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170 Cards in this Set
- Front
- Back
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What is the definition of shock?
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Decreased blood flow to tissues ( alt blood vol, alt blood flow, altered contractility, alt vasc resistance)
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What is the compensatory stage of shock?
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Mechanisms that occur in response to shock are designed to restore blood volume and pressure toward normal....(augmenting cardiac ouput, redistributing blood flow, and restoring blood volume)
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What is the physiologic response of the compensatory stage?
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The dec pressures initiate a stong SNS response (CI 2.0-2.2, impending sense of doom, thirst, tachy, narrowed pulse pressure, oliguria, dec bowel sounds)
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What is the progressive stage of Shock
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Compensatory mechanisms begin to falter and perfusion to vital organs is diminished. (BEGINNING of MODS due to low blood flow, poor tissue perfusion, inadequate oxygen, inc metabolic wastes)
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What is the Physiologic response to progessive stage?
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Body is in a state of hypoperfusion.
(CI <2.0, dysrhythmias, hypotension, cold, clammy skin, anuria, absent bowel sounds, lethargy - coma) |
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The Refractory state of shock.
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Hypoperfusion is so profound and cellular destruction so severe that death is inevitable. (CI < 1.8, hypoxemia, ARDS, coagulation disorders ...DIC..., ATN, MI, unresponsiveness)
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Relative hypovolemia
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distributive shock....the tank is full but the fluid isnt where it needs to be...third spacing.
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Distributive shocks are triggered
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by an insult that causes massive vasodilation and fluid shifts.
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Anaphylatic shock
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re-exposure to sensitizing foreign substance that causes mediator - induced changes in microvascular permeability.
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Neurogenic shock
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loss of sympathetic regulatory mechanisms due to spinal cord injury
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Septic shock
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an infectious focus that stimulates an immunological host response causing changes in vascular tone and permeability
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What is the critieria for SIRS?
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Two or more of the following
1. temp > 38 or < 36C 2. HR > 90 bpm 3. Respiratory Rate > 20 breaths/min 4. WBC > 12000 or <4000 |
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What is the definition of Sepsis
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SIRS plus infection
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what is the definition of severe sepsis
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sepsis plus evidence of organ dysfunction
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What is the definition of septic shock
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severe sepsis plus evidence of hypoperfusion despite fluid resuscitation
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What are the organ dysfunction of hematology
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thrombocytopenia, DIC
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What are the signs of Renal dysfunction
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dec urine output, anuria, inc creatinine
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WHat are the signs of impaired tissue oxygenation
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lactic acidosis, metabolic acidosis
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What are released to trigger the endothelium?
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chemical mediators (proinflammatory)
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what is normal svr?
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800-1200
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If cardiogenic shock then give
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dopamine
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Inoptrope of choice in shock
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dubutamine
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what do we initially give hypovolemic shock patients
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Levophed and fluids
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What is the drug for refractory shock?
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vasopressin
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What are the goals with in the first 6 hrs of shock
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CVP of 8-12
MAP of > 65 Urine output of > 0.5 mL/kg/hr ScvO2 or SvO2 >70 |
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lactic acid is significant
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when greater than 4
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What percent of the volume stays in intravascular space?
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1/3
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afterload of R side
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SVR
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afterload of L side
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SVR
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What is the formula for MAP?
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(SBP)+2DBP)/3
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What is the halmark of sepsis?
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low peripheral resistance
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Where is mixed venous drawn from?
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PA
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What is sepsis
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SIRS + infection
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What is severe sepsis
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sepsis plus evidence of hypoperfusion
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What supplies the liver?
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Hepatic artery and vein
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What is the excess in cushings?
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Corticosteroid
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Involuntary rigidity, spasm, or rebound tenderness
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peritoneal inflammation
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What is cullens sign
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exxhymosis around umbilicus= intraperitoneal hemorrhage
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Bruit over vessels
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aneurysm
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friction rub over liver or spleen
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hepatic tumor, splenic infarct
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continuous venous hum- periumbilical
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hepatic cirrhosis
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dullness percussed mid axillary
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enlarged spleen
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pain on palpation
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peritoneal irritation
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abdominal distension
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trapped air or fluid in the abdoment
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What is mallory-weiss syndrome
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tear in lower part of esophagus near stomach, caused by repeated or forceful vomiting
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what is melena
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black, tarry, foul smelling stool
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What drug reduces portal hypertension
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octreotide
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What does the liver secrete?
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bilirubin, bile salts, cholesterol, electrolytes
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Reyes syndrom
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can be related to ASA
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Budd-Chiari syndrome
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portal vein blockage. triage of abdomainal pain, ascites, hepatomegaly
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Wilson's disease
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genetic disposition to accumulate copper in the body
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Laennecs cirrhosis
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portal, nutritional, alcoholic. stems from chronic alcoholism and malnutrition
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Post necrotic
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complication of viral hepatitis
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Jaundice occurs when
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bilirubin level greater than 3 mg/dL
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If you dont have albumn
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thirdspacing
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icterus
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jaundice
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What is bilirubin
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breakdown of normal hemoglobin in red blood cells
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What value of AST is hepatic failure?
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AST > 40
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ALT hepatic failur
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ALT >35. Cell death - enzyme release
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What happens with fibrinogen in Hepatic failure
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decreased
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what is albumin in hepatic failiure?
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<3.2
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What is cullens sign
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periumbilical ecchymosis
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What is grey turners sign
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Flank ecchymosis
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What will be decreased in pancreatitis
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potassium, calcium, magnesium, albumin
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What will be elevated in pancreatitis
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glucose and triglycerides, amylase, lipase
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Vent setting that provides pressure augmented during spontaneous inspiratory breathing
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PSV - pressure support ventilation
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Normal SVR
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800-1200
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Tip of the swan ganz sits where
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pulmonary artery
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indication for agatroban
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HIT
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What drug treats refractory vasodilatory shock ....where does it act?
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Vasopressing (acts on V1/v2 receptors
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What CO values indicatie Left side preload
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PAWD & PAD
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How do you decrease afterload
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vasodilate or diurese
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Average amount of urine produced in 24 hours
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800mL
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WHat two pieces of data are collected during nursing assessment monitoring ARF and CRF
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I&O and daily weight
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What is the volume of blood pumped out of the left ventricle/min
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Cardiac output
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Preload is made up of these componesnt
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CVP, PAWD, RAP, PAD
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Class of drug that inhibits platelet aggregation
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glycoprotein IIb/IIIA inhibitors. Dec stickiness, ex integrilin or plavix
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This is the bodys response to stimulation of Beta 1 receptor
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inc hr, inc contractility, inc co
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Intervention to inc afterload is
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volume or vasocontstrict (Isotonic fluids, epi, levo, dopamine
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When valves open and pressures equal in ventricelse and atria at end diastolic volume what is this measurement
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preload
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Vent setting where I:E ratio is reversed to allow longer inspiration than expiration
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Inverse ratio ventilation
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Life threatening event requiring chest drainage. dec CO and quickly leads to cardiovascular collapse
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Tension pneumothorax
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Normal SvO2 range?
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60-80%
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How do you inc contractility
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inotrope
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What kind of inotrope?
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dobutamine, dopamine 5-10 mcg, milrinone
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Dopamine works as an inotrope at this dose & does what
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5-10 mcg/kg/min.
Beta ,1 stimulator, inc heart rate, inc contractility, inc CO |
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Potent arterial and venous vasodilator
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nitroprusside or nipride - need to have an a line for bp monitoring
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Reading for how well tissues are extracting O2
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SVO2
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invtervention to lower preload
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diuretics or vasodilators
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Electrolyte disorder often seen in pts with DI
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hypernatremia
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During DKA insulin drip continues until this occurs
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close anion gap
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Norm for PAP
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15-25/8-15
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Intervention for RAP or CVP of 2
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Volume
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bodys response to stimulation of A1 receptor
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vasoconstriction
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Class of drugs used primarily in an attempt to slow down cardiac conduction
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Ca Channel blockers, beta blockers, antiarrhythmics
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Components of afterload
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PVR, SVR, and MAP
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The force the left ventricle must overcome
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SVR or sfterload
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In this condition, chest wall is intact but there is air in the pleural space
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Closed pneumothorax
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A pt presents with the following symptoms, hypotension, hypothermia, lethargy, RR of 5 - hint life threatening
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Myxedema coma, results from chronic untreated hypothyroidism
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What intervention do you use to inc preload
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volume and vasoconstrict
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P swan readings are CO 4.5, SvO2 50 is this adequate?
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No
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Drug used as arterial constrictor. acts only on alpha receptos and is usually started at 20 mcg/min
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phynylephrine. neosynephrine. up to 200 mcg/min
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Vasopressor mainly acts on a1 receptors it may be dosed from 2-30 mcg/min
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norepinephrine (levophed)
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Normal range for CVP and RAP
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2-5
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What is the calculation for anion gap?
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Na - (Cl+CO)
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Copious amount of secretions in ventilated pt may trigger this to happen on their vent
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high pressure alarm
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Process for wave and # selection in CO monitorin with thermodilution
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Obtain 3 waves within 10 of each other
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What do you need to remember when priming pressure tubing
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never prime under pressure
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Class of drug that relaxes vascular smooth muscle and is effective treatment of HTN
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Vasodilator (Nitro & Nipride)
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Receptor site mainly found in the pulmonary vasculature
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Beta 2....metoprolol is beta 1 selective
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Pt has a PAWP of 17, low O2 sat of 92% how do you treat
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Diuretic first then vasodilator
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How do you verify the accuracy of your arterial wave form on the monitor
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square wave test
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WHy do you push thermodilution soln over 4 sec
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because 4 sec is approx to respiratory cycle
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Wave form to pull back to in case of ventricle migratio of the PA catheter
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RA wave
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This sideeffect is most common from IV Diltiazem...
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hypotension
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Receptor mainly found in vasculature
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A1
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If the thermodiluation curve is long this means what about the CO
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low output
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When measuring hemodynamic waveforms, when do you obtain you wave measurements
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end expiration
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This therapeutic intervention must be done with caution when treatening HHNS
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adminster NS
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Vent mode that delivers pressure cycled breathing. the tidal volume varies with changes in mechanical properties of lungs
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PCV.. Pressure control ventilation
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adverse event with PA cath
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ruptured PA or possible Vtach if in R ventricle
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Which port do you use for thermodiluation
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blue port
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the drug that stimulates beta 1 & 2
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Epinephrine
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Use drug cautiously in pt with asthma or COPD
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beta blocker
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Pt has high preload, low co and high afterload...which type of shock
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cardiogenic shock
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your patient has low preload, low svr, high CO what type of shock are they in
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septic shock
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3 types of distributive shock
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septic, anaphylaxis, neurologenic
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What two electrolytes are often elevated in renal failur
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K and Phos
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drug class that will help heart beat stronger and more efficientyl
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inotropes
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What drug acts as inotrope or vasopressor depending on dose
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dopamine 5-10 inotrope or 10-20 vasopressor
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WHat is the metabolic acidosis diagnostic tool
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Mudpiles
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On the vent, this setting helps prevent atelectasis
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PEEP
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Receptor primarily found in the heart
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beta 1
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Polydipsia and large amounts of dilute urine withought hyperglycemia would be
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DI
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Differentiates type 1 and type 2 diabetes
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endogenous insulin
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failure to captue would indicate a need to change
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mA
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ischemia on anterior and lateral wall is shown on the EKG in what leads? treatment
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leads v1,v2,v2, avl....vasodilate
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type of mechanical vent that on every spontaneous breath your own volume is delivered
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SIMV
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Vent mode where the rate and tidal volume is preselected. will deliver a breath if the patient initiates inspiration, also will adminiter a breath at a set rate if pt does not initiate within a certain amount of time
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AC
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Trtment for the hyper acute MI phase that occurs 0-6 hrs
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cardiac cath lb
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Documentation of grade 2 murmur
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2/5 murmur heard at the 5th left intercostal space
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dilation and costriction of afferent and efferent arterioles is called what
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autoregulation
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trauma pt with 4:/day of urine output is in what phase of intrarenal failure
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diuretic
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stroke volume and hr is what
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cardiac output
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second stage of MI is
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1. ischemia
2. injury 3 death |
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negative prssures in the pleural and intrapulmonary space are
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-8cm and -4 cm
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what is the most common complication post MI
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dysrhythmia
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failure to sense means the pacemakesr is no seeing which wave
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T waves
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serum os of over 350 means what to ICU pt
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dehydration, hypovolemia
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IV meds effective in treating hyperkalemia
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glucose and insulin
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this one way valve can monitor airleaks and changes in intrathoracic pressure
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waterseal
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this condition is known as sucking chest wound
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open pneumo
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Physiology of s1 heart sound is what
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closure of AV valves
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s2 is
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sumilunar valves
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the ability of the pacemaker to detect the hearts electrical activity
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sensing
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20% of cardiac output is called what a
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atrial kcik
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parameter reflecting alveolar ventilation
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PaCo2
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an EKG finding that would indication a old MI
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qwave
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This heart sound is always pathological
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s4
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a build up of transudate or exudate in the pleural space an cause this condition
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pleural effusion
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most common cause of AKI
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ATN acute tubular necrosis
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How to fix failure to capture
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inc mA
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assessment finding that is an indicator for reintubation
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inspiratory stridor
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What test for cyanide toxicity and what drug is it for?
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Thiocyanate. nipride
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non invasive pacing
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transcutaneous
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when this drug reaches 150 mcg/mn it becomes arterial and vasodilator
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nitroglycerin
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right side MI do not
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give beta blockers, give vasodilators, give labetaolol
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post thyroidectomy pt are at risk for what
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hypocalcemia
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which value reflects adequate ventilation
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paCo2
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pt has cardiac arrhythmia, afib with rvr, dehydration, metabolic acidosis and heart failure equals what endocrine disorder
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Thyroid storm
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