Patho Quiz 6 (BP, Shock, Respiratory) Flashcards
What does an “A-line” measure?
“A-lines” or arterial lines measure blood pressure constantly by means of a catheter inserted into an artery.
What are long-term regulations of systemic BP that the body utilizes?
Extracellular fluid, RAAS, SNS, Na+ regulation, Natriuretic hormones, circulating enzymes and peptides
What is the cause of primary HTN?
Primary HTN is idiopathic in nature (no known cause).
HTN is an independent risk factor for __ , ___ , ___ (3).
Renal failure, CVA, CAD
High blood pressure increases the workload of the left ventricle because it increases what?
Afterload.
What is the first line medication class to combat primary HTN?
Thiazide diuretics (ACEI, ARBs, BBs, CCBs may be used in combination).
What are the causes of secondary HTN? (6)
Renal disease, pregnancy, obesity/sleep apnea, endocrine disorders, coarctation of the heart (congenital heart defect)
What is the goal in treating a hypertensive emergency?
Get MAP down by 25% in 1 hour with IV drugs.
What qualifies as a HTN emergency?
Sudden increase in either or both systolic or diastolic blood pressure with evidence of end-organ damage
What is a common cause of orthostatic hypotension?
Volume depletion (dehydration).
What is true of HTN urgency?
Exceedingly high BP levels are present–will not be treated aggressively.
Shock is defined by what?
Tissue perfusion (NOT BP).
Which signs do all three types of shock share (cardiogenic, hypovolemic, and septic)?
Hypotension and low urine output.
What the signs of shock? (7)
- Narrowed pulse pressure
- Tachycardia
- Hyperventilation
- Decreased urine output
- Cool, clammy skin
- ALOC
- Dilated pupils
How does the body compensate during shock? (3)
- Increased vascular resistance
- Increased HR
- Increased force of contraction
What occurs during the progressive stage of shock?
Oxygen-free radicals (chemical disruption involving Oxygen molecule float around in blood stream), release of inflammatory cytokines, and activation of the clotting cascade system.
What are the common causes of obstructive shock? (3)
Pulmonary embolism, cardiac tamponade, and tension pneumothorax.
Define sepsis
An inflammatory response to widespread infection
Name and describe the stages of septic shock
- Initial Phase (Hyperdynamic): warm stage-shunting of blood to core
- Progressive Phase (Hypodynamic): cold stage-BP and CO drop
What are the four criteria to indicate Systemic Inflammatory Response Syndrome (SIRS)?
- HR>90
- RR>20
- WBC below 4,000 or above 12,000
- Temp less than 36 or above 38 C
What are complications of shock? (4)
- Acute Respiratory Distress Syndrome (ARDS)
- Disseminated Intravascular Coagulation (DIC)
- Acute Kidney Injury
- Multiple Organ Dysfunction Syndrome (MODS)
What is the rationale for the appearance of a rapid heart rate in shock?
SNS stimulation
Neurogenic shock is a result of ______.
Loss of sympathetic activation of arteriolar smooth muscle, caused by medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury)
Where does gas exchange occur?
Terminal bronchioles and alveoli.
What is the role of surfactant?
Keeps alveoli from collapsing on itself and causing atelectesis.
What is dead space?
Volume of air filling lung which is not involved in gas exchange.
What is the ratio of tidal volume v. total lung volume?
500 mL : 6 L
What are the three types of dead space?
Anatomic (everyone has some), alveolar, physiologic
What is the difference between PAO2 and PaO2?
PAO2: amount of Oxygen entering the the alveoli
PaO2: amount of Oxygen leaving the alveoli and going into the arteries
What do the central chemoreceptors in the medulla respond to to regulate the respiratory system?
PaCO2 and decrease in pH
What do the peripheral chemoreceptors in the aortic arch and carotid bodies respond to to regulate the respiratory system?
PaO2 and decrease in pH
What is the ideal ventilation : perfusion ratio?
0.8
What are the characteristics of a pulmonary embolus with regards to V/Q mismatch?
Ventilation without perfusion
What are the four ways CO2 are transported?
- Dissolved in plasma
- As carbonic acid in the plasma
- As bicarbonate
- As carbamino compounds on the hemoglobin molecule
Define hypoventilation
Air is insufficient to provide O2 and remove CO2, results in increased PaCO2
Define hyperventilation
Increase of air entering the alveoli leads to hypocapnia (reduced CO2 in blood)
What are the four categories of hypoxia?
- Hypoxic hypoxia (high altitude)
- Anemia hypoxia (low hemoglobin)
- Circulatory hypoxia (low CO, shock)
- Histologic hypoxia (poisoning)
Define acute respiratory failure
State of disturbed gas exchange resulting in low PaO2 (<60) and PaCO2 >50 with a pH less than 7.30, when the pt. is breathing room air
What is a PaO2 goal during respiratory failure?
> 60 mmHg
What is Virchow’s Triad and when does it occur?
Occurs during VTE (DVT, PE)
- Venous stasis
- Hypercoagulability
- Intimal wall injury
What is the difference between the two types of asthma?
- Intrinsic (non-allergic): develops in middle age, repetitive respiratory infections
- Extrinsic (IgE-mediated): develops in children, allergic rhinitis, family history
What is the difference between symptoms of a minor asthma attack v. a severe attack?
Minor: Wheezing on EXHALATION
Severe: Wheezing on INHALATION
Define chronic bronchitis
Chronic or recurrent productive cough >3 months over 2+ successive years with hypersecretion of bronchial mucus.
Define Cor Pulmonale
Right sided HF as a result of pulmonary diseases
What is one of the treatments used in chronic bronchitis (especially in younger patients)?
Theophylline (liquid caffeine) which causes bronchodilation and vasoconstriction
What virus can lead to bronchiolitis in children?
RSV
What is the end treatment goal for CF patients?
Lung transplant
What is the most dangerous complication of epiglottitis?
Complete airway obstruction (closes off top off trachea)
What are the cardinal symptoms of Croup?
Barking cough with inspiratory stridor
A pulmonary assessment that reflects increased resistance to airflow due to narrowing, or internal or external obstruction of the passages would cause:
Decreased forced expiratory volume
What does SOB, coarse breath sounds, and a productive cough likely indicate?
Chronic bronchititis
What is a common finding of Acute Respiratory Distress Syndrome (ARDS)?
Severe hypoxemia caused by intrapulmonary right-to-left shunting of blood
What is the cause of Infant Respiratory Distress Syndrome?
They do not yet produce surfactant (premie babies)
How can Bronchitis and Pneumonia be differentiated?
Through a chest X-RAY (Pneumonia will show up, Bronchitis won’t)
Pneumonia can occur in what parts of the body?
Lungs, brain, liver, spinal cord, etc.
