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S4 2539 > M5 Perfusion > Flashcards

M5 Perfusion Flashcards

1
Q

Shock 101

A

Condition in which vital tissue and organs are not receiving enough blood

Without O2 and nutrients from blood, things start to die

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2
Q

Shock can happen due to any mechanism of action that disrupts

A

Heart function
Blood volume
Blood pressure

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3
Q

Subjective shock S/S

A

Feeling sick
Weak
Cold/hot
LOC

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4
Q

Objective shock S/S

A

Hypotension BELOW 60
SOB

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5
Q

Cardiac output and urinary output with shock

A

Decreases

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6
Q

Respiratory output with shock

A

Rate Increase resulting in Resp Alkalosis

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7
Q

Resp Alkalosis is an impending indicator of

A

SHOCK

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8
Q

O2 sat and shock

A

Drops

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9
Q

First organs to be affected by shock are heart and brain so what are the earliest symptoms

what about respirations

A

LOC
BP drop
HR increase
Cardiac output drop

rapid and shallow

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10
Q

5 Types of shock

A

Hypovolemic
Neurogenic
Cardiogenic
Septic
Anaphylactic

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11
Q

Shock treatment ABC

A

Airway
Breathing
Circulation

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12
Q

To treat shock, threat

A

Underlying cause

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13
Q

Supportive measures for shock

A

IV to expand intravascular volume
Vasopressors to increase BP
Supplemental O2
Keep PT warm
Keep environment quiet

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14
Q

What makes treatment difficult in the later stages of shock

A

Positive feedback loop

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15
Q

Causes for fluid loss shock

A

Hemorrhage
Burns
Dehydration
Vomit/diarrhea
Diuretics

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16
Q

Diagnostics scans for Hypovolemic shock

A

CT
Ultrasound
EGD
detects bleeding

Echocardiography

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17
Q

Labs for hypovolemic shock

A

ABG
Electrolytes
Renal panel
CBC
Urinalysis

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18
Q

Diagnostic tests for cardiogenic shock

A

12 lead EKG
Nuclear scan
Cardiac cath
Coronary angiography

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19
Q

Lab tests for cardiogenic shock

A

All the hypovolemic labs +

CRP
Cardiac biomarkers
Thyroid hormones drugs

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20
Q

Diagnostics and Lab test for neuro shock

A

12 lead EKG
CT MRI of brain

ABG
lytes
CBC
Urinalysis

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21
Q

Diagnostics and labs for anaphylactic shock

A

12 lead EKG
sensitization test

ABG
Lytes
CBC
Urinalysis

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22
Q

Diagnostics and labs for septic shock

A

12 lead EGK

Same as hypovolemic

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23
Q

Diagnostics and labs for septic shock

A

12 lead EGK

Same as hypovolemic+

Serum lactate
Pro-calcitonin
Coagulation factors
Blood/other CULTURES

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24
Q

Hypovolemic shock is defined as a loss of _% of intravascular volume

A

15

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25
Q

Difference between hypovolemic and cardiogenic shock

A

Fluid volume and cardiac health

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26
Q

S/S of hypovolemic shock

cardiac
resp
integument

A

rapid pulse
low BP-high SVR

rapid respirations-low preload

poor skin turgor, tenting, thirst

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27
Q

Hypovolemic shock management

Replace volume with

A

BLOOD, COLLOIDS or CRYSTALLOIDS

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28
Q

What hormone to give to hypovolemic shock PTs

A

ADH
Antidiuretic Hormone

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29
Q

Treat acute massive blood loss with

What is the _% for acute blood less

A

Whole blood
Know blood admin procedures

More than 30% of total volume

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30
Q

Depending on what is low during hypovolemic shock, what other blood components can we give

A

Plasma protein fraction
Fresh-frozen plasma
Packed RBCs

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31
Q

Colloids 101

what kind of pressure

A

Expand plasma by drawing body cell molecules in to blood vessels

Oncotic

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32
Q

When to use colloids

A

When up to 1/3 of adult blood volume is lost

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33
Q

Colloid types
nonblood

we can administer

A

Dextran
Hespan

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34
Q

Natural colloids in blood

A

Albumin
Plasma protein fraction
Serum globulin

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35
Q

Crystalloids 101

Types

A

Intravenous solutions that contain lytes
replace fluids and promote urine output

Isotonic
Hypotonic
Hypertonic

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36
Q

Crystalloid solution examples

A

NS
LR
Plasmalyte

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37
Q

Neuro shock patho

A

Sympathetic v/parasympathetic ^ = v in vascular tone = v SVR = v cardiac output = v tissue perfusion = Impaired Cellular Metabolism

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38
Q

Neuro shock risk factors

A

Spinal trauma
Regional anesthesia
Autonomic nervous system drugs

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39
Q

Neuro shock S/S

heart
skin

A

v cardiac output
hypotension
bradycardia

cold
Dusky

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40
Q

Volume replacement for neuro shock

A

Crystalloid
Colloid

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41
Q

Meds for neuro shock

A

Vasopressors
Corticosteroids

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42
Q

Other neuro shock interventions

A

Cardiac pacing
GCS (Glasgow coma) scale
Ventilation/intubation

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43
Q

Another name for neuro shock

A

Vasogenic due to dilation

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44
Q

When the medulla does not get enough O2 or GLUCOSE we get

A

neurogenic shock

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45
Q

SVR
Systemic vascular resistance

A

Resistance of blood vessels
Used to create blood pressure

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46
Q

Cardiogenic shock 101

A

Decreased cardiac output
Impaired cellular metabolism

Hypoxia in presence of adequate volume

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47
Q

Causes for cardiogenic shock

A

HF
Dysrhythmias
Valve dysfunction
Myocardial infection
Massive emboli
Cardiac temponade

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48
Q

Cardiac temponade

A

Space around heart fills with fluid

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49
Q

Cardiogenic shock risk factors

A

Age
MI/HF history
DM
CAD

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50
Q

Cardiogenic shock S/S

neuro
resp
integ
cardiac
GI

A

LOC

Tachypnea, dyspnea due to pulmonary edema

dusky skin

hypotension BELOW 60

Oliguria

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51
Q

Managing cardiogenic shock
Meds

A

Vasodilator - nitro
Vasopressor - dopamine
Beta-agonist - increase contraction force
Morphine - improve coronary perfusion

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52
Q

Volume replacement with cardiogenic shock

A

Crystalloid/colloid

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53
Q

Managing airway and cardiogenic shock

A

Intubation

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54
Q

Surgeries and procedures for cardiogenic shock

A

Intra aortic balloon
VAD
Revascularization (bypass surgery)

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55
Q

Septic shock 101

A

Gram positive TLR2 receptor or gram negative TLR 4 receptor activation = Macrophage engagement = SIRS=w/c shock=MODS

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56
Q

SIRS
Systemic inflammation response syndrome

S/S

A

Fever
Tachycardia
Tachypnea
Leukocytosis

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57
Q

MODS

A

Multiple organ disfunction

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58
Q

w/c shock s/s

1st warm shock

2nd cold shock

A

vasodilation
hypotension
hypoperfusion
inflammation

Myocardial depression
Worsening tissue hypoperfusion

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59
Q

Most common sites of entry for septic shock

A

Lung
Urinary
GI
Wound
Vascular cath

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60
Q

Risk factors for septic shock

A

age
nutrition
Hx (trauma surgery caths, HF, DM)

Immunosuppression - AIDS, steroids, chemo, post-organ transplant

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61
Q

Early septic shock S/S

heart
GU
Skin
Neuro

A

Tachycardia
^ Cardiac output
Hypo OR hyperthermia

Deranged renal system

Jaundice

Deterioration of mental status

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62
Q

Labs for septic shock

A

Culture
C-reactive proteins
Serum lactate
Pro-calcitonin
Coagulation factors

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63
Q

Fluids for Septic shock

A

Crystalloids
Colloids

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64
Q

Meds for septic shock

A

Antibiotics (central line cath)

Vasopressors
Steroids
Beta-agonists

Antipyretics

Insulin

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65
Q

Septic shock airway management

A

Intubation

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66
Q

Anaphylactic shock 101

A

Hypersensitivity reaction

vasodilation and hypovolemia=decreased perfusion and impaired metabolism

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67
Q

Most common allergens causing anaphylactic shock

A

Insect bites
Shellfish
Peanuts
Latex
Meds (pcn)

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68
Q

What else is a big allergen that can happen in hospitals

A

blood transfusion

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69
Q

Anaphylactic shock S/S

neuro
resp
integument
GI/GU

A

loc

Stridor/Wheezing

Pruritus
Hives
Swollen lips/tongue

Abdominal cramps, oliguria

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70
Q

Cardio S/S of anaphylactic shock

A

BP drop
SVR drop
Increased Cardiac Output

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71
Q

Meds for anaphylactic shock

A

Antihistamines
Bronchodilators
Corticosteroids
Vasopressors

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72
Q

Airway management and anaphylactic shock

A

intubation/ventilation

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73
Q

Fluid replacement to give in anaphlectic shock

A

Crystalloids/colloids

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74
Q

1st things to remove in anaphylectic shock

A

ANTIGEN

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75
Q

Vasoconstrictor/sympathomimetic for shock 101

A

Act on alpha-adrenergic receptors

raise blood pressure

positive inotropic effect

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76
Q

Vasoconstrictor/sympathomimetic meds

A

Norepinephrine
(Levophe, Levaterenol)

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77
Q

Vasoconstrictor/sympathomimetic adverse effects

A

tachycardia
hypertension

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78
Q

Vasoconstrictor/vasopressors 101

A

Good for early stages
Activates sympathetic system

raises BP and increases contractions

79
Q

Purpose of vasopressor meds

A

Maintain blood flow to vital organs heart brain

decrease flow to other organs
kidneys liver

80
Q

Monitoring for vasopressors

discontinue as soon as

A

continuous

pt is stable

81
Q

How to discontinue vasopressors

A

GRADUALY

prevents rebound hypotension

82
Q

Vasoconstrictor/vasopressors drugs

A

Norepinephrine (levophed) - alpha/beta agonist
Phenylephrine - alpha agonist
DDAVP- antidiuretic agent

83
Q

Only use Sympathomimetic vasocontrictors or vasopressors when

A

Fluid and Lyte replacement has FAILED

84
Q

What to monitor when pt on vasopressors

A

BP
HR
ECGs
Urine Output
GLAUCOMA

85
Q

Extravasation of vasopressors and dopamine causes

A

Tissue necrosis

Titrate dose based on BP

86
Q

What must be injected at Extravasation site immediately

A

Phentolamine (regitine)

87
Q

Teach pt to monitor extravaccation via reporting

A

Pain and burning at IV site
Blanching and blueness of fingers
Chest pain or palpitations

88
Q

Inotropic drugs 101

A

Strengthen contractions
Increase cardiac output

89
Q

Inotropic drug names

A

Digoxin
Dobutamine
Dopamine

90
Q

Prototype inotropic agent

treats what shock types

A

Dopamine

HYPERvolemic
Cardiogenic

91
Q

Dopamine activates what receptrs

A

Both Alpha and Beta

92
Q

Inotropic drug digoxin

A

increases contractility

gets essential oxygen to critical tissue quickly

93
Q

Inotropic drug dobutamine

A

Beta 1 agent
increases contractility

best for HF

Half life - 2MIN
IV ONLY

94
Q

What to monitor for Inotropic drugs

A

BP
Telemetry
IV site
RENAL function

95
Q

Because inotropic drugs work on heart pt will have continues _ monitoring

A

Cardiac

96
Q

What to teach pt to report on Inotropics

A

Chest pain/palpitations
SOB

burning/pain at IV site

numbness or tingling in extremities

97
Q

Sympathomimetic for anaphylaxis 101

A

Epinephrine (Adrenalin)
Nonselective adrenergic agonist

Supports system by preventing hyperresponse

98
Q

Assessment for epinephrine use in anaphylactic shock

A

Vitals
Lungs
Renal (BUN, creatinine)
LOC

99
Q

Goals for patient with anaphylactic shock

A

Client will report itching SOB
Maintain urine output at 50ml/hr
Maintain Systolic BP at 90mmHg
Client will remain A&O

100
Q

Preload

A

Venous blood return to the heart

101
Q

Substances to increase blood volume

A

PRBCs
Albumin
Normal saline

102
Q

Substances to decrease blood volume

A

Diuretics
Ace inhibitors

103
Q

Substances to increase venous dilation

A

Nitroglycerine
Ca+ channel blockers
Clonidine
Morphine

104
Q

Substances to decrease venous dilation

A

Dobutamine

105
Q

Contractility

A

Forcefulness of contractions

106
Q

Substances that increase contractility

A

Digoxin
Dobutamine-dopamine
Milrinone

107
Q

Afterload

A

Work required to open aortic valve and eject blood

RESISTANCE to flow in arteries

108
Q

Substances that increase afterload

A

HIGH dose of dopamine

109
Q

Substances that lower afterload

A

Ace inhibitors
Nitro
Ca+ channel blockers
Beta blockers

110
Q

Normal heart rate

A

60-100 bpm

111
Q

Substances that lower HR

A

Beta blockers
Ca+ channel blockers

112
Q

Substances that increase HR

A

Atropine
Dopamine

113
Q

5 steps of the electrical pathway of the heart

A

SA node
AV node
Bundle of His
Left/right bundle branches
Purkinje fibers

114
Q

Atrial depolarization initiated by the SA node causes the _ wave

A

P

115
Q

After depolarization the impulse in delayed at the AV node

this is the _ segment

actually ends at _

A

PR segment
PQ

116
Q

Ventricular depolarization begins at the apex, causing the _ complex.
This is also where… occures

A

QRS

Atrial repolarization

117
Q

the _ segment marks ventricular depolarization

A

ST segment

118
Q

Then ventricular repolarization begins at apex casing the _ wave

A

T

119
Q

MI
CRUSHING s/s

A

Chest pain
Radiating to left arm jaw back
Unrelieved by nitro
Sweating
Hard to breath
Increase in HR and BP
N/S
Getting anxious

120
Q

MI s/s women excpetion

A

No chest pain

paint is lower, just above abdomen

121
Q

MI and diabetic neuropathy

A

Silent MI due to damaged nerves not feeling pain

122
Q

Labs 1hr with MI

A

Myoglobin in blood

123
Q

Labs 2-4hr with MI

A

Troponin is released at 0-0.4ng/ml

124
Q

Labs 4-6hr with MI

A

CKMB is released at 0-0.4ng/ml

125
Q

24-36h post MI

A

Inflammation and neutrophils

Could lead to
Pericarditis (Friction rub)
Pump failure
Cardiogenic shock
Arrhythmias

126
Q

STEMI
ST elevated myocardial infarction
on EKG

A

ST segment elevated

127
Q

NSTEMI
Non-ST elevated myocardial infarction
on EKG

A

ST will depress or invert

128
Q

If ST slopes down or stays horizontal before coming up for the T, this indicates

A

Ischemia

129
Q

MI first meds
AONM

A

Aspirin
O2
Nitro
Morphine

130
Q

With MI time is

A

Muscle

131
Q

What to assess in MIs

A

Chest pain
Cardiovascular system
Bedside monitoring
Blood ressure
Resp sounds

132
Q

What to assess for in cardiovascular system with MI

A

12 lead EKG
ST elevation/depression
T waves

133
Q

What is continuous bedside monitoring for MIs

A

Telemetry

134
Q

What lung sounds will you hear in MIs

A

crackles
fluid overload due to heart dying

blood is backing up

135
Q

basic interventions for MI

A

O2 2-4L
Working IV
Bedrest

136
Q

MI labs

A

Troponin
CKMB

137
Q

What to do in first 10 min of MI pt arrival

A

Vitals
O2 sta
IV access
12 lead ECG
Blood sample

138
Q

Fibrinolytic therapy is used for what MIs

when to be given

A

STEMI

within 12h of symptom onset

139
Q

Fibrinolytic MOA

A

Breaking down of clots

140
Q

Fibrinolytic med contradictions

A

Post OP
Hemorrhage
Ulcers
Pregnancy

141
Q

Acute Angina means

A

Artery Blockage
Cardiac Complication

142
Q

Most common anticoagulants

A

Heparin
Lovenox

143
Q

What to monitor with Antigcoagulants

A

PTT
Normal 25-35
Therapeutic 60-80

144
Q

Antiplatelet meds 101

A

Decrease platelet aggregation
Aspirin
Plavix

145
Q

Aspirin
Plavix

side effects

A

asa GI bleed

Plavix - Thrombocytopenia purpura

146
Q

Stop antiplatelet meds like aspirin and plavix how many days before surgery

A

5-7

147
Q

Morphine for chest pain route

A

IV ONLY

148
Q

Nitroglycerin 101

A

Vasodilates coronary arteries
Increases blood flow

149
Q

Nitro watch for

A

Headache
Flushing
Dizziness

150
Q

How to monitor pt on nitro

A

MUST monitor

BP
EKG
Chest pain

151
Q

Ace inhibitors 101
“April”

A

Blocks RAAS system
Vasodilator
Decreases BP and workload

152
Q

ACE side effects

A

Nagging cough
K+ increase

153
Q

Arbs ArTan 101

side effects

A

Specifically block angiotension II part of RAAS
Vasodilators

also increase K+

154
Q

Statins 101

A

Lower cholesterol LDL
increases HDL

155
Q

What to monitor with Statins

A

MUSCLE Pain
CPK level - indicate muscle breakdown

LIVER function

156
Q

Ca+ channel blockers 101

A

Blocks calcium from entering smooth myocardial muscles = vasodilation

157
Q

Ca+ channel blocker meds

A

Norvasc
Cardizem

158
Q

Ca+ channel med side effects

A

Hypotension
Gum enlargement (oral hygiene)

159
Q

Peak or hyper acute Ts indicate

A

MI

160
Q

EBT
Electron Bean CT

Echocardiography

A

Detects Heart Disease in earliest stages 2-6

Only detects later stages only 5-6

161
Q

Other forms of heart health monitoring include

A

Heart cath
Exercise stress test

162
Q

Tetralogy of fallot
PRAV
CYANOSIS

A

Ventral septal defect
Aortic override
Pulmonary stenosis
Right ventricular hypertrophy

163
Q

The degree of CYANOSIS with tetralogy of fallot depends on the

A

Size of the ventricular septal defect
Degree of ventricular outflow obstruction

164
Q

Obstruction of blood flow from right ventricle to the pulmonary artery results in deoxygenated blood being shunted across the … and in to the

A

Ventricular septal defect

Aorta

165
Q

Ventricular outflow obstruction can occur at any of the 3 levels

A

Pulmonary valve stenosis
Infundibular stenosis
Supra-valvular stenosis

166
Q

In tetralogy of fallot the right ventricle eventually becomes

A

Hypertrophied

167
Q

At birth with tetralogy of fallot TOF, neonates O2 sat is

A

Normal, then decreases

168
Q

When is cyanosis initially observed in TOF

A

crying and exertion

169
Q

Other TOF S/S

A

Polycythemia (^RBC)
Exercise intolerance
Tachypnea
LOC

170
Q

TOF home treatment

A

Soothe
place in knee to chest position

171
Q

TOF hospital treatment

A

Knee to chest
Morphine sedation

O2
Beta-blockers

Phenylephrine to increase vascular perfusion

172
Q

Diagnosing TOF

A

Auscultation
CRX
ECG
Cardiac cath

173
Q

Auscultation and TOF

A

Harsh systolic ejection mrmur

174
Q

CXR and TOF

A

Boot shaped heart
(right vent hypertrophy)

175
Q

ECG and TOF

A

Doppler study and color flow mapping

176
Q

Cardiac catheterization and TOF MOST DIFINITIVE DIAGNOSTIC

A

before surgery to ID number of septal defects

177
Q

Med management of TOF

A

O2 sat
Growth and development
Monitor hyper cyanotic spells
Endocarditis prophylaxis
Restrict stranuous activity

178
Q

Life long TOF care

A

Assess R ventricular outflow
Monitor exercise tolerance
Monitor arrhythmias

179
Q

TOF complications

A

Hypoxia
Hyper cyanotic spells
CHR
Polycythemia
Arrhythmias

180
Q

Nursing and TOF

A

Assess vitals pulses cap refil (standing sitting lying)
Monitor cyanotic attacks
Knee-chest
Monitor during exercise
Monitor intake and output

181
Q

VSD Ventricular septal defect

A

Hole in the wall of 2 ventricles

182
Q

Pulmonary stenosis

A

Narrowing of pulmonary valve resulting in low blood volume reaching lungs

183
Q

Right ventricular hypertrophy

A

Right ventricle muscle thickens up

184
Q

Overriding aorta

A

Aorta located over VSD, as such O2 poor blood gets in to aorta

185
Q

Mothers risk factors for TOF

A

Rubella
Viral infections
Poor nutrition
Age over 40
Diabetes

186
Q

tet

A

blue spells due to acute cyanosis or hypoxia

187
Q

TOF can result in

A

Emboli
Seizures
LOC

188
Q

TOF psych problems

A

Stress
Depression
Substance abuse
School problems
Non-compliance with meds in teens

189
Q

During crying or feeding TOF baby’s skin will turn “tet”

A

Blue

190
Q

TOF treatment

A

Beta blockers
O2
squatting - increases afterload
fluids

191
Q

TOF surgeries

A

VSD closure
Complete repair
Palliative shunt

Modified blalock - accesses pulmonary artery but also distorts it

192
Q

Consequences of total correction surgery

A

less than 3% mortality
CHF
heart block
sudden death

193
Q

What to monitor for in TOF correction surgery post op

A

S/S of rejection
Infection
side effects of immunosuppression meds

S4 2539 (11 decks)

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