Fluid & Shock -exam 1

Question 1

Edema

Answer 1

• excess interstitial fluid

- may be localized or systemic

Question 2

Types of edema

Answer 2

• Transudate

- exudative

Question 3

Transudate edema

Answer 3

• salt water, little to no protein content
• results from alterations in starling forces or lymphatic failure
  ex: heart failure, cirrhosis, renal failure, salt-indulgence

Question 4

Causes of transudate edema

Answer 4

• excess total body water
• salt/fluid overloading
• excess aldosterone (tumor, hepatic failure)
• kidney failure
• systemic vein: right heart failure
• pulmonary veins: left heart failure
• leg veins: prolonged standing, pregnancy
• portal vein: cirrhosis
• cerebral capillaries: brain trauma
• lymphatic obstruction

Question 5

Exudate edema

Answer 5

• protein rich salt water
• results from overly leaky cappilaries
• leaked proteins draw water into interstitial space
• inflammation, spesis, burns

Question 6

Hemorrhage

Answer 6

• loss of whole blood from blood vessels
• may be external, into tissues, or into “third” spaces
• significance depends on where and how much

Question 7

Causes of hemorrahge

Answer 7

• trauma
• disease of blood vessels
• disease around blood vessels
• lack of clotting factors
• lack of platelets

Question 8

Class I hemorrhage

Answer 8

• up to 750 ml (1-15%) blood loss

- clinical signs: minimal to none

Question 9

Class II hemorrhage

Answer 9

• 750-1500 mL (15-30%) blood loss

- clinical signs: tachycardia, tachypena, anxiety

Question 10

Class III hemorrhage

Answer 10

• 1500-2000 mL (30-40%) blood loss

- clinical signs: tachycardia, tachypena, hypotension, altered mental status

Question 11

Class IV hmorrhage

Answer 11

• 2000 mL (40%) blood loss

- clinical signs: tachycardia, hypotension, cold, clammy, severely altered mental status

Question 12

Shock

Answer 12

• widespread hypoperfusion of body tissues - not localized

- hypoperfusio leads to organ malfunction/failure

Question 13

Types of shock

Answer 13

• hypovolemic
• cardiogenic
• distributive
• obstructive

Question 14

Hypovolemic shock

Answer 14

• decreased in blood volume

- ex: hemorrhage, vomiting diarrhea, burns, third-spaces losses

Question 15

Cardiogenic shock

Answer 15

• pump failure

- ex: massive infarction, rupture of ventricle or valve, some rhythm disturbances

Question 16

Distributive shock

Answer 16

• warm shock
• profound vasodilation, lack of venous return
• ex: sepsis, anaphylaxis, high spinal cord injury, profound anesthesia, vasovagal, newer war gasses

Question 17

Obstructive shock

Answer 17

• external compression of heart or its outflow

- tension pneumothorax, larege pericardial effusion, massive PE

Question 18

Stages of shock

Answer 18

• compensated

- progressive

Question 19

Compensated shock

Answer 19

• blood shunted from kidneys, salivary glands, gut, skin
• maintains perfusion to heart and brain
• oliguria, dry mouth, and skin
• BP is maintained

Question 20

Progressive shock

Answer 20

• sympathetic compensatory mechanism fail
• BP and cardiac output drop
• lung and kidney damage occurs
• survival becomes unlikely

Question 21

Goals for shock

Answer 21

• tx is to restore tissue perfusion
• tx is NOT to simply raise the BP
• control of bleeding
• fluids, fluids, fluids
• address underlying cause