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Medsurg 2 > Final > Flashcards

Final Flashcards

1
Q

Stages of shock

A

Initial
Compensatory
Progressive
Refractory (mods)

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2
Q

Initial stage of shock

A

↑ hr/rr - may be only signs
↓ map - 5-10 (still normal)

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3
Q

Compensatory stage of shock

A

↑ hr/rr, ↓ map 10-15
↓ urine,↑ na+
Tissue hypoxia
Kidney mechanisms -RAS
• ↑ renin, epi, norepi
Acidosis (↓ ph ),↑ lactic,↑ k+

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4
Q

Progressive stage of shock

A

↓ map 20+
Still compensating but hypoxia to vital organs
Ischemia to less vital organs (skin, kidneys, brain)

Impending doom, confusion, ↑ thirst
↑ hr/rr, weak pulse, ↓ bp, narrow pulse pressure
Pallor, cyanosis, cool extremities, decreased cap refill
↓ urine, ↓ GFR, ↑ specific gravity. Sugar/acetone in urine
↓ bowl sounds, slowed gi mobility

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5
Q

Refractory (mods)

A

Everything crashing, no return
Massive release of toxins = microthrombi formation
→ DIC ** all platelets 1 fibrin used up

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6
Q

Interventions for shock

A

Semi fowlers, ↑ perfusion
Meds:
- vasoconstrictors: Levo (norepi), epi (adrenaline), vasopressin
- inotropic agents: dobutamine
- nitro + sodium nitroprusside =↑ myocardial perfusion
Q15 VS

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7
Q

Sepsis vs sepsis shock

A

Sepsis: mods
Sepsis shock: system inflammatory response syndrome (SIRS)
- ↓ gas exchange and perfusion occurs

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8
Q

What causes SIRS?

A

Infection + widespread inflammation
Inflammatory mediators released, body attacks itself = SIRS

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9
Q

SIRS s/sx?

A

↓ bp, ↓ UOA, ↑ rr
Temp change (based on WBC function & duration)
Inappropriate clotting, microthrombi form (DIC), ↑ lactic

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10
Q

Lactic levels?

A

Lactic: 1-2

> 2 = sepsis, 4-6= septic shock

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11
Q

Nursing interventions for sepsis

A

broad spectrum abx
Blood cultures

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12
Q

Innate vs compensatory response sepsis

A

Innate: fever, leukocytosis, left shift/bandenemia

Compensatory: ↑ hr, ↓ bp, MODS

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13
Q

1 change in V/s in ____ to ____ hrs =↑risk of sepsis

A

4-6hrs

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14
Q

DIC labs

A

↑ d dimer, FDP, pt / ptt

↓ plts, fibrinogen

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15
Q

s/sx of DIC
Tx?

A

Bleeding from everywhere
Hemorrhagic manifestations: petechia, seeeping IV, bruising

Reversal for anticoags: vit K, protamine sulfate

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16
Q

Hypovolemia s/sx
End stage?

A

↑ hr, ↓bp, ↑ rr
Orthostatic hypotension, thready pulse, ↓ LOC
= hypoxia, ↓ CVP, seizures ( ↓ Na+)

End stage: pale, clammy

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17
Q

Causes of hypovolemic shock

A

Trauma:
hemorrhage = ↓JVP
and third spacing

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18
Q

What is 3rd spacing

A

Hypovolemia → ruptured vessels → ↑ inflammatory mediators = SIRS

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19
Q

Nursing interventions for hemorrhage?

A

PRBCs
FMP/Cryo = whole blood

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20
Q

CVP
What does it monitor?
What are the ranges?

A

Monitors R atrial pressure
2-8 = good
<2 = hypovolemia
>8 = hypervolumia

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21
Q

How to calculate MAP?
What do we want it at?
What is cardiac output?

A

SBP + 2 (DBP) =____ /3 = MAP
>65
Co= hr x stroke volume

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22
Q

Primary assessment?

A

Immediate: ABCDE
A=irway/alert: APVU (alert, pain/voice arousal, unresponsiveness), cspine
B-reathing: 6L with no order, broken ribs/flail chest can do this
C-irculation: IV, pulses, transfusion
D-isability: GCS, pupils
E-xposure, remove clothing `

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23
Q

secondary assessment:

A

Everything else
SAMPLE
Symptoms
Allergies
Medications
Past hx
Last oral intake
Events

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24
Q

Objective vs subjective

A

Objective: what we see, pain scale, V/s
Subjective: what pt says

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25
Q

Heat exhuastion s/sx?
nursing interventions

A

flu like ha, N/V, weakness
rehydrate, remove tight clothing

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26
Q

Heat stroke

A

temp above 104
AMS, dehydration, cerebral edema
↑ hr, ↓bp, ↑ rr, weak pulses,
↓ Na+, ↑ trop,

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27
Q

Color code:
Red:
Yellow:
Green:
Black:

A

red = emergent
yellow= can wait short time
green = walking, unwounded
Black = dead

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28
Q

internal vs external disasters?

A

internal: fire, explosion, violence, loss of critical utilities
External: Epic shut down, viruses, natural disasters

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29
Q

Level 1-4

A

Level 1: teaching hospital, all resources, conducts research for trauma verification
Level 2: provides care to most pt
Level 3: stabalizes pt with most injuries, transfers
Level 4: rural/remote, basic trauma stabilization + ACLS, transfer immediately

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30
Q

Left sided heart failure s/sx:

A

Pulmonary congestion: ↑ RR, wheezing, crackles, blood tinged sputum, orthopnea, nocturnal/exertional dyspnea

↑ hr, weak pulse, S3 = overload
cyanosis, cool extremtiies

restles, dizzy, AMS, confusion

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31
Q

what is L sided HF also called?
what should we monitor?

A

congestive heart failure
PAP and PAWP -
*****increased PAWP

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32
Q

what is R sided heart failure also called

A

Cor pulmonale if not caused by L sided HF

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33
Q

s/sx of R heart failure

A

fatigue, ascites, edema, weight gain, enlarged spleen/liver, RUQ pain

RV heave, loud S2, increased peripheral venous pressure

anorexia, GI distress, poly/nocturia

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34
Q

what causes R sided HF

A

LHF, RV MI, Pulm HTN, and COPD

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35
Q

when do we give nitro to a HF patient?

A

if SBP is <100

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36
Q

systolic vs diastolic

A

systolic = impaired contractility
diastolic = impaired filling

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37
Q

Nstemi vs Stemi

A

Nstemi: ST depression, T wave inversion, no increased trop = ischemia

Stemi: ST elevation, trop increased = infarction/necrosis

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38
Q

MI s/sx
Male
Female

A

Male: neck, jaw, lower back, chest pain
SOB, n/v

Female: fatigue, neck, jaw, upper back pain, epigastric pain, heartburn, abd pain

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39
Q

What is an MI ?

A

occlusion of BF = injury -> ischemia -> infarction

plt aggregation, thrombi form at site, infarction begins = heart ↑ o2 demand but ↓ supply

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40
Q

Labs for MI

A

↑ K+, mag, calcium, trop, CK

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41
Q

what is released during an MI

A

catecholmines release -> ↑ HR afterload/contractions = ↑ o2 requirements -> vent rhythyms

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42
Q

MI nursing interventions
surgical?

A

MONA
Oxygen first
Nitro x3 back to back
-contraindicated with viagra/afil meds
morphine Q5-15 min
aspirin: chew for faster effect

Surgery: PCI

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43
Q

MI meds

A

MONA
Beta blockers
antiplts (ASA)
thrombolytic therapy (alteplase)
Anticoags (heparin, Lovenox)

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44
Q

cardiogenic shock?

A

caused by acute MI
s/sx: ↑ hr, rr, low bp, cool, clammy, decrease UOA, JVD, pulm edema, orthopnea, chest discomfort, syncope

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45
Q

Preload definition

when is it increased?
what drugs decrease in?

A

volume of blood in Ventricles at end of diastole
increases in hypervolemia, regurg, HF

drugs: decrease preload- diuretics, vasodilators

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46
Q

Define afterload

drugs to reduce after load?

A

resistance LV must overcome to circulate blood

drugs: ACE, ARBs, ARNI
(triple A, decrease Afterload)

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47
Q

drugs to ↑ contractility

A

digoxin, BB< CBB, aldosterone Antag

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48
Q

what is CAD
what does CAD lead to?

A

Plaque buildups in arteries

atherosclerosis -> angina (partial block) -> MI (complete block)

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49
Q

Types of angina?

A

stable: on exertion/stress, no other s/sx
Unstable: with/wo exertions - worsens, considered pre infarction (diaphoresis, SOB)

Prinzmetal (variant): occurs at complete rest, spasms (ST changes, but no trop/Ck changes)

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50
Q

Try performing better always

A

Tricuspid, pulmonary, bicuspid, aorta

51
Q

Pacemakers education?

A

no magnets, dont place leads/lat pads on it, pacer spikes on ECG, no MRI

52
Q

indications of pacemaker?

A

bradycardia, heart bloc, sick sinus syndrome, tachy dysrhythmia, sinus arrest

53
Q

complications of pacemaker

A

hemo/pneumothorax
cardiac tamponade

54
Q

cardioversion vs defib

A

cardiovert: out of abnormal rythyms, lower amount of jules
-atrial dysrhythmia, SVT, Vtach with pulse

Defib: direct shock, stop electrical activity, allows SA node to perfuse
-pusless Vtach/Vfib

55
Q

what meds do we give for extreme bradycardia

A

Atropine, epi, dopaminewh

56
Q

what meds do we give for extreme tachy?

A

adenosine, amniodarone, verapamil
-AFIB, SVT, VTach with pulse

57
Q

when do we give lidocaine/epi?

A

Vtach w/o pulse
Vfib

58
Q

cardiomyopathy:
dilated?
hypertrophic?
restrictive?

A

Dilated: decreased systolic
Hypertrophic: decreased diastolic filling
Restrictive: no diastolic filling due to fatty tissue depos

59
Q

Drugs we give for cardiomyopathy?

A

diuretics, vasodilators, cardiac glycosides

60
Q

what is pericarditis?
what are the types?

A

inflammation of pericardium
Acute (infection, post MI)
Chronic constrictive (thickening of pericardium)

61
Q

s/sx of pericarditis?
what do we not do with this pt?

A

substernal precordial pain, worsens w/breathing
coughing
pericardial friction rub

Do NOT place pt supine

62
Q

what can pericarditis lead to?

A

CARDIAC TAMPONADE= fluid accumulation in pericardium

63
Q

s/sx of cardiac tamponade?
tx of this?

A

JVD, paradoxical pain
BECKS triad: hypotension, muffled heart sounds, bradycardia

Pericardiocentesis

64
Q

what causes rheumatic carditis?

A

infection from group A

65
Q

s/sx of rheumatic carditis?

A

↑ hr, cardiomegaly, murmur, friction rub, precordial pain, prolonged PR, HF

66
Q

what causes ineffective carditis?
s/sx?

A

IV drug use

s3/s4, murmur, neuro changes, petechiae, splinter hemorrhages, osler nodes, lesions of hands/feet, roth spots, sudden abd/flank pain, renal infection

67
Q

what does mitral regurg cause?

A

afib, palpitations, high pitched diastolic murmur

68
Q

Cardiac cath care?

A

two sites: radial, femoral
Preop: CHG, V/s, informed consent
Post-Op: post op v/s, watch for bleed in TR band, dont move extremities

69
Q

define AFIB
causes?

A

irregular hr, no p’s, irregular electrical signals from SA node

intrinsic: within heart
extrinsic: outside heart, age, disease`

70
Q

s/sx of afib

A

palpitations, dyspnea, fatigue, syncope, murmur, s1 loudness

71
Q

tx of afib

A

high risk for blood clots, anticoagulation needed

tx underlying issue
rate control:
BB - class 3
CCB - class 4

rhythym control:
amnio- class 1
sotalol - class 3

72
Q

CHAD 2 score interpretation

A

CHAD2 score
+1: DM, HTN, obesity, age, CHF
+2: stroke

0= asa only
1= lt anticoag (warfarin, asa)
2= indefinite anticoag

73
Q

AFIB RVR tx?
Atrial tachyardia?
aflutter?

A

Cardioversion and BB

only monitor unless symptomatic

monitor `

74
Q

what is more threatening atrial or vent rhythyms?

A

ventricular

75
Q

torsades de pointes tx?

A

DONT SHOCK
bolus MAG/30min

76
Q

digoxin therapeutic range:

A

1.5

77
Q

normal
PR
QRS
QT

A

0.12-0.20
0.04- 0.08
0.32-0.40

78
Q

BPM
SA node
AV node
Bundle of His
Purkinje fibers

A

60-100
40-60
L/R bundle branches
20-40

79
Q

define
automaticity
excitability
conductivity
contractility

A

spontaneous, cardiac cell, automatic

polorization/generate action potential

beating of heart, electrical impulses

performance of heart, pre/afterload

80
Q

diagnostic + Pathophysiology of ARDS

A

diagnostic criteria: PaO2/FIo2 ration <200, PWP <18, Cxray infiltration

Release of 3 inflammatory mediators: histamine, seratonin, bradykinin
decreased surfactant, increased cap permeability = pulmonary fibrosis + multi system failure

81
Q

s/sx of ARDS:

A

hypoxia, decreased pulmonary compliance, dyspnea, bilateral pulm edema

82
Q

worst complication of ARDS?
TX for this? why?

A

intrapulmonary shunting: aveoli collapse = deoxy but no reoxygenate

PEEP: opens aveoli, keeps them from collapsing

83
Q

Hypoxemia vs hypoxia

hyperventilation?

A

hypoxemia: decrease o2 in blood
hypoxia: decreased tissue perfusion

hyperventilation increases CO2, resp alkalosis then acidosis `

84
Q

ventilatory failure?

A

physical problem with lung (trauma), defect in resp control (neuro), poor function of resp muscles
-hypercapnic: paCo2 >50

85
Q

oxygenation failure?

A

insufficiemt o2 in aveoli, decreased lung perfusion but normal ventilation
-R-L shunting
vent/perfusion mismatch
abnormal hgb
hypoxemia: PaO2 <60%

86
Q

both ventilatory and oxygenation failure

A

problem with lungs (asthma, emphysema, bronchitis), decreased bronchioles/aveoli

02 failure, increased work of breathing, resp muscles dont work

87
Q

acute resp failure?

A

oxygenation/ventilatory failure
hypoxemic, hypercapnic

88
Q

early s/sx of acute resp failure
late ?

A

Restlessness, air hunger, tachypnea, tachy, dyspnea, anxiety

late: AMS, confusion, lethargy, diaphoresis, cyanosis, decreased breath sounds, use of accessory muscles, resp arrest

89
Q

PE risk factors:

TX?

A

prolonged immobilization, hx, obesity, age, central venous catheters, surgery, conditions

o2, continous monitor, IV access, drugs (anticoags, fibrinolytics)

90
Q

what 4 major sx do PEs lead to?

A

hypoxemia, hypotension, hemorrhage and anxiety

91
Q

s/sx of PE

A

resp: dyspnea, increased RR, pleuratic chest pain, dry cough, hemoptysis: hypoxemia

cardiac: tachy, JVD, syncope, cyanosis, abmromal heart sounds: hemorrhage + hypotension

Impending doom: anxiety

92
Q

assist control vs SIMV

A

AC: breaths for pt, does all the work
SIMV: lets pt breath on own, easier to wean off, synchronizes with breath/inspiratory effect

93
Q

PEEP normal level?
complications?

A

8
increased intravacular pressure, decreased venous return = Decreased BP/CO = need pressors

94
Q

PIP level

A

below 40
if greater = tube dislodegemnt or pt has problem, can cause lung damage/barotrauma

95
Q

Pio2 level

A

30-35 before extubation
at 60 for longer than 6hrs = lung damage = o2 toxicity , hypoxemia

96
Q

what should PaO2/FiO2 ratio be?

A

300-400
less than 200 = intubation needed

97
Q

pulmonary contusionn

A

asymptomatic at first, lethal
Tele monitor
s/sx: bloody sputum, crackles/wheezing, decreased breath sounds

98
Q

Rib fracture

A

compromised ventilation due to pain
-IS, cough, deep breath, do NOT bind/splint

99
Q

Flail chest:

A

intubate if true paradoxical

100
Q

Tension pneumothorax:

A

Chest tube

MEDICAL EMERGENCY
assymetry of thorax, trach deviation, JVD, no breath sounds one side

101
Q

pneumothorax:

A

accumulation of air in pleural cavity
hyperresonance

102
Q

Hemo thorax

A

monitor for s/sx of hypovolemia

103
Q

Tracheobronch trauma:

A

SURGERY - due to being hit

subq emphysema, stridor

104
Q

fluid overload s/sx:

A

high bp, hr, rr, bounding pulses

105
Q

AKI causes:
how to avoid?
occurs?

A

underlying condition, reduced CO or obstruction
drink 2-3L
occurs quickly- hrs to days, failure to maintain waste elimination, fluid/electrolyte balance, acid base balance

106
Q

diagnostic definition of AKI

A

0.3 increase in 48hrs
1.5x baseline in 7 days
<0.5ml/kg/hr for 6hrs

107
Q

early s/sx of AKI

Late s/sx

A

decreased UOA, unadequate hydration, check weight

Late: lethargy, CNS changes, seizures, muscle twitching, N/V, decreased peristalsis, itchiness, HTN, HF< edema, MI, thrombosis, anemia, bleeding

108
Q

Bun/Cr
pre-renal
intrinsic renal?

A

pre renal: >20
intrinsic: <10

109
Q

health teachings of AKI

A

low potassium (no tomatoes, oranges, banana)
low sodium
do not smoke
no NSAIDs
regular blood work
control BP - take meds
if SOB or no urine occurs go to ED

110
Q

Pre - renal?
Causes?

A

reduced blood flow
hypovolemia/perfusion/tension, burns, sepsis

111
Q

intra renal?
Causes?

A

affect renal cortex/medulla

NSAIDS, gentamicin/vanc, allergic disorders, embolism, thromobosis of renal vessels

112
Q

post renal?

A

urine flow obstruction
calculi, tumors, urethral obstruction

113
Q

what will alter kindey resultd?

A

abx and nsaids

114
Q

4 phases of AKI
what do all phases do?

A

Initiation: begins w/initial result
Oliguria: increased serum concentration of substance usually excreted
Diuresis: gradual increase in UOA, GFR recovering
Recocery: sx improve, takes 3-12m

All phases increases CR

115
Q

ICP range
CPP range

A

ICP: 7-15
CPP: 60-80

116
Q

priority stroke intervention:

A

CT scan

117
Q

cushings triad?

A

widened pulse pressure (SBP high), bradycardia, abnormal respirations

118
Q

SCI vent needed?

A

C1-C3 = intubate
c4-C5: may need vent
C6+: independednt breathing

119
Q

MAP for spinal cord injuries:

A

80-85

120
Q

stroke scale:

A

0- no stroke
1-4: mild stroke
5-15: moderate stroke
16-20: mod-severe
21-41: severe stroke

121
Q

L side stroke causes what

A

R sided weakness, paralysis
Aphasia
visual problems (R visual field gone)
slow performance: cautious
aware of deficits: anxious, depressed
impaired comprehension: math, language

122
Q

R sided stroke causes:

A

Paralsyis and neglect of L side
unable to swallow
denies/minimize problems
rapid short attention span
impulsive, safety problems, bed alarm needed
impaired time, memory loss

123
Q

Ischemic stroke nursing care

A

alteplase within 3.5-4 hrs
BP dropped gradually
ASA - antiplt therapy

124
Q

hemorrhagic stroke care

A

manage ICP
craniotomy or ventricular drain system
BP goal of 140 (130-150)
\

Medsurg 2 (8 decks)

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