and CO ultimately lowering MAP

A

hypvolemic shock

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41
Q

accompanied by weak pulse

A

hypovolemic shock

42
Q
  • decrease EDV, SV, CO –> MAP
  • decreased pulse pressure
A

hypovolemic shock

43
Q
  • excessive NO production leads to arteriolar vasodilation
  • decreased TPR, MAP
A

septic (distributive) shock

44
Q

systemic arteriolar dilation results in higher rate of runoff

A

distributive shock

45
Q

cause of low MAP in all types of distributive shock

A

decreased TPR

46
Q

mast cell degranulation triggers the release of histamine causing arteriolar vasodilation and increased vascular permeability

A

anaphylactic (distributive) shock

47
Q

degranulation of mast cells in response to allergen

A

anaphylactic (distributive) shock

48
Q

epi pens activate what receptors?

A

alpha 1 and beta2

49
Q

causes decreased sympathetic activity and generalized arteriolar dilation resulting in low TPR

A

neurogenic (distributive) shock

50
Q

deep anesthesia, pain reflex from deep trauma, and vasovagal syncope are causes of what kind of shock?

A

neurogenic

distributive

51
Q
  • fluid accumulation in the pericardial sac causes impaired filling of the heart
  • decreases SV, CO and MAP
A

cardiogenic shock

52
Q

jugular venous distension will be observed in what kind of shock?

A

cardiogenic

53
Q

increased sympathetic firing will have what effects on beta 1 and alpha 1 receptors?

A

beta 1: increase HR and SV
alpha 1: arteriolar constriction and venoconstriction

54
Q

decreased parasympathetic firing in shock will cause

A

increased HR

55
Q

impaired oxygen delivery to tissues leads to

A

anaerobic metabolism

lactic acid = acidosis

56
Q

decreased MAP will decrease baroreceptor stretch leading to a reduction in the release of

A

atrial natriuretic peptide

57
Q

angiotensin II and ADH would be expected to […] in response to decreased MAP

A

rise

58
Q

decreased MAP leads to increased sympathetic firing, […] the metabolites of NE in plasma

A

increasing

59
Q

cold skin and jugular vein distension indicates what kind of shock?

A

cardiogenic

60
Q

[…] serum lactate would indicated adequate volume replacement

A

decreased

indicates adequate tissue oxygenation

61
Q
  • hypotensive with signs of HF
  • JVD
  • cold, clammy extremities

what kind of shock?

A

cardiogenic

62
Q

in what type of shock is CO greater than normal?

A

distributive

63
Q
  • low MAP
  • skin feels warm
  • high heart rate
A

distributive shock

64
Q

increased rate of runoff of blood from systemic arteries to veins

A

distributive shock

65
Q

extensive burns cause loss of plasma, but not RBC. what kind of shock is this?

A

non hemmorrhagic

hypovolemic

66
Q
  • central venous pressure low
  • EKG normal
A

hypovolemic shock

67
Q
  • venous return decreased
  • EDV decreased
A

hypovolemic shock

68
Q

in response to low BP, the baroreflex will

A

increase HR

69
Q

when whole blood is lost, that is

tonicity/volume

A

isotonic contraction

70
Q

hypovolemic shock causes […] stroke volume

A

decreased

71
Q

decreased venous return and cardiac output

A

hypovolemic shock

72
Q

increased sympathetic firing to ventricular myocytes will cause

A

increased cytosolic calcium

73
Q

increased sympathetic firing to systemic arterioles will cause

A

increase TPR

74
Q

during hypovolemic shock, capillary pressure is

A

low

filtration of fluid out of capillary is decreased

75
Q

giving 2.0% saline would cause

tonicity/volume

A

hypertonic expansion

76
Q

severe dehydration causes

tonicity/volume

A

hypertonic contraction

77
Q

normal compensatory response for shock

2

A
  • increase HR
  • increase arteriolar constriction
78
Q

what causes the decrease in hematocrit in hemorrhagic shock?

A
  • decreased capillary pressure reduces filtration
  • net reabsorption of fluid into plasma

decreases crit and ECF volume

79
Q
  • the volume of the ECF is increased, increasing the plasma volume as well as the interstitial fluid volume
  • ICF volume will decrease

tonicity/volume

A

hypertonic expansion

80
Q

calculate ICF volume

A

2/3 x TBW

81
Q

calculate ECF volume

A

1/3 x TBW

82
Q

calculation for TBW using lean body mass

A

(weight - body fat) x .72

83
Q

when calculating ECF after an infusion remember to add

A

liters infused to the ECF value

84
Q

an infusion of 0.45% NaCl would cause

tonicity/volume

A

hypotonic expansion

85
Q

an infusion of isotonic saline to a person with dilutional hyponatremia will […] ICF volume and […] intracellular osmolality

A

decrease volume
increase osmolality

86
Q

infusion with 5% dextrose is the equivalent of

A

administering water

87
Q

infusion of […] will increase both extracellular and intracellular fluid volumes

A

5% dextrose

similar to administering water (hypotonic expansion)

88
Q

ingesting a large amount of water will have what effect on
ICF volume
ICF osmolality
ECF volume
ECF osmolality

A

ICF volume: increase
ICF osmolality: decrease
ECF volume : increase
ECF osmolality: decrease

hypotonic expansion

89
Q

effect of EpiPen on alpha 1 and beta 2 receptors?

A

alpha 1: vasoconstriction
beta 2: relaxation of airway smooth muscle

90
Q

administering 5% dextrose plus 0.9% NaCl would result in

volume/tonicity

A

isotonic expansion

91
Q

administering 5% dextrose would result in

volume/tonicity

A

hypotonic expansion

92
Q

elevated plasma osmolality suggests what kind of shock?

A

hypovolumic

dehydration

93
Q

in hypovolumic shock due to dehydration, the person should be given […] to increase total body water

A

5% dextrose solution

94
Q

increased rate of runoff off blood from sytemic arteries to veins

A

distributive shock

95
Q
  • low MAP
  • warms skin
  • high heart rate

what kind of shock?

A

distributive

96
Q
  • low MAP
  • cold skin
  • no JVD
  • weak pulse

what kind of shock?

A

hypovolemic

97
Q
  • cardiac output is increased due to baroreflex
  • warm skin

what type of shock?

A

distributive

98
Q

cool, clammy skin indicates the cause of the low MAP is

2

A

either hypovolemic or cardiogenic

99
Q

cardiac tamponade impairs ventricular filling, causing

effect on preload and SV

A

decreased preload and SV

100
Q

decreased MAP increases SYM firing to the heart causing

A

increased inotropy

increased HR

101
Q

decreased MAP decreases PARA firing to the heart via the baroreflex causing

A

increased HR

102
Q

mast cell degranulation causes dilation of systemic arterioles and decreased TPR

A

anaphylactic (distributive) shock

CP Test 4 (15 decks)

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