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BSNC 7110 > Module 6 > Flashcards

Module 6 Flashcards

1
Q

Normal UOP

A

0.5-1 ml/kg/hr
or 800-2000 mL/daily

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1
Q

Oliguria

A

<500 mL/day
or <0.5ml/kg/hr for six hours

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2
Q

Infection

A

invasion of sterile tissue by microbes
prompts inflammatory/immune response

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3
Q

Septicemia

A

presence of microbes in circulating blood

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4
Q

SIRS

A

systemic inflammatory response syndrome
uncontrolled inflammation not d/t infection resulting in impaired organ function and altered hemodynamics

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5
Q

SIRS criteria

A

T >38 or <36
HR >90
RR >20 or PaCO2 <32
Altered mental status
WBC >12 or <4 or >10% immature band formsS

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6
Q

Sepsis

A

SIRS + infection
clinical manifestations similar to SIRS
dysregulated host response to infection resulting in widespread inflammation + organ dysfunction

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7
Q

MODS

A

multiorgan dysfunction syndrome
altered organ function in acutely ill patients where homeostasis cannot be maintained without intervention

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8
Q

Levels of immunity

A

first = physical barriers
second = innate immunity (neutrophils, macrophages, histamine)
third = acquired immunity (T-cells, B-cells)

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9
Q

Causes of elevated lactate

A

hypoperfusion (sepsis)
impaired hepatic clearance (cirrhosis)
medications (b2 agonist, metformin)
hypoxia

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10
Q

Disseminated Intravascular Coagulation (DIC)

A

release of cytokines + procoagulant agents cause excessive clotting
results in micro-thrombi that become lodged in smaller blood vessels/capillaries
activates fibrinolysis which inhibits platelet aggregation
cause ischemia –> necrosis of tissue or organ dysfunction
consumptive coagulopathy –> increased r/o bleeding d/t decreased number of circulating platelets, fibrin, clotting factors

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11
Q

Sepsis + GI

A

altered gastric mucosa
r/o peptic ulcers, bleeding
ileus
mucosal ischemia = increased permeability of gut bacteria = bacterial translocation

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12
Q

Sepsis + GU

A

r/o AKI
fluid + electrolyte imbalances

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13
Q

Sepsis + CV

A

decreased cardiac output (low preload, impaired cardiac contractility)
micro-emboli decrease perfusion to peripheral tissue + cause organ dysfunction/necrosis
r/o bleeding d/t consumption of platelets, fibrin, clotting factors

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14
Q

Sepsis + ARDS

A

acidosis –> hyperventilation
can lead to ARDS
need for mechanical intubation

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15
Q

Sepsis 1 hour bundle

A

1) lactate (remeasure if >2)
2) obtain blood cultures BEFORE abx (do not delay more than 1 hour)
3) broad-spectrum abx
4) crystalloid fluids 30 mL/kg (for hypotension or elevated lactate)
5) vasopressors if fluids don’t work

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16
Q

Vasopressors for Sepsis

A

TARGET MAP 65

norepinephrine
vasopressin
epinephrine
dobutamine
steroids can be added if ongoing vasopressor treatment indicated

17
Q

How long can vasopressors be administered through a PIV

A

6 hours

18
Q

Causes of SIRS

A

pancreatitis
burns
multiple trauma
aspiration
ischemia
hemorrhagic shock

19
Q

Stages of ARDS

A

early = exudative
intermediate = proliferative
late = fibrotic

20
Q

Exudative phase of ARDS

A

ACUTE INFLAMMATION

massive inflammation –> nonhydrostatic pulmonary edema
alveoli fill with fluid = decreased compliance, impaired gas exchange, V/Q mismatch
inflammation promotes coagulation = formation of hyaline membrane impermeable to gas exchange
hypoxemia refractory to supplemental O2, tachycardia, tachypnea, SOB, bilateral opacities on CXR, hypercapnia

21
Q

Proliferative phase of ARDS

A

TISSUE REPAIR

residual debris cleared by phagocytes
restoration of alveoli epithelium
restoration of alveolar surface area + reabsorption of pulmonary fluid
improved oxygenation

22
Q

Fibrotic phase of ARDS

A

SCARRING + LONGTERM ISSUES

fibrosis of alveoli–> pulmonary HTN + pulmonary fibrosis
longterm impaired gas exchange
r/o RHF
impaired function depression, anxiety, PTSD, chronic respiratory dysfunction

23
Q

Causes of hypovolemia in SIRS

A

insensible losses s/t increased metabolism, fever, tachypnea
vascular permeability –> third spacing
decreased oral intake

24
Q

Definition of AKI

A

increase in creatinine by 26.5 umol or 1.5x of baseline within 24 hours
oliguria for 6 hours
**GFR cannot be used to diagnose AKI

25
Q

Prerenal causes of AKI

A

hypovolemia
NSAIDs (target afferent arteriole
low cardiac output (heart failure)

26
Q

Intrarenal causes of AKI

A

ischemia –> acute tubular necrosis
certain drugs (chemotherapy)
CT contrast
infection

27
Q

Postrenal AKI

A

obstruction (kidney stone)
BPH
neurogenic bladder

28
Q

S/S AKI

A

fluid overload (pulmonary edema)
hyponatremia (impaired reabsorption/excretion)
hyperkalemia
metabolic acidosis
increased creatinine/BUN/decreased GFR
oliguria or anuria
hypocalcemia/hyperphosphatemia (inverse relationship)
anemia (kidneys release EPO)
platelet abnormality/bleeding (urea impairs clotting)
neuro: fatigue, seizures, coma

29
Q

Diuretic phase of AKI

A

kidneys lose ability to concentrate urine
low urine specific gravity
polyuria
r/o hypovolemia, hypotension, hyponatremia/hypokalemia

30
Q

Conditions causing hyperkalemia

A

tissue trauma (rls of intracellular content)
bleeding
blood transfusion
metabolic acidosis

31
Q

Hyperkalemia EKG

A

peaked T waves
prolonged PRI
wide QRS
PVCTr

32
Q

Treatment for hyperkalemia

A

insulin + dextrose
kayexalate
calcium gluconate (stabilize cardiac membrane)
loop diuretics
dialysis
B2 agonist
sodium bicarbonate (increase pH, cause cells to shift hydrogen outward and potassium inward)

33
Q

S/S of acidosis

A

Kussmaul resps
flushed, warm skin (vasodilation)
hypotension
headache
tachycardia
N/V
bradycardia
altered LOC

34
Q

Nutrition + kidney disease

A

important to maintain adequate nutrition to prevent proteolysis
when glucose low, body breaks down fat/protein to convert into glucose
protein metabolism –> ammonia –> urea
kidney unable to excrete urea –> uremia –> encephalopathy

35
Q

CXR

A

ID infection (pneumonia common cause of sepsis)
pulmonary complications (edema, ARDS)
assess cardiac silhouette

36
Q

12-Lead ECG

A

sepsis can cause cardiac dysfunction + development of arrhythmias
obtain baseline info on pt cardiac rhythm
ID if heart site of infection

37
Q

ABG

A

evaluate end-organ perfusion (lactate)
assess acid-base imbalances
oxygenation/hypercapnia

38
Q

VBG

A

similar information as an ABG but easier to obtain
uses different parameters

39
Q
A
40
Q
A

BSNC 7110 (4 decks)

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