Chapter 7: Fluid and Hemodynamic Disorders

Question 1

dilation of arterioles

-blushing, exercise, inflammation

Answer 1

active hyperemia

Question 2

decrease of venous flow; often associated with ______

Answer 2

passive hyperemia (congestion)
hydrostatic edema

Question 3

the liver in patients with ______ results in a characteristic of ‘Nutmeg Liver’ (______)

Answer 3

chronic passive hyperemia of liver
right ventricular failure
multiple red depressed cells

Question 4

the lung in the patients with left ventricular failure often leads to ______ (brown induration of the lung). The macrophages in the lung are known as ______

Answer 4

chronic passive hyperemia of lung
alveolar fibrosis
heart failure cells

Question 5

pulsating flow

bright red color

Answer 5

arterial hemorrhage

Question 6

steady, slow flow

dark red color

Answer 6

venous hemorrhage

Question 7

slow, even flow

bright red color

Answer 7

capillary hemorrhage

Question 8

• results from soft tissue injury
• accounts for nearly 10 million emergency department visits in the US each year
• can carry significant risks of patient ______ and ______
• the seriousness of the injury is dependent on ______ of the hemorrhage (arterial, venous, capillary) and the amount of ______ that can be tolerated by the patient

Answer 8

external hemorrhage 
morbidity
disfigurement 
anatomical source
blood loss

Question 9

• can result from blunt or penetrating trauma, and acute or chronic medical illness
• internal bleeding that can cause ______ usually occurs in one of four body cavities: (list the 4 cavities)

Answer 9

internal hemorrhage
hemodynamic instability
chest
abdomen
pelvis
peritoneum

Question 10

respiratory tract bleeding

Answer 10

hemoptysis

Question 11

vomiting blood

Answer 11

hematemesis

Question 12

blood in urine

Answer 12

hematuria

Question 13

uterovaginal bleeding

Answer 13

metrorrhagia

Question 14

blood in stool or feces

indication of a GI bleed

Answer 14

melena

Question 15

clot formation

Answer 15

thrombi

Question 16

obstruction of the blood supply to an organ or tissue region (typically a thrombus) causes local death of the tissue

Answer 16

infarction

Question 17

• white (______) infarct
• red(______) infarct
• the fate of infarcts depend on their ______, the type of cells forming in the ______, ______ of the organism, extent of ______

Answer 17

pale
hemorrhagic
anatomic site
tissue
circulatory status
necrosis

Question 18

Shock is:

Answer 18

INADEQUATE TISSUE PERFUSION

Question 19

Stages of shock cellular level:
Stage 1:
Stage 2:
Stage 3:
Stage 4:

Answer 19

vasoconstriction
capillary and venule opening
disseminated intravascular coagulation
multiple organ failure

Question 20

if this stage of shock is not treated by prompt restoration of ______, shock progresses to the next stage

Answer 20

stage 1

circulatory volume

Question 21

• occurs with a 15%-25% decrease in ______ blood volume
• ______ rate, ______ rate, and ______ refill are increased. Blood pressure may still be normal
• Postcapillary sphincters resist local effects and remain closed, causing blood to pool or stagnate in the ______, producing ______
• as increasing ______ and ______ lead to opening of additional venules and capillaries, the vascular space expands greatly

Answer 21

Stage 2: Capillary and venule opening
intravascular 
heart
respiratory
capillary 
capillary system
capillary dilation
hypoxia
acidosis

Question 22

Stage 2 continued:

• sluggish blood flow and the reduced delivery of oxygen result in increased ______ and the production of ______
• the ______ attempts to compensate for the acidosis by increasing ventilation to blow off ______
• as acidosis increases, and pH falls, the RBCs may cluster together (______)
• this stage of shock often progresses to the third stage if ______ is inadequate or delayed, or if the shock state is complicated by ______ or ______

Answer 22

anaerobic metabolism
lactic acid
respiratory system
carbon dioxide 
rouleaux formation
fluid resuscitation
trauma
sepsis

Question 23

• time of onset will depend on degree of shock, patient age, and pre-existing medical conditions
• this stage occurs within 25%-35% decrease in ______ volume. At this stage, ______ occurs. This type of shock usually requires ______.
• This state is ______ to treatment (refractory shock), but is still ______
• distal tissue cells use ______ and lactic acid production ______

Answer 23

stage 3: disseminated intravascular coagulation (DIC)
intravascular blood
hypotension
blood replacement
resistant
reversible 
anaerobic metabolism
increases

Question 24

• the amount of cellular necrosis required to produce organ failure varies with each organ and the underlying condition of the organ
• usually, ______ failure occurs, followed by ______ failure, and then ______ failure
• if ______ persists for more than 1 to 2 hours, the cells nourished by that capillary undergo changes that rapidly become irreversible.
• in this stage, ______ falls dramatically (to levels of 60 mmHg or less)
• cells can no longer use ______, and ______ stops.

Answer 24

Stage 4: multiple organ failure
hepatic
renal
heart
capillary occlusion 
blood pressure
oxygen
metabolism

Question 25

• earliest stage
• body can still compensate for blood loss
• level of responsiveness is best indicator of tissue perfusion. Blood pressure is maintained
• treatment will typically result in recovery

Answer 25

compensated phase of shock

Question 26

• blood pressure is falling
• blood volume drops by more than 30%
• compensatory measures begin to fail
• signs and symptoms are more obvious
• cardiac output falls dramatically
• treatment will sometimes result in recovery

Answer 26

decompensated phase of shock

Question 27

• systemic inflammatory response syndrome (SIRS) is a generalized manifestation of a local immune or inflammatory reaction, which is often fatal. SIRS is a hyper metabolic state that features 2 or more signs of systemic inflammation such as fever, tachycardia, tachypnea, leukocytosis
• septic shock is defined as clinical SIRS so severe that it results in organ dysfunction and hypotension
• anti-inflammatory factors also play an important role in some patients. The result is compensated anti-infammatory response syndrome (CARS) , in which paralysis of the immune system resulting in a poor outcome
• Mortality of SIRS/MODS exceeds 50%, making it responsible for most deaths in non coronary intensive care units in the US

Answer 27

irreversible phase of shock

Question 28

generalized manifestation of a local immune or inflammatory reaction, which is often fatal. it is a hyper metabolic state that features 2 or more signs of systemic inflammation such as fever, tachycardia, tachypnea, leukocytosis

Answer 28

systemic inflammatory response syndrome (SIRS)

Question 29

defined as clinical SIRS so severe that it results in organ dysfunction and hypotension

Answer 29

septic shock

Question 30

Heart fails in shock due to these conditions:

• myocardial heart failure
• ______ blood volume
• ______ vasodilation
• ______ vascular permeability

Answer 30

decrease
increase
increase

Question 31

single most important factor in thrombosis is ______

• injury to endothelial cells can also alter local blood flow and affect ______
• abnormal blood flow (stasis or turbulence) in turn, can cause ______ injury
• the factors may act independently or may combine to cause thrombus formation

Answer 31

endothelial integrity
coagulability
endothelial