Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medsurg 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Shock S/S
~Neuro

A

Early: anxiety, restlessness, increased thirst
Late: ↓ CNS (lethargy,) AMS, weakness, diminished/absent deep tendon reflexes, sluggish pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Shock S/Sx
~Cardiac:

A

↓ cardiac output,↓ bp
↑ hr
Thready/weak pulses, narrowed pulse pressure, decreased peripheral pulses
↓JVP, flat veins (neck, hand)
Slow cap refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Shock S/S:
~respiratory

A

↑ rr
Shallow breathing
↓PaCo2 →↑
Cyanosis (nail beds /lips)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Shock S/S
~ gi

A

↓ motility
Diminished / absent bowel sounds
N/V/constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Shock S/S:
~GU

A

↓ urine output
↑ specific gravity
Sugar/acetone in urin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Shock S/S:
~skin

A

Cool → cold
Pale → mottled → cyanotic
Dry mouth
↓ cap refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to calculate MAP?

A

SBP+ 2 (DBP) and divide by 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens to MAP during shock?

A

↓ due to ↓ total blood volume / cardiac output ( hr x stroke volume) and size/integrity of vascular bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What level do we want the map to be?

A

> 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 3 things does hemorrhage lead to?

A

↓ venous return =↓ JVP
↓ bp
Hypovolemic shock → insufficient organ perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 2 things does trauma cause?

A

Hemorrhage
Third spacing of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 2 things happen w/ third spacing of fluid?

A

Hypovolemic shock
Ruptured vessels leaking into large cavities and ↑ inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Insufficient organ perfusion
~ Brain

A

Cerebral hypoxia = progressive ↓ in LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Insufficient organ perfusion
~ cardiac

A

↓ bp =↑ hr
↓ myocardial contractility (from lactic acidosis) = PEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Insufficient organ perfusion
~ kidneys

A

A renal perfusion
= renal ischemia = acute tubular necrosis = renal failure
↓ GFR = oliguria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Insufficient organ perfusion
~ skin

A

Body vasoconstricts - preserves circulation to vital organs
= cold mottled extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Insufficient organ perfusion
~ all body tissue

A

↓ lactate clearance (liver, kidneys, skeletal muscle)
= lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 4 stages of shock?

A
  1. Initial stage
  2. Compensatory stage
  3. Progressive stage
  4. Refractory/MODS stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe initial stage of shock
What is the alert?

A

↓MAP 5-10
↑ hr, mild vasoconstriction
Body compensates well, maintaining bp and perfuse to vital organs
Normal range for cardiac output and MAP

Alert: ↑ hr/rr may be the only sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the compensatory stage of shock

A

↓ map: 10-15
Kidney/hormonal mechanisms activated to maintain MAP
• ↑ renin, ADH, aldosterone, epi and norepinephrine
↓ urination, ↑ Na +, ↑ blood vessel constriction
↓ tissue hypoxia to vital organs (no permanent damage)
↓ blood ph= acidosis
↑ K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S/S shock
~ objective
~ subjective

A

~ objective: restlessness, ↑ hr/rr, ↑DBP, narrow pulse pressure, cool extremities, decreased Co2
~ subjective: thirst, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Shock
The younger the pt is…

A

The longer the body will try to compensate for

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

S/S of progressive stage of shock

A

↓ MAP - 20
Compensatory mechanism function but ↓ perfusion/oxygenation to vital organs
Hypoxia (vital organs) and Anoxia /ischemia (less vital organs)
= ↑ metabolites → Cell death occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

S/S of progressive stage
Subjective
Objective

A

~subjective: impending doom, confusion, ↑ thirst
~ objective: ↑/ weak pulse, ↓ bp
pallor → cyanosis of mucosa/nailbeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Labs of progressive stage
↓ blood pH ↑ lactic ↑ K+ ↑ PaCo2 / pao2 If caused by dehydration: H&H ↑
26
Describe refractory/ mods stage
Too much cell death from ↓ perfusion / extensivee vital organ damage Will not respond to tx
27
What position do we place patients in to ↑ perfusion
Semi fowlers
28
Medications for shock, what are the categories?
Vasoconstrictors Iotropic agents Drugs that enhance myocardial perfusion
29
What kind of vasoconstrictors do we use in shock
Norepinephrine (levophed) Epinephrine (adrenaline) Vasopressin (Pitressin)
30
What kind of inotropic agents do we use in shock?
Dobutamine / milirione
31
What kind of drugs do ul use to enhance myocardial perfusion?
Sodium nitroprosside Nitroglycerin - dilates coronary arteries
32
How often should he assess vitals
Q 15
33
Sepsis vs sepsis shock
Sepsis = mods Sepsis shock = system inflammatory response syndrome
34
S/s of hypovolemia
↑ hr, ↓ bp, thready pulse, orthostatic hypotension, ↓ CVP, ↑ rr, hypoxia Seizures can occur
35
Define sepsis shock
Infection + Widespread inflammation occurs = systemic inflammatory response syndrome = hormonal, tissue, vascular and oxidative stress → ↓Gas exchange / perfusion
36
Difference between Innate response vs compensatory response
Innate: fever, leukocytosis/ leukopenia, left shift/bandemia Compensatory: tachypnea, hypotension, altered loc = mods
37
S/S of sepsis shock
↓ bp, ↓ urine output,↑ rr Temp changes based on duration of sepsis/ WBC function Inappropriate clotting w/microthrombi formation ↑ toxic metabolites, ↑ inflammation
38
Define DIC What is this a complication of?
Complication of sepsis Fibrin and clotting factors are consumed, none are left causing bleeding
39
What are normal lactate levels?
1-2 = normal >2 = sepsis 4-6-septic shock
40
Hemodynamic monitoring: CVPP What does it stand for? What are the levels
Central venous pressure Normal: 2-8 Hypovolemic: <2 Hypervolemic: > 8
41
Define SIRS
Pro / anti inflammatory mediators released, causing them to fight each other and body attacks itself
42
Lab values during DIC
Decreased: - ↓ serum fibrinogen -↓platelets on CBC Increased: ↑ d-dimer ↑ fibrin degradation products ↑ prothrombin time (pt) ↑ partial thromboplastin time (ptt)
43
What are clinical manifestations of bleeding during DIC
Petechia, ecchymoses, weeping wound sites Bleeding mucous membranes (mouth, nose, ears, eyes)
44
What is an end stage s/s of hypovolemia?
Pale, cold clammy skin
45
In hemorrhagic shock, what “fluids" do we give?
PRBC's Clotting factors: FMP and Cryo
46
A change in one v/s in a 4-6 hr period =?
↑ sepsis risk
47
Why do all those lab levels change in DIC?
Clotting factors break apart and float in blood
48
What is the difference between primary and secondary assessment?
Primary: What needs to be taken immediately • ABCDE Secondary: anything else wrong but doesn't need to be addressed immediately
49
What does ABCDE stand for?
Airway (confirm patent and c-spine is immobile) Breathing (can place pt up to 6L w/o order) Circulation (check all pulses, establish IV/IO access, consider blood order) Disability (state GCS, pupil size/response) Exposure (remove clothing, cover w warm blanket)
50
Objective vs subjective
Objective: what nurse evaluates (vital signs, assessment, pain scale) Subjective: what pt feels
51
What does CVP monitor?
' R atrial pressure (changes due to volume loss )
52
How to calculate Cardiac output
Stroke volume x hr (amount of blood in left ventricle)
53
Emergency nursing Changes in pupils indicate what?
Construction: drug related Dilation: drugs, brain injury, sever hypoxia Unequal: brain swelling, head injury, blunt force trauma Unreactive: brain injury and poor outcomes
54
Are pupils changing an early or late sign
Late sign in decompensating pt
55
Danger v/s emergency nursing Age, hr, rr
<3m0, >180 bpm, > 50 RR 3m -3y, >160, 140 RR 3-8y, 140,> 30 8y, > 100, >20
56
What are the reversal of anticoagulants?
Vit k Concentra Prothrombin complex Protamine Praxablind
57
What are CVP levels?
Normal: 2-8 Hypervolemic: >8 Hypovolemic : 0-2
58
Heat exhaustion s/s
Flu like headache, weakness, N/V
59
Heat exhaustion tx Community vs clinical
Community: stop activity, find cool place, drink water, remove tight clothes Clinical: monitor v/s, rehydrate w/NS, draw electrolytes, may need admitted
60
Heat stroke S/S
Body temp >104-105 AMS (confusion, bizarre behaviors, seizures, coma) ↓BP, ↑ hr, ↑ rr, weak pulse Weakness, hot/flushed dry skin ↓ NA+ Can cause cerebral edema/encephalopathy, brain hemorrhage then coma
61
Heat stroke Tx Community vs clinical
Community: medical emergency, ensure airway, contact EMS, no food or liquid (aspiration risk) Clinical: give O2, large bore IVs, NS rehydration, cooling blanket, labs, core temp (rectal/foley), check for elevated troponin and myoglobinuria
62
Emergency nursing Primary survey
AIRWAY/ALERT (AVPU-Alert, Voice arousal, Pain arousal, Unresponsiveness) Breathing (broken ribs/flail chest can affect this) Circulation (palpable carotid, femoral and cap refills) Disability (neuro status, GCS, PERRLA) Eexposure
63
Emergency nursing Secondary Survey
Needs attention after emergent condition SAMPLE Symptoms, Allergies, Meds, Past hx, Last oral intake, Evebts Head to toe Check/palpate head, drainage from eyes (CSF LEAK), chest, GI, extremities, log roll and check back
64
Color code Red =? Yellow =? Green=? Black =?
Red-emergent Yellow- can wait for short time Green= monurgent/walking wounded Black= expected to die
65
Trauma centers Level 1?
Large teaching hospitals All trauma surgeon (Paeds/adults) Conducts research for trauma verification
66
Trauma centers Level 2 vs 3
both community hospitals Level 2: provides care to most pt Level 3: stabilizes pt with most injury then transfer
67
Trauma center Level 4
Rural and remote Basic trauma stabilization and ACLS THEN TRANSFER IMMEDIATELY
68
Types of disasters External vs internal
Internal: fire, explosion, loss of critical utilities, violence External: earthquake, tornado, technology problems, viruses

Medsurg 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions