Shannon Cen

Front 1

Shock

Back 1

Lack of oxygen to the tissues

Front 2

Types of Shock

Back 2

Hypovolemic
Cardiogenic
Distributive
Obstructive

Front 3

Hypovolemic Shock

Back 3

lack of circulating volume

-early (compensatory)
bp normal, increased/narrow pulse pressure, pulse thready/weak, tachypneic, resp. alkalosis, skin diaphoretic/cool, anxious/restless, decreased urinary out put.
-late (decompensatory)
inflammatory mediators are released in response to foreign invasion of tissue or tissue damage: vasodilation, increased capillary permeability, increased coagulation.
decreased bp, tachycardia/pulse not palpable, tachypneic/shallow, metabolic & respiratory acidosis, skin cool clammy mottled, decreased loc, anuria.

treatment:
fluids. crystalloids given at 3:1 ratio. colloids pulls fluid into vessels given at a 1:1 ratio. blood products.

Front 4

Cardiogenic Shock

Back 4

decreased cellular perfusion due to failure of the central pump.

Front 5

Distributive Shock

Back 5

decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery.
-neurogenic shock: spinal cord injuries above t4-t6. brain injury. cns depressants. hypoxia. lack of glucose or excessive insulin, vasovagal syncope. parasympathetic stimulation. tx: 1-2 liter fluid bolus for hypovolemia- consider vasoconstrictor if ineffective. atropine for low hr. assist respiration if needed.
-septic shock:
hyperdynamic sepsis: malaise, not feeling well, tiredness, restlessness, warm flushed dry skin, tachycardia, full bounding pulses, respiration > 20, decreased urine output, respiratory alkalosis, fever shaking chills.
hypodynamic sepsis: dec loc, stupor, coma, cold, clammy, pale, mottled, tachycardia, weak/thready pulse, shallow/tachypneic, decreased uo or anuria, metabolic/respiratory acidosis, hypothermic.
tx: check lactate, BCx2, broad spectrum antibx, fluid bolus (hypotension/lactate > 4), vasopressor
anaphylactic shock: mild s/sx: give 0.2-0.3ml 1:1000 epi sq/im q5-10 mins. severe s/sx: give 0.1-0.5ml 1:10000 epi. maintain abcs. antihistamines. beta 2 agonists. corticosteroids.

Front 6

Obstructive Shock

Back 6

decreased cellular perfusion secondary to obstruction of blood flow into or out of the ventricles.
example: PE, pericardial tamponade, tension pneumothorax.

Front 7

Alpha Receptors

Back 7

sympathetic:
vasoconstriction
glucogeonolysis
diaphoresis
parasympathetic:
vasodilation
gluconeogene sis
dry skin

Front 8

Beta-one Receptors

Back 8

sympathetic:
increased heart rate
increased contractility
increased automaticity
parasympathetic:
decreased heart rate
decreased contractility
decreased automaticity

Front 9

Beta-two Receptors

Back 9

sympathetic:
increased respiratory rate
bronchodilation
parasympathetic:
decreased respiratory rate
bronchoconstriction

Front 10

blood

Back 10

whole blood: all components of blood. must be abo compatible. 500ml volume. 20ml/kg for kids.
prbcs: elevates hgb by 1, hct by 3%. rapidly elevate oxygen carrying capacity. must be abo compatible. 250ml volume. give 10ml/kg in kids.
platelets: doesn't need abo compatibility. one unit equals 5000 - 10000.
ffp: used for hypovolemia with hemorrhage due to clotting deficiencies. must be abo compatible. one unit equals 7% of coagulation.
cryoprecipitate: given for bleeding disorders like hemophilia or dic. must be abo compatible. to get to clot faster.

Front 11

hemolytic reactions

Back 11

early signs:
anxiety, restlessness, n/v, flushing, chest/lumbar pain, tachypnea, tachycardia, chills.
late signs:
fever, cyanosis, hemoglobinemia, hemoglobinuria, heat along the vein receiving transfusion, shock.

Front 12

Airborne Precautions

Back 12

-agents which remain infectious over long distances when suspended in the air
-rubeola virus, varicella virus, and tb.
-negative air pressure and closed door
- n-95 mask
- mask pt when transported outside negative pressure room.

Front 13

Droplet Precautions

Back 13

- pathogens spread through close respiratory or mucous membrane contact with respiratory secretions
- b. pertussis, influenza, group a streptococcus.
- private room, wear a mask when within 3 feet of pt, mask pt when transported.

Front 14

Contact Precautions

Back 14

- microorganisms spread by direct or indirect contact w the pt or pts environment.
- mrsa, scabies, shingles, c diff.
- private room, gloves, gown, single pt use equipment, limit pt transport.

Front 15

Tuberculosis

Back 15

- active or latent
- latent: positive skin test, asymptomatic, non contagious, tx with drug therapy.
- active: cough > 2 weeks, hemoptysis, night sweats/fever/chills, unexplained weight loss, fatigue. pt is contagious. dx with culture of affected area, tx with drug therapy, standard and airborne precautions.
- tx: six months or longer in duration. isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin. no alcohol for 9 months. check liver enzymes.
discharge teaching: stress medication compliance, teach how to contain respiratory secretions, dispose of contaminated materials in sealed bag, no work or school and avoid close contact w others till medically cleared, air out the sleeping room of infected pt every day.

Front 16

Mononucleosis

Back 16

-Prodrome: fatigue, anorexia, vomiting, chills, diaphoresis, headache, myalgia, distaste for cigarettes.
-Illness: low grade fever, sore throat, diarrhea, earache, red throat, enlarged tonsils, petechiae on palate.
-Potential complications: hepatomegaly, splenomegaly, thrombocytopenia, pneumonia, meningitis, encephalitis, hepatitis, pericarditis.
-dx: monospot positive by second week of illness. may remain negative in children under 5 yrs. cbc shows neutropenia, thrombocytopenia, lymphocytosis w atypical lymphocytes, leukocytosis. abnormal liver functions.
-tx: symptom control: analgesics (avoid nsaids and asa), corticosteroids for sore throat.
- death is rare but can occur from splenic rupture or airway obstruction from tonsillar hypertrophy.
- discharge instruction: salivary precautions, warm salt water gargles, don't donate blood for six months, avoid heavy lifting and contact sports for four weeks, avoid alcohol for a month, return for signs of intra abdominal bleeding.

Front 17

Measles (rubella)

Back 17

-s/sx: conjunctivitis, coryza, cough, fine red rash, koplik's spots, fever.
- standard and airborne precautions.
- easily spread. 5 days ac rash to 5 days pc rash. incubation: 8-12 days.
- complications: fetuses (1st trimester)- heart defects, developmental delays, deafness, stunted growth.
- tx: no scratching, tx symptoms, darkened room.

Front 18

Mumps

Back 18

- s/sx: parotitis, pain on salivation, uri symptoms, fever
- standard and droplet Precautions.
- transmission 1-2 days before parotitis until 5 days after glandulat enlargement.
- complications: pancreatitis, orchitis, meningitis, cns involvement.
- tx: warm or cold packs to face, steroids/scrotal support for orchitis.

Front 19

Pertussis (whooping cough)

Back 19

- s/sx: catarrhal stage (1-2 weeks), paroxysmal stage (1-6 weeks), convalescent stage (months)