Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med Surg 3 > Midterm > Flashcards

Midterm Flashcards

1
Q

What parameters are going to be monitored with hemodynamic monitoring?

A

preload (CVP and PAWP)
afterload (PVR ad SVR)
CO/CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe preload

A

Right atrial pressure
- CVP (central venous pressure): 2-8 mmHg

Left atrial pressure
- PAWP (pulmonary artery wedge pressure): 8-12 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What will be done if the preload is high vs low?

A

high (CVP/PAWP) = pt in fluid volume overload, give diuretics and vasopressors

low = pt dehydrated - fluids (crystalloids/colloids) 1st if CVP is low, but if CVP is high give vasopressors

if CVP and PAWP is on the lower end of the normal range, it is still considered low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe afterload

A

Right side of heart
- PVR (pulmonary vascular resistance): 100-250 dynes/sec/cm5

Left side of heart
- SVR (systemic vascular resistance): 800-1200 dynes/sec/cm5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What will be done if the afterload is high vs low?

A

high = give vasodilator
low = give vasopressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between vasopressors and vasodilators?

A

vasopressors increase BP
vasodilators decrease BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are examples of vasodilators?

A

nitroglycerin
nitroprusside
morphine
ca channel blockers
ace inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are examples of vasopressor?

A

norepinephrine
dopamine
vasopressin
epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe cardiac contractility

A
  • electrolytes and oxygen affect contractility
  • low CO/CI = ineffective contractility

cardiac output (CO)
- volume ejected each min
- 4-8 L/min

cardiac index (CI)
- dependent on height and weight of pt
- 2.5-4.3 L/min/m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What will be done if the cardiac contractility is high vs low?

A

high = negative inotropes (beta blockers and ca channel blockers)

low = give positive inotropes (dopamine, dobutamine, digoxin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the cause of cardiogenic shock?

A
  • heart not pumping effectively (within the heart)
  • MI
  • HF
  • cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the cause of hypovolemic shock?

A
  • loss of fluid
  • dehydration
  • hemorrhage
  • burn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are examples of distributive shock?

A

whole body

septic (#1 shock state)
neurogenic
anaphylactic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the cause of septic shock?

A
  • infection
  • sepsis (urosepsis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the cause of neurogenic shock?

A

head trauma
spinal cord injury (T6 or higher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the cause of anaphylactic shock?

A

allergy (drug, food, environmental)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the cause of obstructive shock?

A

heart not pumping effectively (outside the heart)

  • pulmonary embolism
  • tension pneumothorax
  • aortic dissection
  • cardiac tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs of cardiac tamponade?

A

beck’s triad
- hypotension
- JVD
- muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs of cardiogenic shock?

A
  • high HR , low BP
  • high CVP/PAWP, high SVR
  • low CO/CI
  • confused
  • SOB
  • tachypnea
  • crackles
  • low urine output
20
Q

What is the treatment for cardiogenic shock?

A
  • inotropes (dopamine/digoxin)
  • diuretics
  • stent
  • valve replacement
21
Q

What are the signs of hypovolemic shock?

A
  • high HR, low BP
  • low CVP/PAWP, high SVR
  • low CO/CI
  • altered LOC
  • low urine output
  • cold/clammy skin
22
Q

What is the treatment for hypovolemic shock?

A
  • fluids (NS or LR), but vasopressors (norepi or dopamine if CVP high
  • lower HOB
  • if bleeding = packed RBCs
  • fluid replacement using 3:1 rule (3ml of fluids to every 1 ml of blood loss)
23
Q

What is the difference between sepsis and septic shock?

A

sepsis: systemic inflammatory response

septic shock: sepsis w/ hypotension despite fluid resuscitation

24
Q

What are the signs of early (warm) septic shock?

A

restlessness/confusion
low BP, high HR, high RR
warm, flushed skin
low CVP/PAWP, low SVR
high CO
high lactate, WBC

25
Q

What are the signs of late (cold) septic shock?

A

lethargy/coma
low BP, high HR, low RR
cool, pale skin
low CVP/PAWP, high SVR
low CO
high lactate, low WBC

26
Q

What is the treatment for septic shock?

A

oxygen
IV fluids
antibiotics
vasopressors
maintain glucose levels <180
prevent stress ulcer (PPI)

27
Q

What are the signs of neurogenic shock?

A

massive vasodilation
bradycardia
low BP
temp dysregulation
low preload, afterload, CO

28
Q

What is the treatment for neurogenic shock?

A

fluids (NS, cautious bc it increases BP)
vasopressors
atropine
corticosteroids (reduce inflammation)

29
Q

What are the signs of anaphylactic shock?

A

massive vasodilation
high HR, low BP
decreased RR
SOB, wheezing, stridor

low preload, afterload, CO

30
Q

What is the treatment for anaphylactic shock?

A

epinephrine (IM)
fluids (if they don’t work, give vasopressors)
diphenhydramine
corticosteroid
airway mngmt

31
Q

What are the signs of obstructive shock?

A

high CVP/PAWP, high SVR
low CO/CI
JVD
high HR, low BP, high RR

SOB, tracheal deviation, unilateral breath sounds

32
Q

What is the treatment for obstructive shock?

A

needle decompression
chest tube
pericardiocentesis
thrombolytic therapy
laparotomy
removal of mass

33
Q

What are the stages of shock?

A

initial
compensatory
progressive
irreversible

34
Q

Describe the initial shock stage

A
  • s/s absent
  • subtle changes
35
Q

Describe the compensatory shock stage

A
  • non progressive
  • low oxygen
  • tachycardia
  • tachypnea

ex: neurogenic shock

36
Q

Describe the progressive shock stage

A
  • organ failure
  • lethargic
  • low BP

ex: hypovolemic, anaphylactic

37
Q

Describe the irreversible shock stage

A

death is imminent

ex: cardiogenic

38
Q

What diagnostic studies are done for the different types of shock?

A

hemodynamic monitoring
12 lead ECG
echo
CXR
EGD
lactate above 2 = bad

39
Q

Describe SIRS

A

systemic inflammatory response syndrome

manifested by 2 or more of following:
- 36 C < Temp > 38 C
- HR > 90 bpm
- RR > 20 or PaCO2 < 32
- 4,000 < WBC > 12,000

40
Q

How can a local infection progress?

A

local infection - systemic infection (shock) - SIRS - multiple organ system syndrome (MODS septic shock) - death

41
Q

How does SIRS (organ failure) present?

A
  • neuro: ALOC, fever, lethargy
  • resp: high RR, low O2
  • cardio: tachycardia
  • GI: ulcer, bleed, electrolyte imbalance
  • GU: AKI, high BUN/creatinine
  • hematologic: DIC, bleeding, petechiae, high PTT/aPTT, INR > 1.5, low wbc
42
Q

How is SIRS treated?

A

infection control
maintain oxygen
provide nutrition via enteral route

support of failing organs:
- ARDS: O2 therapy and mech vent
- DIC: blood products
- renal failure: CRRT or hemodialysis

43
Q

What is DIC?

A

disseminated intravascular coagulation

  • not a disease, but a complication
  • proteins that control blood clotting become overactive, causing many blood clots to form all over the body
44
Q

What causes DIC?

A
  • infection/sepsis
  • trauma
  • shock
  • cancer
  • OB complication
45
Q

What are the signs of DIC?

A

severe bleeding everywhere
- petechiae, purpura, epistaxis (nosebleed), hematuria, melena (black tarry stools), hematomas

thrombosis
- brain= CVA (stroke)
- heart= MI (heart attack)
- lung= PE (pulmonary embolism)
- leg= DVT (deep vein thrombosis)

46
Q

What will the labs show for DIC?

A

prolonged PT, aPTT, INR
low platelets
low fibrinogen

47
Q

What is the treatment for DIC?

A

treat underlying cause
O2 therapy
IV fluids
blood transfusion
- packed RBC (blood loss)
- platelets
- FFP
- cryoprecipitate (replaces fibrinogen)
- heparin (decrease clots)

Med Surg 3 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions