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S4 2539 > M7 Immunity 2 > Flashcards

M7 Immunity 2 Flashcards

1
Q

MODS

A

Multiple organ distress syndrome

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2
Q

MODS is characterized by

A

failure of a t least 2 major organs
hemostasis cannot be achieved without intervention

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3
Q

SIRS leads to _ leads to

A

MODS
Shock

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4
Q

Causes for mods

A

Severe injury or illness
Muscle or tissue trauma
Shock

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5
Q

Which shock is most common with mods

A

Septic

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6
Q

MODS Patho

A

Uncontrolled inflammation
Vasodilation
Protein mediators leak into interstitial space
Coagulation cascade activates

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7
Q

Hypotension leads to decreased perfusion/micro emobli
this decreases flow to

A

Lungs
Kidneys
Heart
Liver

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8
Q

MODS leads to ARDs
Acute respiratory distress syndrome 101

A

Increased capillary permeability
Fluid moves from vessels to alveoli, edema
Surfactant decreases, alveoli collapse

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9
Q

ARDs is indicated by

A

VQ mismatch
Pulmonary hypertension
Increased resp rate
hypoxia
Bilateral infiltrates

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10
Q

Cardiac mods symptoms

A

Myocardial depression
BP Drop
Increased HR
Increased permeability causes albumin to go into tissue with fluid

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11
Q

Neuro MODS symptoms

A

Confusion agitation combativeness letharby

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12
Q

Renal MODS symptoms

A

AKI
RAAS system stimulation
Aldosterone mediated Sodium and water reabsorption
Tubular necrosis

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13
Q

GI and MODS

A

Mucosal ischemia
GI Bleed

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14
Q

Hepatic and MODS

A

Hepatic Encephalopathy

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15
Q

Diagnostics for mods

A

12 lead EGK
Echocardiography
Stress tests

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16
Q

Immaging for MODS

A

Xray
CT
MRI

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17
Q

Labs for mods

A

Lytes
CBC
Renal panel
Liver panel
Cardiac biomarkers
Thyroid
Coagulation factors

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18
Q

MODS medical history

A

recent injury/surgery
chronic illness - aids, copd, cancer etc.
immunosuppressant meds

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19
Q

MODS interventions

A

Tissue oxygenation
Volume management
Nutrition management
Organ support

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20
Q

Support for organs

A

Dialysis or CRRT
Ventilation

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21
Q

When is care withdrawn

A

Three or more organ systems worsen despite intervention
Death is inevitable with doctor judgment

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22
Q

Life support major interventions

A

Ventilator
Dialysis
TPN
Blood transfusion
Lab work

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23
Q

Withdrawal of care

A

Obtain DNR
Start comfort meds
Care for fam
Talk to social work/chap

document

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24
Q

Comfort meds

A

Fentanyl
Hydromorphone
Propofol

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25
Q

2 Major contributing infections to sepsis

A

UTI
Pneumonia

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26
Q

Biggest lab value for sepsis

A

LACTATE

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27
Q

What does lactate indicate

A

Switching from aerobic to anaerobic metabolism = inflammation

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28
Q

Skin problems that can lead to spesis

A

Pressure ulcers
Cellulitis

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29
Q

3 Biggest sepsis bacteria

A

Staph
Strep
E. Coli

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30
Q

Why are diabetics at risk for sepsis

A

Bacteria love sugar

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31
Q

Best thing to start first with sepsis

A

Fluids

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32
Q

Hyperbaric therapy used for wounds
why and how

A

helps wounds health

provides 100% oxygenation to the wound

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33
Q

How soon do you need to do CBC and Lactate cultures for sepsis

A

Within 6h

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34
Q

Aminoglycoside drugs names end in

can result in what toxicities

A

Myocin

Renal
Hearing

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35
Q

How to measure Aminoglycoside toxicity…

what labs

A

First measure Trough
Measure in hour to check Peak

BUN, Creatinine

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36
Q

Biggest number indicator of BP

A

MAP
Less than 65 PROBLEM

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37
Q

Is SIRS a disease

A

NO

its a syndrome, first stage of sepsis

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38
Q

Only reason for AIDS patients to get admitted to hospital

A

Overwhelming infection

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39
Q

Type of Pneumonia that is common with AIDS

A

Pneumocystis Jerovic
(PJP)

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40
Q

Once you have AIDS, if your CD4 goes up past 200 can you go back to HIV

A

NO

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41
Q

HIV pregnant mothers can only deliver via

A

C section

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42
Q

Meningitis that affects HIV pts

A

Cryptococcal meningitis
Very Dangerous

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43
Q

Skin cancer most common with HIV AIDS

A

Kaposi Sarcoma

Red spots all over skin

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44
Q

CDC Categories for HIV

A

Above 500 Cat A
Between 499 and 200 Cat B
Below 200 Cat C

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45
Q

ELISA HIV test is same name as

A

EIA

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46
Q

HIV Pneumonia jerovic treatment

A

Sulfamethoxazole trimethoprime
SMZ TMP

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47
Q

HIV Oral candidiasis treatment

A

Ketoconazole
Nystatin
Mycelex

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48
Q

CART
vs
HART

A

Combination antiretroviral

High antiretroviral

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49
Q

Best IV antiemetic

A

Zofran

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50
Q

Decreased cardia contractility results in a drop in stroke volume and cardiac output,

This leads to what other complications

A

Pulmonary congestion
Drop in body perfusion
Drop in heart perfusion

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51
Q

Cardiogenic shock S/S

A

Systolic BP below 90
Urine output below 30ml/h
Weak pulse
Cold clammy skin
Decreased bowel sounds

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52
Q

Mental and resp S/S of shock

A

confusion, lethargy

dyspnea, tachypnea, cyanosis

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53
Q

First line treatment for cardiogenic shock

A

Oxygenation
Fluids
Pain control
Hemodynamic monitoring
Monitor lab markers

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54
Q

Meds for cardiogenic shock

A

Dobutamine
Amrinone
Digoxin
Diuretics
Antiarrhythmics

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55
Q

Nursing management of cardiogenic shock

A

Monitor hemodynamics
Oxygenation
Admin IV fluids
Safety and comfort

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56
Q

Hemodynamic monitoring

A

I&O
Daily weight
MAP
CO
Swan-Ganz

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57
Q

Monitoring Heart changes with cardiac shock

A

ECG
Lytes

58
Q

Oxygenation interventions with cardiac shock

A

Monitor respirations
Auscultate lungs
Observe for pink cough sputume
Admin O2
Elevate head

59
Q

Perfusion monitoring with cardiac shock

A

Neuro checks
BUN/Creatinine
Temp
Arterial pulses

60
Q

What to monitor with pulses

A

Rate Rhythm Quality

61
Q

If there is a significant change in LOC with cardio shock

A

Report Immediately

62
Q

Hypovolemic shock chain of path

A

Drop in volume
Drop in venous return
Drop in stroke volume
Drop in CO
Drop in perfusion

63
Q

Dr. interventions for Hypovol shock

A

Treat cause
Give fluids
Give vasopressors

64
Q

Nursing interventions for Hypovol shock

A

Admin fluids safely
Admin O2

65
Q

Position for Hypovol shock

A

Modified Trendelenburg _/

66
Q

Aneurysm

A

Abnormal bulging of vessels

67
Q

Aneurysm types

A

Saccular
Fusiform

68
Q

Major risks for anurisms

A

SMOKING
HYPERTENSION
Age over 55
Connective tissue disorders

69
Q

Most common pain with anurisms

A

Left lower quadrant
Intense lower back

70
Q

Other symptoms of anurisms

A

Syncope
Tachycardia
Hypotension

aka hammorrhage

71
Q

Thoracic aortic aneurysm S/S

A

Trouble speaking, breathing and swallowing

72
Q

Sharp ripping or tearing pain in anterior of chest shoulder or back indicates

A

Aneurism rupture

73
Q

Nursing interventions for Aneurism

A

Prepare for MRI CT or XRay
Monitor for S/S of hypovolemic shock
Perform neuro checks

74
Q

Post aneurism surgery interventions

A

Frequent vitals
Labs
Urine output
Bowel distension
Skin perfusion

75
Q

labs to monitor post anurism surgery

A

CBC

76
Q

MODS is a severe form of

A

Shock

77
Q

Stages of shock

A

Initial
Compensatory
Progressive (failure of compensation)
Refractory (shift to end of life care)

78
Q

First organ to get hit by MODS

A

Kidneys

79
Q

Body holds on to sodium and water via what hormone

A

Aldosterone

80
Q

EARLY signs of shock

A

1# CONFUSION

hypotension
MAP v
tachycardia

81
Q

Hypoxia S/S
ON TEST

A

Restlessness
Irritability
Tachycardia

82
Q

1 reason for ARDS

A

Pneumonia
Infection

83
Q

Allographt transplants can be received from

A

Living
or
Cadaver

bodies

84
Q

1 concern for organ transplants

A

Rejection

85
Q

Med types for organ transplant

A

Corticosteroids
Antibiotics
Anticoagulants
Immunosuppressants

86
Q

Most important part of organ transplant meds

A

Compliance

87
Q

Normal CD4 count
HIV count

A

800-1000

below 200

88
Q

Do we report HIV to health organizations
Is there and HIV vaccine

A

YES
YES, not a live one

89
Q

HIV Neuro manifestations

A

LOC Changes
May be due to ENCEPHALOPATHY

90
Q

Cryptococcus neoformans 101

S/S

A

Opportunistic neuro disease that prays on HIV patients

Stiff neck
Seizures
Mental changes
Fever

91
Q

Most common HIV infection

S/S

A

Pneumonia

fever, chills, non productive cough

92
Q

What to assess with HIV patients

A

Albumin, weight, BMI- malnutrition BIG problem

93
Q

Biggest factor of HIV is viral load, the higher

A

the greater the progression to AIDS

94
Q

HIV Precaution

A

Contact and standard

95
Q

Where to take HIV PTs X rays

A

In room instead of lad to limit exposure

96
Q

If HIV needlestick

A

Report to ED Immediately
Viral meds start w/in 2h of stick for at least 4 weeks

97
Q

HIV penumonia treatment

A

Trimethoprim sulfamethoxazole

Pulmonary care - cough, deep breaths, postural drainage Q2H

98
Q

Sulfamethoxazole trimethoprim side effect

A

Hyperkalemia

99
Q

How to manage HIV Viral load

A

TAKE MEDS REGULARLY

100
Q

How does HIV pneumonia start

A

Perianal and oral mucosa infections
Thrush/fungus
Skin integrity

101
Q

HIV GI problems

A

Oral candidiasis
Diarrhea
Wasting syndrome

102
Q

Most common HIV tests

A

EIA
Western Blot - confirms EIA

103
Q

HIV Transmission

A

Sex
IV drugs
Birth

104
Q

HIV Is transmitted in body fluids including

A

Amniotic fluids
Breast milk
blood
semen
vagina semen

105
Q

1 med o promote nutrition

A

MEGACE (Megestrol)
ON TEST

106
Q

10% weight loss
Chronic diarrhea
Weakness
Fever

and NO OTHER CUASE =

A

HIV wasting syndrome

107
Q

A/B of MODS

A

metabolic ACIDOSIS
body going into anaerobic metabolism INCREASES lactic acid

108
Q

1 organ to fail with MODS

A

Kidneys

109
Q

Compensatory stage of mods S/S

A

VASOCONSTRICTION
cool clammy skin - body shunts blood from core
acidosis

110
Q

Progressive stage of mods S/S

A

VASODILATION
hypoperfusion

111
Q

Normal MAP is more than

A

60

112
Q

Nutritional management for encephalopathy

A

Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good

113
Q

Lytes with encephalopathy
what to do

A

Hypokalemia
give lactulose

114
Q

With encephalopathy and increasing ammonia first symptom is

A

LOC - SLEEPINESS
stupor
impaired thinking

115
Q

Second encephalopathy S/S are
neuromuscular

A

Asterixis - liver shakes
Hyperreflexia

116
Q

Too much lactulose would be indicated by

A

Diarrhea
Hypokalemia
Dehydration

117
Q

How do you know lactulose is working

A

2-3 soft stools per day ***

118
Q

For MODS and shock you want MAP to be

A

Greater than 65

119
Q

Other things to maintain with MODS and shock

A

pH
Liver/GI function
Kidney function

watch for onset of DIC

120
Q

Once multiple organs start failing

A

Switch care to comfort

121
Q

If pt is an organ donor keep map at

A

100
or high as possible

122
Q

Goal of family care

A

Keep fam informed of situation and process

123
Q

SIRS glucose

A

Will be over 120 w/o Diabetes or other explanations

124
Q

SIRS age risk categories

A

Adult over 65
Kid under 1

125
Q

SIRS biggest infection causes

A

UTIs
Pressure ulcers

126
Q

Most common bacteria types

A

Staph
Strep
Escherichia Coci

127
Q

Consults for discontinuation of life support

A

DNR
Social worker
Chaplain
Have Dr. explain

128
Q

SIRS S/S of worsening

A

Difficulty breathing
Drop in urine output
Hyperglycemia
^in lactic acid
Edema

129
Q

With SIRS we try to prevent

A

HYPOTENSION
Bottoming out

130
Q

Bad temperatures

A

OVER 100.4
UNCER 96.8

131
Q

Why does lactic acid increase with SIRS

A

anaerobic metabolism

132
Q

Treat drop in BP

A

Saline bolus
Norepi
Dopamine

133
Q

With septic shock. blood pulls to extremities so

A

Skin will be warm as opposed to EVERY OTHER shock

134
Q

Septic shock risk reduction

A

Up to date vaccines
Proper wound care
Hand hygiene
NO delays in antibiotics

135
Q

Prior to surgery give _ to maintain hydration
What kind of bath
What med to give 30 min prior

A

LR
CHG wipe bath
Antibiotic

136
Q

urinary sign of organ rejection

A

drop in urine output
less than 30ml/hr

137
Q

Labs with low urine

A

Elevated BUN/Creatinine

138
Q

Organ transplant post op care

A

VS q15m
check wound
NPO
Hydration
MONITOR PISS OUTPUT less than 30ml/hr

139
Q

post surgery uncontrolled pain

A

something is wrong
CALL DR

140
Q

Post surgery moving pain

A

CO2 pain
only treatment is more movement

S4 2539 (11 decks)

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