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Med Surg > Exam 1, Deck 3 > Flashcards

Exam 1, Deck 3 Flashcards

1
Q

Shock (def)

A

Generalized inadequate circulation

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2
Q

What happens to electrolytes during shock?

A

K+ rushes out of the cell

Na+ and water rush into cell (cellular edema)

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3
Q

Result of cellular edema (4)

A
  • Fluids and electrolytes move more freely, Na+ pump impaired
  • Cell damage and death
  • Lysosomal membrane rupture
  • Mitochondrial damage
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4
Q

3 types of shock:

A

Hypovolemic

Cardiogenic

Distributive / Circulatory

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5
Q

Hypovolemic shock - what is happening?

A

Loss in circulating volume (Heart is still working)

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6
Q

Cardiogenic shock - what is happening?

A

“Pump failure” - there may be adequate blood, but it’s not being pumped where it needs to go

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7
Q

Disruptive / circulatory shock: What is happening?

A

“Massive Vasodilatation”

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8
Q

3 types of disruptive / circulatory shock

A
  • Neutrogenic
  • Anaphylactic
  • Septic
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9
Q

3 causes of neutrogenic shock

A
  • Spinal cord injury
  • Spinal anesthesia
  • ADEs
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10
Q

3 causes of anaphylactic shock

A
  • Med allergy
  • Bee sting
  • Blood transfusion reaction
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11
Q

Two causes of septic shock

A
  • Systemic infection

- Uncontrolled pneumonia

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12
Q

Vital signs of a client in shock: Compensatory

  • RR
  • HR
  • BP
A

RR: >20/min
HR: >100/min
BP: WNL

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13
Q

Vital signs of a client in shock: Progressive

  • RR
  • HR
  • BP
A

RR: Rapid, shallow
HR: >150/min
BP: Systole <80

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14
Q

Vital signs of a client in shock: Irreversible

  • RR
  • HR
  • BP
A

RR: Intubated
HR: Erratic
BP: Requires support

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15
Q

Mental status of a client in shock:

  • Compensatory
  • Progressive
  • Irreversible
A
  • Compensatory: Restless
  • Progressive: Lethargy
  • Irreversible: Unconscious
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16
Q

Urine output of a client in shock:

  • Compensatory
  • Progressive
  • Irreversible
A
  • Compensatory: Decreasing
  • Progressive: <30cc/hr
  • Irreversible: Anuria
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17
Q

Skin changes of a client in shock:

  • Compensatory
  • Progressive
  • Irreversible
A
  • Compensatory: Cold, clammy
  • Progressive: Mottled, gray
  • Irreversible: Jaundiced
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18
Q

Acid / base of a client in shock:

  • Compensatory
  • Progressive
  • Irreversible
A
  • Compensatory: Respiratory alkalosis
  • Progressive: Respiratory and metabolid acidosis
  • Irreversible: Profound acidosis
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19
Q

What is going on with compensatory shock (sum it up - 1 word)

A

HYPOXIA

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20
Q

What is going on with progressive shock (sum it up - 1 word)

A

HYPOINFUSION

of all symptoms

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21
Q

What is going on with irreversible shock? (sum it up - one word)

A

DEATH

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22
Q

Three things you do assess with a patient in shock:

A

1) VITALS: Check RR & HR often
2) Check for orthostatic hypotension
3) Assess for changes in LOC

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23
Q

When does cellular damage occur with shock?

A

BEFORE blood pressure begins to drop

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24
Q

Respiratory Sxs of a patient in progressive shock (4)

A
  • Shallow, rapid respirations
  • Crackles 2/2 PE
  • Decreased O2 levels (hypoxic)
  • PaCO2 levels increase (hypercapnic)
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25
Q

Cardiac Sxs of a patient in progressive shock (5)

A
  • HR increases to 150 bpm
  • Arrhythmias (2/2 hypoxemia)
  • Ischemic changes (on ECR)
  • Chest pain * MI
  • BP dropping
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26
Q

Neurologic Sxs of a patient in progressive shock (4)

A
  • Confusion
  • Lethargy
  • LOC
  • Dilated pupils
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27
Q

Kidney Sxs of a patient in progressive shock (3)

A
  • Decreased perfusion leads to decreased GFR –> acute renal failure
  • Oliguria (<30mL/hr)
  • Increased BUN and Creatinine
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28
Q

Liver Sxs of a patient in progressive shock (3)

A
  • Enzymes rise
  • Decrease ability to metabolize meds and waste products
  • JAUNDICE
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29
Q

GI Sxs of a patient in progressive shock (2)

A
  • Ulcers

- Bleeding

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30
Q

Priorities for a patient in shock (2)

A

1) Limit further damage
2) Improve cardiac function:
- -> improve blood sully
- -> Decrease oxygen demand

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31
Q

Shock: Position of patient

A

Modified trendelenburg: Torso is flat, legs are elevated 20-40*

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32
Q

Shock: IVs (2)

A
  • Blood products

- Isotonic r most likely to stay intravascular

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33
Q

Comfort for a shock patient

A

DO NOT ADD BLANKET – would increase peripheral vasodilatation and further drop BP

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34
Q

Why do you put a shock patient on bedrest?

A

To decrease BMR

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35
Q

Why are shock meds given IV?

A

Because of poor perfusion to muscles and GI tract

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36
Q

Two goals of shock meds:

A

1) Maintain (or increase) CO

2) Decrease cardiac workload

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37
Q

Two meds that work together to maintain CO and decrease cardiac workload (for shock)

A

Adrenergic

Vasodilator

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38
Q

Adrenergics given for shock (2)

A

Dobutamine or dopamine

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39
Q

Function of adrenergics in shock (3)

A
  • Increase CO
  • Vasoconstriction increases afterload
  • Increased myocardial contractility
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40
Q

Vasodilator given for shock

A

Nitroglycerine

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41
Q

Functions of Nitroglycerine in shock (3)

A
  • Decrease preload and afterload
  • Decrease workload of the heart
  • Overall: DECREASE OXYGEN DEMAND
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42
Q

Overall effect of Adrenergic + Vasodilator (Shock) (4)

A
  • Increased CO
  • Minimizes cardiac workload
  • Vasodilitation (increased blood flow to myocardium)
  • Increased O2 delivery to heart
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43
Q

Besides Dobutamine and Dopaimine, four other adrenergics given for shock

A
  • Norepinephrine (Levophed)
  • Epinephrine
  • Phenylephrine
  • Antiarrhythmic meds
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44
Q

What IV solution do you administer to a patient in shock? Why (2)?

A

NORMAL SALINE.

  • Isotonic more likely to stay intravascular
  • If you give blood products, glucose causes clotting.
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45
Q

Monitoring device for shock

A

“Swan Ganz Catheter” (Right heart catheter)

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46
Q

Where should monitor device be inserted

And why not in the other placei t could go

A

Intrajugular

Could be subclavian, but risk puncturing lung

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47
Q

Shock complications: Respiratory

A

“Shock Lung” / “Adult Respiratory Distress Syndrome”

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48
Q

What is ARDS

A

Adult Respiratory Distress Syndrome

- Increasing capillary permeability leads to fluid seeping around lungs

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49
Q

How do you know if a patient has ARDS

A

PaO2 keeps dropping even as you increase oxygen

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50
Q

Shock complications: Organs

  • Multiorgan complication
  • Four affected symptoms
A

Multiple Organ Dysfunction Syndrome (MODS)

  • Renal failure
  • GI bleed
  • Lungs
  • Liver
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51
Q

What comprises the upper respiratory?

A

Nares to trachea

52
Q

What comprises the lower trachea?

A

Carina to alveoli

53
Q

Where is the carina?

A

At the angle of Louis

54
Q

How do you know if you have intubated too far?

A

Breath sounds on the right side but none on the left – pull back

55
Q

Decreased _______ is a factor in ARDS

A

surfactant

56
Q

Where is anatomical dead space? How big is it?

A
  • Everything respiratory that is not alveoli

- 1mL of anatomical dead space per pound of person

57
Q

Flaring of nostrils: Late or early sign of respiratory distress?

A
  • Late sign in an adult

- Early sign in a baby

58
Q

Mouth breathing: Early or late sign of respiratory distress?

A
  • Usually more of a late sign
59
Q

What is “Negative Inspiratory Force?” What is normal NIF (#)?

A

Force a patient must be able to generate in order to respirate.

Normal NIF = - 60

60
Q

Resistance of airways is determined by

A

DIAMETER

61
Q

Three problems that narrow airways (and how)

A 
Asthma (bronchoconstriction)
Bronchitis Mucus)
Foreign bodies (Obstruction)
62
Q

What is the difference between dyspnea and shortness of breath?

A

Dyspnea = air hunger

Shortness of breath = Breathlessness; often high CO2

63
Q

Hemoptysis (def)

A

Blood in sputum)

64
Q

Early signs of hypoxia (3)

A
  • Restlessness
  • Change in LOC
  • Change in RR
65
Q

Late sign of hypoxia

A
  • Cyanosis
66
Q

What is Stridor? What does it indicate?

A
  • High pitched lung sound
  • Indicates major obstruction

MEDICAL EMERGENCY

67
Q

Chest pain is fairly uncommon in respiratory disease except as a late sign – but what could it indicate? (3)

A

Pleurisy
Bad pneumonia
Pulmonary embolism

68
Q

What does a Chest X Ray show?

A

Shows dense tissues: Tumors, foreign bodies, fluid

69
Q

What is a CAT scan? What can it view

A

X rays in succession - can view tumors

70
Q

3 assessments post- bronchoscopy

A
  • Assess ABGs
  • Gag reflex
  • Dysphagia
71
Q

How does a lung scan work

A

“Ventilation perfusion scan” – patient inhales radioactive isotopes (indicates clot to ung, pumonary emboli)

72
Q

Indications for a spirometry machine

A
  • Diagnosis of asthma or COPD
73
Q

What can be observed with a spirometery machine (2)

A

Disease progression

Efficacy of treatment

74
Q

What oxygen mask enables the highest % of O2?

A

Non-rebreather mask

75
Q

What oxygen mask enables the most precise oxygen delivery?

A

Venturi Mask

76
Q

How does respiration on a PEEP ventilator differ from normal respiration?

A

With a PEEP, pressure is still positive at the end of respiration

77
Q

Benefits of PEEP

A

1) Prevents alveolar collapse
2) Effective dose of O2 can be lower
3) O2 administered at inspiration and expiration

78
Q

What does an incentive spirometer prevent (2)

A
  • Atelectasis (closing alveoli)

- Pneumonia

79
Q

When should you never do percussion / vibration?

A

Immediately post-op

80
Q

Two breathing excescises

A
  • Diaphragmatic breathing

- Pursed lips breathing

81
Q

What does pursed lips breathing?

A

Extends the length of exhalation

82
Q

Why should you provide humidity for a patient receiving respiration assistance

A
  • Helps keep secretions loose

- Patient with trach lost mechanical aid of nose and mouth to hydrate air.

83
Q

COPD is an umbrella term for (2)

A

Emphysema, chronic bronchitis

84
Q

Risk factors for COPD (3)

A
  • Cigarette smoking
  • Air / environmental pollution
  • Alpha1-antitrypsin deficiency (genetic)
85
Q

What is alpha1-antitrypsin?

A

Protein that helps protect lungs

86
Q

Emphasema (def)

A

A slowly progressive disease characterized by destruction of the alveoli

87
Q

What is the pathophysiology of COPD? (3)

A
  • Lung elasticity is lost
  • Alveoli destroyed
  • CO2 retained
88
Q

Two hallmark COPD symptoms

A
  • Shortness of breath

- Shallow cough

89
Q

Cor pulmonale (def)

A

Right ventricle increases pumping power to overcome pulmonary hypertension

(leads to hypertrophy, failure)

90
Q

Three VISIBLE signs an examiner may see on a COPD patient

A
  • Barrel chest
  • Clubbing fingers
  • Weight loss
91
Q

Changes with breathing for a COPD patient (5)

A
  • Shortness of Breath
  • Chronic productive cough
  • Prolonged expiration
  • Expiratory wheezes
  • Increased RR
92
Q

What is the prime focus with treating a COPD patient?

A

IMPAIRED GAS EXCHANGE

93
Q

Two things a COPD patient can do to improve symptoms

A
  • Stop smoking

- Drink 2-3L of fluid a day

94
Q

Type of treatment for mild COPD

A

Short acting bronchodilators

95
Q

Type of treatment for moderate COPD

A

long acting bronchodilators

+ short acting bronchodilators for breakthrough sxs

96
Q

Type of treatment for severe / very severe COPD

A

STEROIDS
+ long acting bronchodilators
+ short acting bronchodilators for breakthrough sxs

97
Q

Purpose of bronchodilators (3)

A
  • Relieve bronchospasm
  • Reduce airway obstruction
  • Increase O2 distribution
98
Q

Three types of bronchodilators:

A
  • Adrenergic
  • Anticholinergics
  • Methylxanthine
99
Q

Two types of Adrenergic Bronchodilators:

A
  • B2 Selective short-acting (acute)

- B2 Selective long-acting (daily mx)

100
Q

B2 Selective Short acting - Prototype

When used

A

Albuterol

acute exacerbation

101
Q

B2 Selective Long acting prototype (2 drugs)

When used

A

Formoteral
Salmeterol

(daily maintenence)

102
Q

Anticholinergic: Prototype
(+ 2 other drugs)

(When used)

A

Atropine
(Atrovent, Spiriva)

(daily maintenence)

103
Q

Methylxanthines (2 drugs)

When used

A

Aminophylline

Theophylline

104
Q

Indication of corticosteroids

A

Anti-inflammatory

105
Q

When would a patient be on daily corticosteroids?

A

If they have very advanced or acute COPD

106
Q

Corticosteroid daily maintenence drug

A

Flunisolide (aerobid)

107
Q

Corticosteroid acute exacerbation drug

A

Prednisone (methylprednisone) – SYSTEMIC

108
Q

It is always OK to give COPD patients…

A

2-3 L nasal canula O2

109
Q

Pulmonary Function Test: What is it measuring?

A

Compares Forced Expiratory Volume with Forced Vital Capacity

measures severity of COPD

110
Q

FEV def

A

How fast the air in lungs can be moved out in 1,2 and 3 seconds

111
Q

FVC def

A

How much air volume can be moved in and out of the lungs

112
Q

Three sxs of chronic bronchitis

A
  • Excessive mucus secretions
  • Cough
  • Dyspnea
113
Q

Bronchits: Diagnostic criteria

A
  • Episode lasting 3+ months in 2 consecutive years
114
Q

Two causes of chronic bronchitis

A
  • Recurrent lower RT infections

- Smoking (#1 cause)

115
Q

Asthma: Def

A

Chronic REVERSIBLE inflammatory disease of the airways

116
Q

Three sxs of asthma

A
  • Bronchoconstriction (hyperresponsive airways)
  • Swelling of mucosal lining
  • Thick secretions
117
Q

Four things that are released during an asthma attack

A
  • Histamine
  • Bradykinin
  • Prostaglandins
  • Leukotrienes
118
Q

Respiratory rate of an asthmatic patient (and implications)

A
  • Increased RR to blow off CO2

When they start retaining CO2 instead, patient is exhausted –> Respiratory distress

119
Q

When should you be concerned with an asthmatic patient?

A

If they go into respiratory acidosis

120
Q

Long acting bronchodilators for asthma (4)

ALL FOR DAILY MAINTENANCE

A
  • Mast cell stabilizers
  • Adrenergic Beta 2 agonist
  • Methylxanthines
  • Leukotriene inhibitors
121
Q

Define Status asthmaticus

A

When treatment isn’t working for 24+ hours

122
Q

Mast cell stabilizer – prototype

A

Cromolyn (Intal)

123
Q

Adrenergic Beta 2 – prototype

A

Formoteral (Foradil)

124
Q

Methylxanthines Prototypes (2)

A

Aminophylline

Theophylline

125
Q

Leukotriene inhibitors - prototype

A

Xarfirlukast (Accolate)

126
Q

Are you going to ace this exam

A

fuck yeah

Med Surg (13 decks)

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