Exam 1, Deck 3 Flashcards Preview

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Flashcards in Exam 1, Deck 3 Deck (126):
1

Shock (def)

Generalized inadequate circulation

2

What happens to electrolytes during shock?

K+ rushes out of the cell
Na+ and water rush into cell (cellular edema)

3

Result of cellular edema (4)

- Fluids and electrolytes move more freely, Na+ pump impaired
- Cell damage and death
- Lysosomal membrane rupture
- Mitochondrial damage

4

3 types of shock:

Hypovolemic

Cardiogenic

Distributive / Circulatory

5

Hypovolemic shock - what is happening?

Loss in circulating volume (Heart is still working)

6

Cardiogenic shock - what is happening?

"Pump failure" - there may be adequate blood, but it's not being pumped where it needs to go

7

Disruptive / circulatory shock: What is happening?

"Massive Vasodilatation"

8

3 types of disruptive / circulatory shock

- Neutrogenic
- Anaphylactic
- Septic

9

3 causes of neutrogenic shock

- Spinal cord injury
- Spinal anesthesia
- ADEs

10

3 causes of anaphylactic shock

- Med allergy
- Bee sting
- Blood transfusion reaction

11

Two causes of septic shock

- Systemic infection
- Uncontrolled pneumonia

12

Vital signs of a client in shock: Compensatory
- RR
- HR
- BP

RR: >20/min
HR: >100/min
BP: WNL

13

Vital signs of a client in shock: Progressive
- RR
- HR
- BP

RR: Rapid, shallow
HR: >150/min
BP: Systole <80

14

Vital signs of a client in shock: Irreversible
- RR
- HR
- BP

RR: Intubated
HR: Erratic
BP: Requires support

15

Mental status of a client in shock:
- Compensatory
- Progressive
- Irreversible

- Compensatory: Restless
- Progressive: Lethargy
- Irreversible: Unconscious

16

Urine output of a client in shock:
- Compensatory
- Progressive
- Irreversible

- Compensatory: Decreasing
- Progressive: <30cc/hr
- Irreversible: Anuria

17

Skin changes of a client in shock:
- Compensatory
- Progressive
- Irreversible

- Compensatory: Cold, clammy
- Progressive: Mottled, gray
- Irreversible: Jaundiced

18

Acid / base of a client in shock:
- Compensatory
- Progressive
- Irreversible

- Compensatory: Respiratory alkalosis
- Progressive: Respiratory and metabolid acidosis
- Irreversible: Profound acidosis

19

What is going on with compensatory shock (sum it up - 1 word)

HYPOXIA

20

What is going on with progressive shock (sum it up - 1 word)

HYPOINFUSION

(of all symptoms)

21

What is going on with irreversible shock? (sum it up - one word)

DEATH

22

Three things you do assess with a patient in shock:

1) VITALS: Check RR & HR often
2) Check for orthostatic hypotension
3) Assess for changes in LOC

23

When does cellular damage occur with shock?

BEFORE blood pressure begins to drop

24

Respiratory Sxs of a patient in progressive shock (4)

- Shallow, rapid respirations
- Crackles 2/2 PE
- Decreased O2 levels (hypoxic)
- PaCO2 levels increase (hypercapnic)

25

Cardiac Sxs of a patient in progressive shock (5)

- HR increases to 150 bpm
- Arrhythmias (2/2 hypoxemia)
- Ischemic changes (on ECR)
- Chest pain * MI
- BP dropping

26

Neurologic Sxs of a patient in progressive shock (4)

- Confusion
- Lethargy
- LOC
- Dilated pupils

27

Kidney Sxs of a patient in progressive shock (3)

- Decreased perfusion leads to decreased GFR --> acute renal failure
- Oliguria (<30mL/hr)
- Increased BUN and Creatinine

28

Liver Sxs of a patient in progressive shock (3)

- Enzymes rise
- Decrease ability to metabolize meds and waste products
- JAUNDICE

29

GI Sxs of a patient in progressive shock (2)

- Ulcers
- Bleeding

30

Priorities for a patient in shock (2)

1) Limit further damage
2) Improve cardiac function:
--> improve blood sully
--> Decrease oxygen demand

31

Shock: Position of patient

Modified trendelenburg: Torso is flat, legs are elevated 20-40*

32

Shock: IVs (2)

- Blood products
- Isotonic r most likely to stay intravascular

33

Comfort for a shock patient

DO NOT ADD BLANKET -- would increase peripheral vasodilatation and further drop BP

34

Why do you put a shock patient on bedrest?

To decrease BMR

35

Why are shock meds given IV?

Because of poor perfusion to muscles and GI tract

36

Two goals of shock meds:

1) Maintain (or increase) CO
2) Decrease cardiac workload

37

Two meds that work together to maintain CO and decrease cardiac workload (for shock)

Adrenergic
Vasodilator

38

Adrenergics given for shock (2)

Dobutamine or dopamine

39

Function of adrenergics in shock (3)

- Increase CO
- Vasoconstriction increases afterload
- Increased myocardial contractility

40

Vasodilator given for shock

Nitroglycerine

41

Functions of Nitroglycerine in shock (3)

- Decrease preload and afterload
- Decrease workload of the heart
- Overall: DECREASE OXYGEN DEMAND

42

Overall effect of Adrenergic + Vasodilator (Shock) (4)

- Increased CO
- Minimizes cardiac workload
- Vasodilitation (increased blood flow to myocardium)
- Increased O2 delivery to heart

43

Besides Dobutamine and Dopaimine, four other adrenergics given for shock

- Norepinephrine (Levophed)
- Epinephrine
- Phenylephrine
- Antiarrhythmic meds

44

What IV solution do you administer to a patient in shock? Why (2)?

NORMAL SALINE.

- Isotonic more likely to stay intravascular
- If you give blood products, glucose causes clotting.

45

Monitoring device for shock

"Swan Ganz Catheter" (Right heart catheter)

46

Where should monitor device be inserted

(And why not in the other placei t could go)

Intrajugular

(Could be subclavian, but risk puncturing lung)

47

Shock complications: Respiratory

"Shock Lung" / "Adult Respiratory Distress Syndrome"

48

What is ARDS

Adult Respiratory Distress Syndrome
- Increasing capillary permeability leads to fluid seeping around lungs

49

How do you know if a patient has ARDS

PaO2 keeps dropping even as you increase oxygen

50

Shock complications: Organs
- Multiorgan complication
- Four affected symptoms

Multiple Organ Dysfunction Syndrome (MODS)
- Renal failure
- GI bleed
- Lungs
- Liver

51

What comprises the upper respiratory?

Nares to trachea

52

What comprises the lower trachea?

Carina to alveoli

53

Where is the carina?

At the angle of Louis

54

How do you know if you have intubated too far?

Breath sounds on the right side but none on the left -- pull back

55

Decreased _______ is a factor in ARDS

surfactant

56

Where is anatomical dead space? How big is it?

- Everything respiratory that is not alveoli
- 1mL of anatomical dead space per pound of person

57

Flaring of nostrils: Late or early sign of respiratory distress?

- Late sign in an adult
- Early sign in a baby

58

Mouth breathing: Early or late sign of respiratory distress?

- Usually more of a late sign

59

What is "Negative Inspiratory Force?" What is normal NIF (#)?

Force a patient must be able to generate in order to respirate.

Normal NIF = - 60

60

Resistance of airways is determined by

DIAMETER

61

Three problems that narrow airways (and how)

Asthma (bronchoconstriction)
Bronchitis Mucus)
Foreign bodies (Obstruction)

62

What is the difference between dyspnea and shortness of breath?

Dyspnea = air hunger
Shortness of breath = Breathlessness; often high CO2

63

Hemoptysis (def)

Blood in sputum)

64

Early signs of hypoxia (3)

- Restlessness
- Change in LOC
- Change in RR

65

Late sign of hypoxia

- Cyanosis

66

What is Stridor? What does it indicate?

- High pitched lung sound
- Indicates major obstruction

**MEDICAL EMERGENCY**

67

Chest pain is fairly uncommon in respiratory disease except as a late sign -- but what could it indicate? (3)

Pleurisy
Bad pneumonia
Pulmonary embolism

68

What does a Chest X Ray show?

Shows dense tissues: Tumors, foreign bodies, fluid

69

What is a CAT scan? What can it view

X rays in succession - can view tumors

70

3 assessments post- bronchoscopy

- Assess ABGs
- Gag reflex
- Dysphagia

71

How does a lung scan work

"Ventilation perfusion scan" -- patient inhales radioactive isotopes (indicates clot to ung, pumonary emboli)

72

Indications for a spirometry machine

- Diagnosis of asthma or COPD

73

What can be observed with a spirometery machine (2)

Disease progression
Efficacy of treatment

74

What oxygen mask enables the highest % of O2?

Non-rebreather mask

75

What oxygen mask enables the most precise oxygen delivery?

Venturi Mask

76

How does respiration on a PEEP ventilator differ from normal respiration?

With a PEEP, pressure is still positive at the end of respiration

77

Benefits of PEEP

1) Prevents alveolar collapse
2) Effective dose of O2 can be lower
3) O2 administered at inspiration and expiration

78

What does an incentive spirometer prevent (2)

- Atelectasis (closing alveoli)
- Pneumonia

79

When should you never do percussion / vibration?

Immediately post-op

80

Two breathing excescises

- Diaphragmatic breathing
- Pursed lips breathing

81

What does pursed lips breathing?

Extends the length of exhalation

82

Why should you provide humidity for a patient receiving respiration assistance

- Helps keep secretions loose
- Patient with trach lost mechanical aid of nose and mouth to hydrate air.

83

COPD is an umbrella term for (2)

Emphysema, chronic bronchitis

84

Risk factors for COPD (3)

- Cigarette smoking
- Air / environmental pollution
- Alpha1-antitrypsin deficiency (genetic)

85

What is alpha1-antitrypsin?

Protein that helps protect lungs

86

Emphasema (def)

A slowly progressive disease characterized by destruction of the alveoli

87

What is the pathophysiology of COPD? (3)

- Lung elasticity is lost
- Alveoli destroyed
- CO2 retained

88

Two hallmark COPD symptoms

- Shortness of breath
- Shallow cough

89

Cor pulmonale (def)

Right ventricle increases pumping power to overcome pulmonary hypertension

(leads to hypertrophy, failure)

90

Three VISIBLE signs an examiner may see on a COPD patient

- Barrel chest
- Clubbing fingers
- Weight loss

91

Changes with breathing for a COPD patient (5)

- Shortness of Breath
- Chronic productive cough
- Prolonged expiration
- Expiratory wheezes
- Increased RR

92

What is the prime focus with treating a COPD patient?

IMPAIRED GAS EXCHANGE

93

Two things a COPD patient can do to improve symptoms

- Stop smoking
- Drink 2-3L of fluid a day

94

Type of treatment for mild COPD

Short acting bronchodilators

95

Type of treatment for moderate COPD

long acting bronchodilators
+ short acting bronchodilators for breakthrough sxs

96

Type of treatment for severe / very severe COPD

STEROIDS
+ long acting bronchodilators
+ short acting bronchodilators for breakthrough sxs

97

Purpose of bronchodilators (3)

- Relieve bronchospasm
- Reduce airway obstruction
- Increase O2 distribution

98

Three types of bronchodilators:

- Adrenergic
- Anticholinergics
- Methylxanthine

99

Two types of Adrenergic Bronchodilators:

- B2 Selective short-acting (acute)
- B2 Selective long-acting (daily mx)

100

B2 Selective Short acting - Prototype

(When used)

Albuterol

(acute exacerbation)

101

B2 Selective Long acting prototype (2 drugs)

(When used)

Formoteral
Salmeterol

(daily maintenence)

102

Anticholinergic: Prototype
(+ 2 other drugs)

(When used)

Atropine
(Atrovent, Spiriva)


(daily maintenence)

103

Methylxanthines (2 drugs)

(When used)

Aminophylline
Theophylline

104

Indication of corticosteroids

Anti-inflammatory

105

When would a patient be on daily corticosteroids?

If they have very advanced or acute COPD

106

Corticosteroid daily maintenence drug

Flunisolide (aerobid)

107

Corticosteroid acute exacerbation drug

Prednisone (methylprednisone) -- SYSTEMIC

108

It is always OK to give COPD patients...

2-3 L nasal canula O2

109

Pulmonary Function Test: What is it measuring?

Compares Forced Expiratory Volume with Forced Vital Capacity

(measures severity of COPD)

110

FEV def

How fast the air in lungs can be moved out in 1,2 and 3 seconds

111

FVC def

How much air volume can be moved in and out of the lungs

112

Three sxs of chronic bronchitis

- Excessive mucus secretions
- Cough
- Dyspnea

113

Bronchits: Diagnostic criteria

- Episode lasting 3+ months in 2 consecutive years

114

Two causes of chronic bronchitis

- Recurrent lower RT infections
- Smoking (#1 cause)

115

Asthma: Def

Chronic REVERSIBLE inflammatory disease of the airways

116

Three sxs of asthma

- Bronchoconstriction (hyperresponsive airways)
- Swelling of mucosal lining
- Thick secretions

117

Four things that are released during an asthma attack

- Histamine
- Bradykinin
- Prostaglandins
- Leukotrienes

118

Respiratory rate of an asthmatic patient (and implications)

- Increased RR to blow off CO2
(When they start retaining CO2 instead, patient is exhausted --> Respiratory distress)

119

When should you be concerned with an asthmatic patient?

If they go into respiratory acidosis

120

Long acting bronchodilators for asthma (4)

**ALL FOR DAILY MAINTENANCE**

- Mast cell stabilizers
- Adrenergic Beta 2 agonist
- Methylxanthines
- Leukotriene inhibitors

121

Define Status asthmaticus

When treatment isn't working for 24+ hours

122

Mast cell stabilizer -- prototype

Cromolyn (Intal)

123

Adrenergic Beta 2 -- prototype

Formoteral (Foradil)

124

Methylxanthines Prototypes (2)

Aminophylline
Theophylline

125

Leukotriene inhibitors - prototype

Xarfirlukast (Accolate)

126

Are you going to ace this exam

fuck yeah