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S4 2539 > M5 Perfusion 4 > Flashcards

M5 Perfusion 4 Flashcards

1
Q

4 stages of shock

A

initial
compensatory
progressive
refractory

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2
Q

What to do with MODS in end stage

A

Shift care from pt to family
Gotta have that talk

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3
Q

Compensatory shock S/S

A

Compensation

Tachycardia

Cold/clammy skin
Circulation is now shunted just to vital organs

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4
Q

kidneys will die due to poor perfusion within

S/S

A

20MIN

oliguria
anuria

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5
Q

Cardiogenic shock 101

A

Not providing enough oxygenated blood to organs

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6
Q

Most common cause of septic shock

A

UTIs!!!

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7
Q

Biggest septic shock S/S

A

LACTATE LEVEL ELEVATED
Altered consciousness

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8
Q

Restlessness
Irritability
Tachycardia
=
____

on TEST

A

HYPOXIA

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9
Q

hypoxia 1st check

A

Pulse oxymetry

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10
Q

VTE=

A

Pulmonary embolism
or
DVT

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11
Q

Rx interventions for Cardiogenic shock

A

pressors
Dobutamine
Dopamine
Ionocore

blood pressure support

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12
Q

Body systems that will kick in at shock

A

Epi/Norepi
RAAS

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13
Q

Aldosterone =

A

sodium and water excretion
potassium retention

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14
Q

How often to do vitals for CarioShock patients on BP meds

A

q15m

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15
Q

Other cardiogenic shock meds

A

pressors

digoxin

diuretics

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16
Q

Only progressive cardiogenic shock solution

A

Transplant

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17
Q

Hypovolemic shock 101

A

low volume

15% of intravascular volume loss
according to instructor

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18
Q

Biggest causes of hypovolemic shock

A

Hemorrhage
Burns

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19
Q

Total body edema

A

ANASARCA

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20
Q

urinary output after burn

initial
progressive

A

Low
oliguria
anuria

then high after 72h

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21
Q

After 72h during the high output what are we worried about

A

Hypervolemia

fluid is rushing back into vessels from body

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22
Q

What to give when pt has hypervolemia

A

Diuretic

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23
Q

Why do we do isotonic solutions when transufing

A

Same as blood
Will stay where you put it

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24
Q

ADH =

A

H2O

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25
Q

Not enough ADH with diabetes insipidus, pt will

A

pee out all volume

hypovolemic shock

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26
Q

To prevent this with diabetes insipidus, give

A

Desmopressin

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27
Q

Due to shock, blood will shunt to brain and heart
Stomach will become

what to do

A

Paralytic

NG suction

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28
Q

Nursing management for hypovolemic shock of elderly and very young

A

slow infusion

easy to toss pt into hypervolemia

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29
Q

Modified trendeleberg

A

Supine but legs are up
_/

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30
Q

Aneurisms

A

Bulge or ballooning of blood vessel

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31
Q

2 types of anurism

A

Saccular - small on one side, like a hernia

Fusiform - vessel expands on both sides

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32
Q

Aneurism in upper aorta

A

Difficulty swallowing
Difficulty speaking
Heart burn

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33
Q

Age of most common aneurisms

Other risk factors

A

55 and older

FAMILY HISTORY BIG
connective tissue problems
smoking
hypertension

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34
Q

To prevent aneurisms manage

A

Hypertension

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35
Q

Most prone demographic for aneurisms

A

White male

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36
Q

Gut problems are usually what triage category

A

Emergent
may be bleed
may be infection

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37
Q

When you auscultate and feel belly, an abdominal aortic aneurism will feel and sound like

A

Bruit

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38
Q

Procedures to prevent large aneurisms

A

Surgery - sowing a mesh graft inside the aneurism to reinforce the area

Nonsurgical - endovascular deployment of that mesh, done at cath lab

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39
Q

What s/s indicates a worsening

A

WORST back burning pain
Pain in groin area
Impending doom

aneurism is dissecting (stretching with every beat)

most likely will die

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40
Q

S/S of hermorrhage

A

Tachycardia
Low bp
MAP drop
diaphoresis
cold/clammy skin
Tachypnea

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41
Q

Who ALWAYS does the first dressing change

A

The surgeon

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42
Q

Core measure for surgery

A

antibiotics 30 min before cut

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43
Q

ASD Atrio septal defect

A

Abnormal communication between left and right atria

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44
Q

3 types of ASD

A

Ostium Primum
Ostium Secundum
Sinus Venosus

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45
Q

Ostium Primum ASD

A

Abnormal opening at bottom of atrial septum

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46
Q

Ostium secundum ASD

A

abnormal opening at middle of atrial septum

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47
Q

Sinus venosus ASD

A

Abnormal opening at top of atrial septum

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48
Q

Atrial Septal Defect 101

A

Left to right shunt

Blood flows from high pressure left to low pressure right atrium

Increased pulmonary flow lead to elevated pulmonary pressure

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49
Q

Increase in right atrum pressure =

A

increase in right ventricle volume overload and dilation

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50
Q

S/S of ASD

A

mostly asymptomatic

CHF in third or fourth decade of life

Resp infections
Poor weight gain
Poor exercise tolerance

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51
Q

Diagnosing ASD

A

Auscultate
CXR
ECG
Cardiac cath

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52
Q

ASD Auscultate

A

Soft systolic murmur

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53
Q

ASD CXR

A

Increased pulmonary markings

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54
Q

ASD ECG

A

Right access deviation
Right ventricular hypertrophy
Right bundle branch block

55
Q

ASD Cardiac cath

A

Used to close with Atrial Occlusive Device

56
Q

Spontaneous ASD closures happen at age

57
Q

Treat ASD with what meds

A

Anti-congestives

Digoxin
Laxis
for CHF

Atrial occlusion device placement surgery

58
Q

After Atrial occlusion device

A

do ineffective endocarditis prophylaxis for 6 months

59
Q

ASD complications

A

Ineffective endocarditis
Embolic stroke
Pulmonary hypertension
Arrhythmias

60
Q

Risk factors for ASD

A

Down syndrome
Fetal Alcohol syndrome

61
Q

COA
Coarctation of the aorta 101

A

narrowing of the aortic arch

increases left ventricle workload and (systolic BP)

62
Q

Neonates and older children overcoming COA

A

Neonate perfuse lower body through Patent ductus arteriosus PDA

Older children develop collateral vessels to bypass the coarctation

63
Q

Patent ductus atrial

A

Pulmonary artery to aorta

64
Q

COA manifestations neonates

A

Asymptomatic until PDA starts closing

then

Severe CHF
Poor lower perfusion (pedal pulses)
High upper uplses
Tachypnea
Acidosis
Circulatory shock

65
Q

COA manifestations childre/adolescnets

A

hypertension in upper extremities

weak femoral pulses

nose bleeds
headaches
leg cramps

66
Q

Diagnosing COA

A

Auscultation
ECG
CXR

67
Q

COA Auscultation

A

nonspecific ejection murmur

68
Q

COA CXR

A

Cardiomegaly
Pulmonary edema
Pulmonary venous congestion

69
Q

COA ECG

A

Right ventricle hypertrophy in infants

Left ventricle hypertrophy in older children

70
Q

Meds for COA

A

PGE1
Prostaglandin E1 infusion Alprostadil

Inotropics
Digoxin Lasix

71
Q

Interventions for COA

A

Intubation
Endocarditis prophylaxes
Balloon angioplasty

72
Q

Surgery for COA

A

Subclavian flap repair
End to end anastomosis
Dacron patch repair

73
Q

COA Complications

A

Hypertension
CHF

Cerebral hemorrhage
Left ventricular failure
Aortic tear
Berry Aneurysm

74
Q

COA Nursing inteventions
Observe

A

Heartbeat
Peripheral pulses
Skin color/warmth

assess cyanosis

assess CHF

75
Q

Assess cyanosis COA

A

Circumoral
Mucous membranes
Clubbing

76
Q

Assess CHF COA

A

Periorbital edema Tachycardia
Tachypnea
Oliguria
Hepatomegaly

77
Q

Nursing interventions for COA

A

Collaborative therapy
Give treatment for afterload
Give diuretics

78
Q

Nursing pulmonary interventions for COA

A

Monitor breathing
Fowlers position
Rest
Nutrition
Oxygen

Avoid sick people

79
Q

Nursing nutrition interventions for COA

A

High nutrients

Monitor height and weight (DAILY weight)

I&O

Small frequent feed

80
Q

Diuretic use in children

A

Will be thirsty

Fluids are NOT restricted in COA

81
Q

Patent ductus arteriosus 101

A

Normal fetal connection between pulmonary artery and aorta

Bypasses lungs during gestation

82
Q

PDA’s are common in premature neonates who weigh less than

A

1500 grams

83
Q

How long for PDA to close after birth

A

48h partial
4-6w complete

84
Q

What ductus arteriosus fails to close

A

high pressure aortic blood goes into low pressure pulmonary artery

Pulmonary over circulation
=
volume overload in left ventricle

85
Q

S/S of PDA
Lung heart

A

small - asymptomatic

large
Acyanotic!!!
CHF
Tachypnea
Resp infection

86
Q

Body S/S of PDA

A

Poor weight gain
Failure to thrive
Feeding difficulties
Exercise intolerance

87
Q

PDA Auscultation

A

Continuous murmur
LEFT UPPER STERNAL BORDER

88
Q

PDA pulses

89
Q

PDA CXR

A

cardiomegaly

90
Q

PDA ECG

A

Left Ventricular Hypertrophy

91
Q

PDA with symptomatic neonate give

A

Indomethacin IV *
NSAIDs*

if working throughout lifetime = good

if not = surgery

92
Q

Monitoring with PDA

A

Cardiac output (PULSES)
Growth/development
Reassess PDA for closure

93
Q

Prophylaxis for PDA

A

Cardiac output (PULSES)
Growth/development
Reassess PDA for closure

94
Q

Prophylaxis for PDA

A

Endocarditis prophylaxis after surgery or coil occlusion

95
Q

Other meds for PDA

A

Diuretics

Furosemide
Spironolactone

96
Q

Complications of PDA

A

CHF
Pulmonary edema
Ineffective endocarditis
Pneumonia

97
Q

Nursing interventions for PDA
assess

A

Vitals
ECG
Lytes
I&O

98
Q

Side effects of indomethacin

A

Diarrhea
Jaundice
Bleeding
Renal dysfunction

99
Q

After surgery PDA, nursing interventions

A

Venous pressure cath assessment
Arterial line assessment

assess vitals, I&O, arterial venous pressure

100
Q

PDA management goals

A

Reduce pulmonary vascular resistance
Maintain activity
Weight and height (GROWTH CHART)

101
Q

PDA and ToF will both need
due to infection potential

A

Dental prophylaxis with antibiotics

102
Q

Ventricular septal defect 101
VSD

A

Abnormal communication between right and left ventricle

103
Q

Blood travel in VSD

A

High pressure left ventricle to low pressure right ventricle

Increased pulmonary pressure

104
Q

In very bad VSD

A

pressure is so high that it reverses circulation resulting in cyanosis

105
Q

Spontaneous closures of small VSDs happen during

106
Q

Large VSD S/S

A

CHF
Upper resp infections
Poor weight
Feeding problems
Exercise intolerance

107
Q

VSD Adult symptoms

A

SOB
Fatigue
Swelling of legs/abdomen
Arrhythmias

108
Q

VSD Auscultation

A

Harsh systolic regurgitation murmurs

LEFT LOWER STENAL BORDER

109
Q

VSD CXR

A

Cardiomegaly
Increased pulmonary markings

110
Q

VSD ECG

A

biventricular hypertrophy

111
Q

VSD and cardiac cath

A

Needed to ID size of shunt and if it can be closed

112
Q

Pills for VSD

A

Digoxin
Diuretics - furosemide, spironolactone
ACE inhibitors

113
Q

How do you know digoxin is working

A

Cardiac output increase

114
Q

Dig toxicity values

S/S

A

0.5-2.0

early
N/V
Anorexia

late
Visual problems (YELLOW)

115
Q

Dig and Low K

116
Q

Digoxin antidote

117
Q

Oxygen and VSD

118
Q

formula and VSD

A

Increase caloric intake
Fortified formula

119
Q

Treatment of choice for VSD

A

OPEN HEART SURGERY

120
Q

Surgical interventions and VSD

A

Ventricular Occlusive Device
Usually before 1y

Endocarditis prophylaxes after

121
Q

Long term follow ups for VSD

A

Ventricular function monitoring

Monitor for
sub aortic membrane/double chambered RV

122
Q

VSD Complications

A

CHF
Resp infection
Failure to thrive
Aortic insufficiency

Eisenmenger’s syndrome*

123
Q

Biggest Symptom of ToF

A

Acute Cyanosis
May progress through life

124
Q

When to interfere with baby heart defects

A

Symptoms are greater than baby can accommodate

125
Q

Systolic murmur happen during S=

126
Q

Tet spells

A

cyanosis and hypoxia during crying or feeding

127
Q

Tet spells happen during

A

Crying and feeding

128
Q

Tet spells during feeding =

A

failure to thrive

129
Q

To adjust for ToF toddlers will naturally

A

squat
knee to chest

INDICATOR of ToF

130
Q

Is ToF genetic

131
Q

Simple treatment for pulmonary stenosis

A

Angioplasty

132
Q

For the lifetime of a ToF patient they will need prophylactic _ for procedures due to…

A

antibiotics

heart stents collecting bacteria

133
Q

Major Med for ToF

A

Progstoglandin E

134
Q

Eisenmenger syndrome

A

reversal of L-R shunt to a R-L shunt, with cyanosis and clubbing***

S4 2539 (11 decks)

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