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R.Scott PMA Midterm 2 > Unit 14- Chapter 8,11,24- bleeding > Flashcards

Unit 14- Chapter 8,11,24- bleeding Flashcards

1
Q

calculating drip rate

A

= amount of fluid x drip rate ( micro 60, macro 10)
divided by
time in minutes

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2
Q

what is infiltration of an IV

A

escape of fluid into surrounding tissue

edema at site, tightness and pain at site and continued IV flow after occlusion above IV point

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3
Q

The “perfusion triangle” consists of the:

A

heart, blood vessels, and blood.

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4
Q

what is the FICK principle

A

1- adequate inspired 02
2- oxygen movement across capillary membrane
3- adequate number of RBC
4- proper tissue perfusion
5- efficient offloading of oxygen at tissue level

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5
Q

what is MODS

what does Multiple-Organ Dysfunction Syndrome (MODS) trigger

when does it form

A

multiple organ dysfunction syndrome- failure of several organs, failure of clotting

complement system- overreactive- inflammation and damage to cells
coagulation system- microvascular thrombus forms and tissue ischemia
kallikrein-kinin- release bradykinin- vasodilation- hypoperfusion and hypotension

MODS occurs when injury or infection triggers a massive immune, inflammatory, and coagulation response

hours to days after resuscitation
14-21 days - renal/ liver failure
death can occur days to weeks after initial injury

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6
Q

A severe bacterial infection can result in shock due to:

A

vasodilation and internal plasma loss.

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7
Q

what are cells fuel supply

A

adenosine triphosphate

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8
Q

What is the pathophysiology of distributive shock?

A

A disproportionate volume of blood due to an enlarged vascular space.

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9
Q

Once the protective wrap is removed from a bag of IV fluid, the fluid must be used:

A

24 hrs

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10
Q

What physiologic response would be expected to occur if a patient’s systolic blood pressure dropped below 80 mm Hg?

A

Vasomotor stimulation with resultant arterial vasoconstriction

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11
Q

Mean arterial pressure (MAP) is:

A

the blood pressure required to sustain organ perfusion

AKA the pt’s blood pressure

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12
Q

What is the pathophysiology of psychogenic shock

A

Temporary, generalized vascular dilation

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13
Q

In most people, a systolic BP of _______ is sufficient to adequately perfuse the brain and other vital organs.

A

80-90 mmHg

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14
Q

Long-term control of blood pressure is regulated by the:

short term controlled by

A

renal system.

nervous system

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15
Q

Which of the following is the MOST significant complication associated with IV therapy in geriatric patients?

A

fluid overload

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16
Q

Once the “pigtail” that covers the access port of a bag of IV fluid has been removed, the fluid must be used:

A

immediately

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17
Q

Patients with internal bleeding are in MOST need of:

A

surgical intervention

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18
Q

what regulates blood flow in capillary beds

A

capillary sphincters

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19
Q

cardiac output equation =

A

heart rate x stroke volume

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20
Q

blood pressure equation =

A

cardiac output x systemic vascular pressure

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21
Q

what is myocardial contractability

A

hearts ability to contract

22
Q

what is preload and afterload

A

preload- the pre-contraction pressure of ventricles filling

afterload- force or resistance against what the heart pumps

23
Q

what is systemic vascular resistance ( SVR ) and where does it not occur

A

resistance to blood flow in all blood vessels

not the pulmonary vessels

24
Q

cardiovascular system has three parts

AKA

A

the heart, the blood vessels and the blood

perfusion triangle

25
Q

3 principles of how blood clot forms

A

block in circulation ( pooling ) , vessel wall wound, ability to clot ( disease / medication )

platelets-sticky red blood cells- fibrogen

26
Q

what are baroreceptors and where are they located

A

they sense changes in pressure and activate the vasomotor center of medulla

located in aortic arch, arteries in neck/chest and carotid sinus )

27
Q

what are chemoreceptors and where are they located

A

stimulated by changes in Pa02 and PaCO2

carotid and aortic bodies

28
Q

failure of compensatory mechanisms in perfusion leads to ( 2)

A

decrease in preload and cardiac output

29
Q

explain anaerobic metabolism

A

perfusion drops, CO2 and intracellular water in cells forms lactic acid, pH of cell increases, acidosis, microemboli ( small clots)

build up of lactic acid and C02, vasodilation, acidosis washes into vascular system, decreased cardiac output

30
Q

what pressure forces fluid into capillaries and into cells

and which one pulls fluids from tissue into capillaries

A

hyrdostatic

oncotic pressure

31
Q

shock can occur from (4)

A

bleeding, respiratory fail, allergic reactions and infection

32
Q

what is cardiogenic shock

A

inadequate function of heart or pump- cant meet cardiac output required to meet demands of body

  • fluid backup into lungs- CHF
  • tissue edema, pulmonary edema
33
Q

what is obstructive shock
examples

what is becks triad

A

conditions of mechanical obstruction impact heart function
cardiac tamponade , tension pneumothorax

muffled heart sounds, JVD and narrowing pulse pressure

34
Q

explain distributive shock

and identify 4 types

A

widespread dilation of small arteries / venules causing blood to pool and decrease perfusion

septic, neurogenic, anaphylactic and psychogenic

35
Q

what is septic shock ( distributive )

A

septic- severe infection- affecting cell permeability- vessels and constrict and leak - serious condition following illness or injury

36
Q

what is neurogenic shock ( distributive )

A

neurogenic shock- significant injury to CNS system- cut off from sympathetic nervous system

vessels below injury dilate- pool blood

** lose ability to control body temperature**

37
Q

what is anaphylactic shock ( distributive )

what is sensitization

what can cause this shock

common signs

A

occurs when person violently reacts to substance or has been sensitized

sensitive to substance that didn’t initially cause reaction

injections, stings, ingestion, inhalation

hives, cyanosis, BP drop, bronchoconstriction

38
Q

what is psychogenic shock ( distributive )

life threatening causes include - 2

A

sudden reaction of CNS system

temporary vasodilation, syncope

irregular heartbeat, aneurysm

39
Q

what is hypovolemic shock

what are some “non-hemorrhagic causes “ - 3

A

inadequate amount of fluid

vomit/diarrhea, dehydration, severe thermal burns

40
Q

what is anemia

A

low amount of red blood cells

41
Q

what is orthostatic blood pressure

A

increase in pulse and drop in pressure when laying to standing

42
Q

3 stages of shock

what is a usually sign of early shock

A

compensated , decompensated and irreversible

increased respiratory rate

43
Q

treating cardiogenic shock

A

IV fluid is not indicated - TKVO only
legs hang if pulmonary edema
position of comfort , support ventilation
tranport

44
Q

emergency medical care is designed to help 4 areas

A

cardiovascular- heart
CNS- brain and spine
respiratory - lungs
renal- kidneys

45
Q

areas and times that require perfusion

A

brain - 4-6 mins
kidneys- 45 mins
skeletal- 2 hours
GI tract- several hours

46
Q

common causes of illnesses that cause internal bleeding

and most common symptoms of internal bleed=4

A

ulcer, colon bleed, ruptured ectopic ,aneurysm

pain, swelling , distension, bruising

47
Q

internal organ injury
right shoulder pain referred pain
left shoulder pain referred pain

A

right- liver

left- spleen

48
Q

first sign of hypovolemic shock

and not reliable indicator of early shock

A

altered LOC

blood pressure

49
Q

blood pressure will not tolerate how much % of blood loss

how much blood does adult have per kg

A

20 % ( approx 1 L loss of 6 L adult)

  • 100-200 mL loss in 1 year old with 800 mL of blood

** 70 mL/ KG

50
Q

what can effect bodies natural response to hemorrhage-3

A

medications ( like beta blockers that prevent constriction)
disease- hemophilia
severe injury

51
Q

4 common signs / symptoms of hypovolemic shock are

A

rapid weak pulse
altered LOC
cool, pale , clammy skin
low blood pressure

R.Scott PMA Midterm 2 (11 decks)

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