Shock and hemodynamic monitoring

Question 1

review hypotonic, hypertonic and isotonic IV

Answer 1

hypotonic solution- causes fluid to move into the cells (good for severe dehydration never when at risk for ICP)
hypertonic- causes fluid to leave the cells (good to correct electrolyte deficiencies, bad for dehydrated or keto acidotic pts)
Isotonic- concentration inside and outside of cell remain the same. (replaces fluid loss pay attention to S/S of fluid overload)

Question 2

crystalloid and colloid

Answer 2

crsyalloids are used to increased intravascular volume, most commonly used is NS .9%.
Colloid- contain larger insolube molecules like albumin.

Question 3

potassium levels S/S

3.5-5

Answer 3

Hyper= cardiac arrhythmias, diarrhea, T waves peaked, priority for too much would be kayexalate. if critically high give IV insulin (regular) but need d50 to balance it out for non diabetics. gluconate protexts heart, worst case you could do hemodialysis.
Hypo- constipation, arrhythmias with a Twave inversiion, priority to give IV k no more than 10 mol (20 in ICU) its an irritant, dont push obvs, can give litocane to numb pain,

Question 4

sodium levels S/S

135-145

Answer 4

hypernatremia- can cause seizures, dehydration symptoms priority seizure precautions, and fluids. maybe hypotonic solution.

hyponatremia- can cause seizures, fluid overload, priority siezure precaustions and fluid restrictions.

Question 5

Calcium levels S/S

8.5-10

Answer 5

hypo- restrict phosphorous, truss and checs sign, give calcium gluconate. calcium cholride not given because irritating to the vien.
hyper- lasix, IV fluids, calcitonin.

Question 6

magnesium levels S/S

1.5- 2.5

Answer 6

hypo- muscle twitching, cardiac instability, confusion, priority give iv mag sulfate
hyper- cardiac instab, breathing probs, priority treat with fluids and lasix

Question 7

how is CO measured

Cardiac Index?

Answer 7

SV*HR
measures effectiveness of hearts pumping abilities. normal CO is approx 4-8 L/min

CI measured by CO/body surface area

Question 8

Stroke volume

Answer 8

SV= amount of blood that leaves the heart with each beat or ventric contract. not all blood ejected normal is 70 ml per beat.

Question 9

How does heart rate related to CO?

Answer 9

when HR is increased so is CO up until >160 BPM then CO is decreased because of increased workload to the heart.

Question 10

Patho of shock

Answer 10

physiologic state, systemic reduction in tissue perfusion results in decreased tissue oxygen delivery, can lead to irreversible cell and tissue damage resulting in:
end-organ damage
multi-system organ failure
death
mortality from shock is HIGH

Question 11

Types of shock

Answer 11

hypovolemic, cardiogenic, distributive (neurogenic, anaohylactic, septic), obstructive.

Question 12

Stages of shock: Early

Answer 12

early:
MAP decrease 5-10 mm/hg
mild vasoconstriction
tachycardia

Question 13

Stages of shock: Compensatory

Answer 13

compensatory:
MAP decrease 10-15 mm/hg
mod vasoconstrict.
physiologic compensations (renin, aldosterone, ADH, decreased UO, mild acidosis, mild hyperkalemia)

Question 14

Stages of shock: Progressive (intermediate)

Answer 14

progressive:
MAP decrease >20mm/hg
metabolism anaerobic (mod acidosis, mod hyperkalemia, tissue ischemia, lactic acidosis- lactate.

Question 15

Stages of shock: Refractory (irreversible)

Answer 15

Too much cell death, tissue damage, too late to save.

Question 16

MODS- multiple organ dysfunction syndrome

Answer 16

most common cause of mortality in the ICU. 50-90% death rate. 100% if 3 or more organ systems involved. uncontrolled inflammation, infection not necessary. hypo perfusion, hypoxia, tissue necrosis.

Question 17

MODS- pulmonary

Answer 17

pulmonary- vascular endothelium and alveolar epithelial damage with resultant surfactant deficiency, mild pulmonary HTN, and pulm edema and hypoxia.

Question 18

MODS- Renal

Answer 18

Renal-prolonged hypovol, hypo perfusion, acute tubular necrosis

Question 19

MODS- Cardiovascular

Answer 19

cardio- prolonged compens efforts to increase CP and vasoconstrict to enhance organ perfusion. cardiac func becomes dependent on pressors and eventually unresponsive to even pressors.

Question 20

MODS- Coagulation

Answer 20

coagulation- uncontrolled excessive consumption of coagulation factors.

Question 21

Obstructive shock

Answer 21

causes: PE, tension pneumo, pericardial tamponade.
flow of blood is obstructed which impedes circulation and can result in circulatory arrest, treatment of choice is to remove the obstruction.

Question 22

Distributive shock

Answer 22

massive dilation of vessels in response to an event:
septic shock (infection)
neurogenic shock (impaired SNS-PNS dominates)
anaphylactic shock (antigen-antibody reaction)
this type of shock is also referred with vasodilatory shock, results from a severe decrease in SVR

Question 23

neurogenic shock

Answer 23

occurs after acute spinal cord injury or spinal anesthesia. sympathetic outflow is disrupted leaing unopposed vagal tone. results in hypotension, bradycardia, warm dry skin. following a spinal- HOB up 30 deg to prevent spread of anestetic agent up the spinal cord.
treatment is mainly support BP and treat bradycardia. if spinal cord inury stabilize spinal cord.

Question 24

anaphylactic shock

Answer 24

acute life threatening. hypersentive reaction to antigen. release of vasoactive subs (complement, histamine, prostaglandins). massive vasodilation, inc capillary permeability, constriction of extravascular smooth muscle (bronchoconstriction, laryngospasm, GI cramps) sample allergies- PCN, snake bite, shellfish, inesct bites, pollens.
treatment- remove anitgen if possible, epi, volume expanders, antihistamines, and steroids. S/S anxiety difficulty breathing, wheezing, GI cramps, uticaria, edema