Test 2

Question 1

What are the three main types of shock?

Answer 1

Cardiogenic, hypovolemic, and distributive

Question 2

What are three compensatory mechanisms of shock?

Answer 2

Neural, hormonal, and chemical

Question 3

What are the four stages of shock?

Answer 3

Initial (usually asymptomatic), compensatory, progressive (when compensatory mechanisms fail), and refractory

Question 4

What are effects of hypoperfusion in shock in each system (8)? (brain, heart, lungs, GI, GU, skin, hematologic, and metabolic)

Answer 4

Brain: ALOC
Heart: ischemia-->infarction
Lungs: VQ abnormalities
GI: impaired mobility
GU: decreased GFR
Skin: vasocontriction
Hematologic: fibronolysis
Metabolic: anaerobic metabolism

Question 5

A potentially fatal result of septic shock relating to the cascade of inflammation and coagulation includes:

Answer 5

Impaired fibrinolysis which results in the formation of clots

Question 6

What is the difference between “warm shock” and “cold shock”?

Answer 6

Warm shock often goes undetected. By the time cold shock ensues, the patient is screwed….
Compensated–>uncompensated

Question 7

What are the four components of SIRS?

Answer 7

>38 C or <36 C
HR > 90 BPM
RR >20 PaCO2 <32
WBC >12,000 or <4,000 or > 10%
*NEED 2 TO QUALIFY AS SIRS

Question 8

What happens to SvO2 in septic shock?

Answer 8

Decreases

Question 9

DIC occurs as a result of which conditions:

Answer 9

Trauma, sepsis, severe disease

Question 10

Describe the process of DIC:

Answer 10

An overabundance of fibrin degradation substance, results in difficulty clotting–at risk for hemorrhage.

Question 11

How do you treat DIC?

Answer 11

Platelets and FFP

Question 12

What are the four causes of acute resp failure? And describe each

Answer 12

• Failure of ventilation- inability to get air in and out (ie. obstruction)
• Failure of oxygenation- inability of oxygenation to pass through alveoli (ARDS, pneumonia, COPD, high altitude)
• Failure of oxygen delivery- inability of oxygen to perfuse the tissues (anemia, hypoxemia)
• Failure of cellular oxygen utilization- impaired cellular function (carbon monoxide poisoning, alcohol)

Question 13

What are the two types of ARF and which conditions are they associated with?

Answer 13

Hypoxemic (Type I)- ARDS

Hypercarbia (Type II)- COPD

Question 14

Explain the difference between dead space and shunting

Answer 14

Dead space is the inspired air which doesn’t make it to the alveoli to participate in gas exchange.
Shunting is unoxygenated blood which is returned to the heart.

Question 15

What are the three hallmark signs of an asthma attack?

Answer 15

Bronchospasm
Inflammation
Mucosal edema

Question 16

Describe “blue bloaters” and “pink puffers”

Answer 16

Blue bloaters: chronic bronchitis patients (cyanotic, overweight)
Pink puffers: emphysema patients (barrel chest, pursed lip breathing)

Question 17

What are the two ways the brain detects when to breathe?

Answer 17

1. ) Build-up of CO2

2. ) Low Oxygen sats (hypoxia)

Question 18

What do COPD patients rely on to know when to breathe?

Answer 18

Low O2 sats

Question 19

What are teaching points for COPD patients? (6)

Answer 19

Smoking cessation, exercise, proper nutrition, avoid irritants, flu shots, regular check ups

Question 20

On a vent, how do you increase Oxygen?

Answer 20

Increase FiO2, increase PEEP

Question 21

On a vent, how do you decrease CO2?

Answer 21

Increase respirations and volume

Question 22

Non-cardiogenic pulmonary edema is synonymous with?

Answer 22

ARDS

Question 23

What are the diagnostic criteria for ARDS?

Answer 23

Dyspnea, tachypnea, refractory hypoxia w/ resp alkalosis, bilateral infiltrates (fuzzy white), Tracheal/Plasma Protein ratio