Med Surg III ABG & Shock

Question 1

Normal level of Anion Gap

Answer 1

8 - 14 mEq/L

Question 2

what causes increase in Anion Gap

Answer 2

lactic acidosis or DKA

Question 3

what causes decrease in Anion Gap

Answer 3

hypermagnesemia and anemic states

Question 4

hypoventilation causes

Answer 4

respiratory acidosis

Question 5

hyperventilation causes

Answer 5

respiratory alkalosis

Question 6

what causes metabolic acidosis

Answer 6

severe diarrhea, renal disease, DKS, ARF, Kussmaul resp

Question 7

what causes metabolic alkalosis

Answer 7

prolonged vomiting, suctioning, ingestion of baking soda and oral antacids, laxatives, enemas

Question 8

clinical manifestations of acidosis

Answer 8

drowsy, disoriented, HA, coma, low BP, dysrhythmias, warm flushed skin, seizures, hypoventilation

Question 9

clinical manifestations of alkalosis

Answer 9

lethargy, confusion, tachycardia, dysrhythmias, N/V, anorexia, tetany, tremors, seizures, hyperventilation

Question 10

normal Hgb levels

Answer 10

men 14 - 18 g/dL, women 12 - 16 g/dL

Question 11

normal hct levels

Answer 11

men 42% - 52%, women 37% - 47%

Question 12

compensatory stage

Answer 12

early, blood flow to heart and brain maintained, increase BP, increased Na and water, watch labs for this

Question 13

progressive stage

Answer 13

begins as compensatory mechanism fail, Need aggressive intervention to prevent MODS

Question 14

refractory stage

Answer 14

late and often irreversible, Need vasoactive drugs (Midrin, Dobutamine, Dopamine, levonfed)

Question 15

drugs for cardiogenic shock

Answer 15

vasodilators, inotropics, diuretics (Nitroglycerin, Nitroprusside)

Question 16

drugs for septic shock

Answer 16

inotropics and antibiotics

Question 17

drugs for anaphylactic shock

Answer 17

epinephrine

Question 18

drugs for neurogenic shock

Answer 18

inotropics

Question 19

what is the primary treatment for hypovolemic and distributive shock

Answer 19

fluid administration and identify, treat, and eliminate cause of fluid loss

Question 20

When should colloids be avoided

Answer 20

when there is an increase in capillary permeability, as in sepsis and septic shock, anaphylactic shock, and early burn injury

Question 21

what are isotonic solutions that are commonly infused

Answer 21

Lactated Ringers and 0.9% normal saline

Question 22

When should Lactated Ringers be avoided

Answer 22

pt’s with impaired liver function or severe lactic acidosis

Question 23

which solutions are not used for fluid resuscitation

Answer 23

5% dextrose in water and 0.45% normal saline

Question 24

When is albumin and plasma protein fraction appropriate

Answer 24

when volume loss is caused by a loss of plasma rather than blood, such as burn injury, peritonitis, and bowel obstruction

Question 25

When is fresh frozen plasma given

Answer 25

when massive transfusions are infused, it is given to restore coagulation factors (1 unit for every 4 - 5 units of packed red blood cells)

Question 26

When are platelets given

Answer 26

to control bleeding caused by low platelet counts (< 50,000/microliter)

Question 27

why evaluate the Hct level

Answer 27

if low = blood loss, if high = fluid loss (need to know so the fluid that is lost can be replaced)

Question 28

early, goal directed therapy for septic shock

Answer 28

IV fluids, vasopressors, and dobutamine, packed red blood cells, or both

Question 29

primary MODS

Answer 29

direct injury to an organ from shock, trauma, burn injury, or infection

Question 30

secondary MODS

Answer 30

a consequence of widespread systemic inflammation that results in dysfunction of organs not involved with the initial insult

Question 31

target level of serum lactate

Answer 31

< 2.2 mEq/L

Question 32

target level of MAP

Answer 32

65 mm Hg or greater

Question 33

target level of CVP

Answer 33

8 mm Hg or greater

Question 34

hemodynamic values associated with initial stage of septic shock

Answer 34

high heart rate, low right arterial pressure

Question 35

dobutamine

Answer 35

increases contractile force of heart in cardiogenic shock

Question 36

dopamine

Answer 36

used in low cardiac output states to increase BP

Question 37

nipride

Answer 37

reduces vascular resistance

Question 38

5 types of shock

Answer 38

1. cardiogenic 2. hypovolemic 3. neurogenic 4. anaphylactic 5. septic

Question 39

Which type of shock do these s/s suggest?
dec cap refill, tachypnea, cyanosis, crackles, rhonchi, cool, clammy, dec. renal blood flow, dec. urine output, dec bowel sounds, n/v, incr. glucose and BUN, dysrhythmias, increase pulse, decrease blood pressure

Answer 39

cardiogenic shock

Question 40

why do the kidneys secrete renin when bp is decreased

Answer 40

renin is a vasoconstrictor and its a compensation mechanism

Question 41

Which type of shock do these s/s suggest? dec. cap refill, tachypnea, decreased urine output, cool clammy skin, increased pulse, no bowel sounds, decreased HgB and Hct.

Answer 41

hypovolemic shock

Question 42

which type of shock do these s/s suggest? change in temp, bradycardia, loss of reflexes, bladder/bowel dysfunction, flaccid paralysis below lesion

Answer 42

neurogenic shock

Question 43

which type of shock do these s/s suggest? swelling of lips/tongue, sob, wheezing, stridor, flushing, uticaria, pruitis, confusion, n/v, diarrhea, hist of allergies

Answer 43

anaphylactic shock

Question 44

which type of shock do these s/s suggest? change in temperature, hyperventilation, change from respiratory alkalosis to respiratory acidosis, hypoxia, ARDS, pulmonary hypertension, decrease urine output, positive blood cultures, vasodilation and maldistribution of circulating volume?

Answer 44

septic shock

Question 45

causes of respiratory acidosis

Answer 45

asthma, bronchitis, emphysema, hypoventilation, pneumonia,PE

Question 46

causes of respiratory alkalosis

Answer 46

fever, hyperventilation, hypoxia, hysteria, pain