Exam # 1 Common Post-op Complications

Question 0

Describe the Pharmacokinetics of Reglan (Metoclopromide).

Answer 0

1) Onset - IV: 1-3 mins; IM: 10-15 mins; PO: 10-15 mins

2) Duration - 1-2 hours

Question 1

What is the indication for Reglan (Metoclopromide) p?

Answer 1

Nausea

Question 2

Why should you not administer PO antiemetics (nausea pills) to patients who are nauseous?

Answer 2

Because they will just throw it up. Only administer PO antiemetic a as prophylactics.

Question 3

What are the 4 adverse effects of Reglan (Metoclopromide)?

Answer 3

1) Restlessness
2) Drowsiness
3) Depression
4) Extrapyramidal symptoms
* Give 30 mins before meal or chemo to maximize effects

Question 4

What is the indication of Ondansetron (Zofran), and what are the 2 side effects?

Answer 4

1) Indication - Antiemetic (used for nausea and vomiting)

2) Side Effects - Hypertension and anxiety

Question 5

Which types of patients are at especial risk when they have Fluid Volume Excess?

Answer 5

Patients with cardiac and renal problems

Question 6

Low electrolytes contribute to what?

Answer 6

Changes in osmolality which leads to fluid shifts and edema.

Question 7

What is the significance of a SUDDEN increase or decrease in wait gain?

Answer 7

Indicates dehydration or fluid retention

Question 8

What is the equivalent amount of fluid to 1 lb of body weight?

Answer 8

500mL

Question 9

Name 5 appropriate outcomes for Deficient Fluid Volume discussed in class?

Answer 9

1) I&O will balance within 200-500 mL
2) Urine specific gravity will be 1.003-1.030
3) BP & HR will be WNL for that patient
4) Moist mucous membranes
5) A&O x 3

Question 10

Describe the fluid volume challenge

Answer 10

Give the patient fluid very quickly and check their BP. ⬆ BP is expected. If BP stays the same or lowers, then there is a problem.

Question 11

Define Shock

Answer 11

Shock is a syndrome defined by an imbalance in the supply and deman for O2 and nutrients and characterized by ⬇ tissue perfusion and impaired cellular metabolism.

Question 12

What are the 3 main results of Shock?

Answer 12

1) Tissue hypoxia
2) Acidosis
3) End organ dysfunction

Question 13

Describe the effects of Shock on the following systems:

1) Heart
2) Brain
3) Lungs
4) Liver
5) Kidneys

Answer 13

1) Heart - ⬇ coronary artery perfusion > ⬇ Fx of the heart muscle as a pump > ⬇ SV, CO and BP.
2) Brain - ⬇ O2 > ⬇ brain Fx > confusion & loss of consciousness
3) Lungs - ⬇ blood volume > ⬇ O2 > ⬇ gas exchange at the capillary level.
4) Liver - Glycogen stores are depleted by an excess of circulating epinephrine, therefore metabolic acids that are normally detoxified in the liver cause acidosis.
5) Kidneys - ⬇ in CO causes a ⬇ in blood flow through the kidneys > ⬇ urinary output and renal failure.

Question 14

What are the 4 different types of Shock? Which ones are caused by low blood flow and which ones are caused by a maldistribution of blood flow?

Answer 14

1) Cardiogenic Shock Low blood flow
2) Hypovolemic Shock - Low blood flow
3) Obstructive Shock - Low blood flow
4) Distributive Shock - (Maldistribution of blood flow) 3 types are neurogenic shock, anaphylactic shock and septic shock.

Question 15

What are the 4 common causes of Cardiogenic Shock discussed in class?

Answer 15

1) Systolic Dysfunction - Inability of the heart to pump blood forward (i.e., myocardial infarction and cardiomyopathy).
2) Diastolic Dysfunction - Inability of heart it fill during diastole (i.e., pericardial tamponade).
3) Dysrhythmias - (i.e., bradydyrhythmias and tachydysrhythmias)
4) Structural Factors - Valvular abnormality (i.e., stenosis)

Question 16

What are the 2 types of Hypovolemic Shock and what are the causes of each?

Answer 16

1) Absolute Hypovolemia
a) External loss of whole blood (i.e., hemorrhage, surgery, or GI bleeding).
b) Loss of other body fluids - (i.e., vomiting, diarrhea, diuresis, diabetes insipidus and mellitis)

2) Relative Hypovolemia
a) Pooling of blood or other fluids (i.e., bowel obstruction)
b) Fluid Shifts (i.e., burn injuries and acites)
c) Internal Bleeding (i.e., hemothorax)
d) Massive Vasodilation (i.e., sepsis)

Question 17

What are the 3 common causes of Neurogenic Shock discussed in class?

Answer 17

1) Hypovolemic consequence of injury and/or disease to the spinal cord at or above T5.
2) Spinal Anesthesia
3) Vasomotor depression (i.e., severe pain, drugs, hypoglycemia, injury).

Question 18

What are the 9 common causes of Anaphylactic Shock discussed in class?

Answer 18

1) Contrast media
2) Blood/blood products
3) Drugs
4) Insect bites
5) Anesthetic agents
6) Food additives
7) Vaccines
8) Latex
9) Environmental agents

Question 19

What are the 2 common causes of Septic Shock discussed in class?

Answer 19

1) Infection

2) Gram negative bacteria

Question 20

What are the 4 early manifestations of Cardiogenic Shock?

Answer 20

1) Tachycardia
2) Hypotension
3) Narrowed pulse pressure
4) ⬆ Myocardial O2 Consumtion

Question 21

What are the 5 SxS of Cardiogenic Shock?

Answer 21

1) Tachypnea and pulmonary congestion
2) Cool clammy skin and pallor
3) ⬇ Cap refill time
4) Anxiety, confusion and agitation
5) ⬇ Renal perfusion and UO

Question 22

What are the 5 Clinical Manifestations of Hypovolemic Shock?

Answer 22

1) Anxiety, confusion, and agitation
2) Tachypnea
3) ⬇ Preload, ⬇ SV, ⬇ CO
4) ⬇ UO
5) Cool, clammy skin, and pallor

Question 23

Regarding Hypovolemic Shock, what’s is the difference between Compensated Shock and Decompensated Shock?

Answer 23

• COMPENSATED SHOCK
  1) Patient may compensate for 15% of total blood volume (750 mL)
  2) Further loss 15-30% activates the SNS > ⬆ HR, ⬆ CO, ⬆ RR
  3) iIf loss is > 30%, blood volume is replaced.
• DECOMPENSATED SHOCK
  1) Happens when compensatory mechanisms fail

Question 24

What are the 3 types of Distributive or Vasogenic Shock?

Answer 24

1) Neurogenic Shock
2) Anaphylactic Shock
3) Septic Shock

Question 25

What are the 5 characteristics of Neurogenic Shock?

Answer 25

1) Occurs within 30 mins of a spinal cord injury (T5 or above)
2) Can be in response to spinal anesthesia
3) Can last up to 6 weeks
4) The patient has adequate blood volume but is profoundly vasodilated
5) Pooling occurs in blood vessels

Question 26

What are the 8 clinical manifestations of of Anaphylactic Schock?

Answer 26

1) Anxiety, confusion and dizziness
2) Sense of impending doom
3) Chest pain
4) Incontinence
5) Swelling of the lips and tongue, angioedema
6) Wheezing and Stridor
7) Flushing, pruritus and uticaria
8) Respiratory distress and circulatory failure

Question 27

Define Sepsis and Severe Sepsis

Answer 27

1) Sepsis - Systemic inflammatory response to documented or suspected infection
2) Severe Sepsis - Sepsis + organ dysfunction

Question 28

What are the 6 clinical manifestations of Septic Shock?

Answer 28

1) Tachypnea and hyperventilation
2) Temperature Dysregulation
3) ⬇ UO
4) Altered neurologic status
5) GI dysfunction
6) Respiratory failure

Question 29

What is the effect of Shock on systolic and diastolic pressure?

Answer 29

Shock causes vasoconstriction which causes systolic pressure to stay the same or slightly decrease due to further fluid loss. Shock causes diastolic pressure to increase due to the vasoconstriction.

Question 30

What are the 4 stages of Shock?

Answer 30

1) Initial - Not always clinically apparent
2) Compensatory - PTs recover if deficit is corrected
3) Progressive - Leads to end organ failure, give meds that mimic the SNS.
4) Refractory - Irreversible

Question 31

What are the 7 characteristics of the Refractory Phase of shock?

Answer 31

1) Profound hypotension and Hypoxemia
2) Tachycardia worsens
3) Decreased coronary blood flow
4) Renal shutdown
5) Circulatory failure
6) Cerebral ischemia
7) Multiple organ failure

Question 32

What are the 3 pharmacological interventions used for Shock?

Answer 32

1) Epinephrine (Adrenalin) - Mimics SNS
2) Norepinephrine (Levophed) - Mimics SNS
3) Antihistamine (Benadryl) - Used for Anaphylactic shock, because it blocks histamine from the allergic reaction.

Question 33

What are the 4 adverse effects of Epinephrine (Adrenaline) administered as an intervention for Shock?

Answer 33

1) HR > 110
2) Dyspnea from pulmonary edema
3) Chest pain from dysrhythmias and ⬆ myocardial O2 use
4) Renal failure from ischemia

Question 34

What are the 2 adverse effects of Norepinephrine (Levophed) administered as an intervention for Shock?

Answer 34

1) Dysrhythmias

2) Hypertension

Question 35

What are the 3 adverse effects of Antihistamine (Benadryl) administered as an intervention for Shock?

Answer 35

1) Drowsiness
2) Blurred Vision
3) Dry mouth

Question 36

Antihistamines (Benadryl) should never be taken at the same time as which other class of medication?

Answer 36

MAOIs

Question 37

(T/F) Shock can happen very rapidly or a little at a time

Answer 37

True - Always monitor your patients

Question 38

What is the most profound difference between Neurogenic Shock and the other types of Shocks?

Answer 38

Neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin, rather than the cool, moist skin seen in Hypovolemic Shock. Also it is characterized by hypotension and bradycardia rather than tachycardia.

Question 39

(T/F) An important feature of Anaphylactic Shock is bronchospasms (throat closes up), which causes airway compromise and uticaria.

Answer 39

True

Question 40

In the case of Anaphylactic Sock, Epinephrine and Benadryl should be administered. Which one should be administered first?

Answer 40

Epinephrine

Question 41

What encompasses the following stages of shock:

1) Compensatory
2) Progressive
3) Irreversible

Answer 41

1) Compensatory - Decreased urinary output, confusion and respiratory alkalosis.
2) Progressive - Metabolic acidosis, lethargy, and rapid and shallow respirations.
3) Irreversible - Use of mechanical ventilation, altered consciousness, and profound acidosis.

Question 42

Organ failure associated with Multiple Organ Dysfunction Syndrome (MODS) usually begins in which organ?

Answer 42

During MODS, the organ failure usually begins in the lungs and is followed by failure of the liver, GI system and kidneys.

Question 43

What is Cardiac Tamponade? What are the 6 clinical manifestations of it?

Answer 43

• Cardica Tamponade: When the myocardium or pericardium is filled with fluid. The 6 SxS are:
  1) Narrowing pulse pressure
  2) Chest pain
  3) Distant or muffled heart sounds
  4) Jugular vein distention
  5) Hypotension
  6) Tachycardia