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Adult health II final > Exam 1: Infection and Shock > Flashcards

Exam 1: Infection and Shock Flashcards

1
Q

Airborne isolation

A
  • Negative airflow rooms required to prevent spread of microbes
  • HEPA filter
  • For TB, measles, chickenpox
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2
Q

Droplet isolation

A

Protect from droplets that may travel 3 feet but are not suspended for long periods

For influenza, mumps, pertussis, meningitis

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3
Q

Contact isolation

A
  • For known or suspected infections transmitted by direct contact or contact with items in environment
  • For MRSA, pediculosis, scabies, RSV, C. difficile
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4
Q

CDC prevention guidelines

A
  • Practice hand hygiene, proper handwashing

- Personal protective equipment (PPE)

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5
Q

MRSA and VRE treatment and prevention

A
  • Vancomycin
  • Linezolid

Health teaching best way to decrease incidence

  • Perform frequent hand hygiene, including use of hand sanitizers
  • Avoid close contact with people with infectious wounds
  • Avoid large crowds
  • Avoid contaminated surfaces
  • Use good overall hygiene
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6
Q

Management of Ebola in hospital

A
  • IV fluid & electrolyte replacement
  • Oxygen & ventilation support
  • Blood pressure support
  • Care & Comfort
  • Symptomatic care
  • Emotional support
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7
Q

Bioterrorism isolation

A
  • Anthrax: Standard Precautions
  • Botulism: Standard Precautions
  • Plague: Droplet & Contact
  • Smallpox: Standard, Contact & Airborne
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8
Q

Hypovolemic Shock etiology

A
  • Total body fluid decreased

- Hemorrhage, Dehydration

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9
Q

Hypovolemic Shock symptoms

A
  • Increased HR
  • Decreased blood pressure
  • Narrowed pulse pressure
  • Postural hypotension
  • Flat neck and hand veins in dependent positions
  • Slow capillary refill
  • Pale, cool, moist skin
  • Decreased cardiac output/cardiac index (know numbers)
  • Low central venous pressure (CVP)
  • Decreased PAWP
  • Increased SVR
  • Increased RR (Decreased Paco2/Decreased Pao2)
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10
Q

Distributive shock etiology

A
  • Blood volume distributed to interstitial tissues where it cannot circulate, deliver oxygen
  • Caused by loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, capillary leak
  • Neural-induced distributive shock
    Neurogenic
  • Chemical-induced distributive shock
    Anaphylaxis, Sepsis, Capillary leak syndrome
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11
Q

Distributive shock from anaphylaxis symptoms

A
  • Decreased BP
  • Increased HR, tachycardia
  • Increased RR, tachypnea
  • Cough, dysphagia
  • Hoarseness
  • Stridor
  • Wheezing
  • Rales/rhonchi
  • Restlessness, anxiety, apprehension
  • Pruritis, erythema, urticaria
  • Angioedema
  • Decreased CO/CI
  • Decreased CVP
  • Decreased PAWP
  • Decreased SVR
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12
Q

Distributive shock from neurogenic symptoms

A
  • Hypotension
  • Bradycardia
  • Warm, dry, skin
  • Hypothermia
  • Bounding pulse
  • Decreased CO/CI
  • Decreased CVP
  • Decreased PAWP
  • Decreased SVR
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13
Q

Distributive shock from septic symptoms

A
  • Increased HR
  • Decreased BP
  • Wide pulse pressure
  • Full, bounding pulse
  • Pink, warm, flushed skin
  • Increased RR
  • Crackles
  • Change in sensorium
  • Increased temperature
  • Increased CO/CI
  • Decreased SVR
  • Decreased CVP
  • Decreased PAWP
  • Increased SvO2
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14
Q

Sepsis pathophysiology

A

When SIRS is a result of infection

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15
Q

Sepsis symptoms

A
  • Temp> 38 C° or < 36° C
  • HR > 90 bpm
  • RR > 20 per min
  • Altered mental status
    • fluid balance > 20ml/kg in 24hrs
  • Glucose >140 mg/dl
  • WBC > 12,000/mm3, < 4,000/mm3, or > 10% bands
  • Elevated C-reactive protein
  • Elevated plasma procalcitonin
  • SBP < 90 mm Hg or a decrease >40 mm Hg
  • MAP < 70 mm Hg
  • Svo2 > 70%
  • CI > 3.5 L/m
  • Serum lactate > 1 mmol/L
  • Pao2/Fio2 < 300
  • UOP < 0.5 ml/kg/hr
  • Creatinine increase > 0.5 mg/dl
  • INR > 1.5 or aPTT > 60 sec
  • Absent bowel sounds, Ileus
  • Platelet count < 100
  • Hyperbilirubinemia > 4mg/dl
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16
Q

SCCM guidelines: within 3 hours of presentation

A
  • Measure lactate level
  • Obtain blood cultures prior to the administration of antibiotics
  • Administer 30 ml/kg of crystalloid for hypotension or lactate > 4 mmol/L
17
Q

SCCM guidelines: within 6 hours of presentation

A
  • Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65mmHg
  • In the event of persistent hypotension after initial fluid administration (MAP < 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion
  • Re-measure lactate if initial lactate elevated
18
Q

Hypovolemic shock treatment

A
  • fluid or blood replacement

- possible vasopressors

19
Q

Distributive shock from anaphylaxis treatment

A
  • Epinephrine
20
Q

Distributive shock from neurogenic treatment

A
  • small fluid bolus

- vasopressors

21
Q

Norepinephrine

A

first choice for vasopressor

22
Q

Vasopressin

A

0.03 units/min as an alternative or in addition

23
Q

Dopamine

A
  • vasoconstrictor

- for pts with low HR

24
Q

Dobutamine

A
  • vasoconstrictor

- for pts with low cardiac output

25
Q

Corticosteriods (hydrocortisone)

A

ONLY if fluid and vasopressor therapy not effective

26
Q

complications of shock: DIC

A
  • Failure of the coagulation system in SIRS
  • Dysfunction of hematologic system in MODS
  • Precipitated by insult to body
  • Results in hypercoagulopathy –
    “out of balance”
    Microvascular clotting
    Hemorrhage
27
Q

Cardiac Output (CO) normal value

A

Normal CO: 4-7 L/min

  • Amount of blood pumped out by the ventricle per minute
28
Q

Central Venous Pressure (CVP or RAP) normal value

A

Normal CVP: 2-5 mmHg

  • Reflects filling pressures of the right side of the heart
29
Q

Cardiac Index (CI) normal value

A

Normal CI : 2.2-4.0 L/min/m2

  • Adjusts CO for body size
  • More precise
30
Q

Systemic Vascular Resistance (SVR) normal value

A

Normal 800-1400 dynes/sec/cm

  • The resistance against which the left ventricle must pump to eject its volume
31
Q

SVO2 (return of blood back to the right side of the heart) normal value

A

Normal value 60%-80%

32
Q

Stroke volume variation (SVV) normal range

A

Normal SVV < 10-15%

  • If SVV is >15%, patient’s cardiac output will increase with fluid infusion
33
Q

PLR (passive leg raising)

A

simple, reversible maneuver that mimics rapid fluid loading and increases cardiac preload. This
procedure enables the tester to obtain accurate measurements to help classify spontaneously breathing
patients as responders or nonresponders.

34
Q

Normal BP

A

120/80

Adult health II final (14 decks)

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