M5 Perfusion Flashcards
(193 cards)
1
Q
Shock 101
A
Condition in which vital tissue and organs are not receiving enough blood
Without O2 and nutrients from blood, things start to die
2
Q
Shock can happen due to any mechanism of action that disrupts
A
Heart function
Blood volume
Blood pressure
3
Q
Subjective shock S/S
A
Feeling sick
Weak
Cold/hot
LOC
4
Q
Objective shock S/S
A
Hypotension BELOW 60
SOB
5
Q
Cardiac output and urinary output with shock
A
Decreases
6
Q
Respiratory output with shock
A
Rate Increase resulting in Resp Alkalosis
7
Q
Resp Alkalosis is an impending indicator of
A
SHOCK
8
Q
O2 sat and shock
A
Drops
9
Q
First organs to be affected by shock are heart and brain so what are the earliest symptoms
what about respirations
A
LOC
BP drop
HR increase
Cardiac output drop
rapid and shallow
10
Q
5 Types of shock
A
Hypovolemic
Neurogenic
Cardiogenic
Septic
Anaphylactic
11
Q
Shock treatment ABC
A
Airway
Breathing
Circulation
12
Q
To treat shock, threat
A
Underlying cause
13
Q
Supportive measures for shock
A
IV to expand intravascular volume
Vasopressors to increase BP
Supplemental O2
Keep PT warm
Keep environment quiet
14
Q
What makes treatment difficult in the later stages of shock
A
Positive feedback loop
15
Q
Causes for fluid loss shock
A
Hemorrhage
Burns
Dehydration
Vomit/diarrhea
Diuretics
16
Q
Diagnostics scans for Hypovolemic shock
A
CT
Ultrasound
EGD
detects bleeding
Echocardiography
17
Q
Labs for hypovolemic shock
A
ABG
Electrolytes
Renal panel
CBC
Urinalysis
18
Q
Diagnostic tests for cardiogenic shock
A
12 lead EKG
Nuclear scan
Cardiac cath
Coronary angiography
19
Q
Lab tests for cardiogenic shock
A
All the hypovolemic labs +
CRP
Cardiac biomarkers
Thyroid hormones drugs
20
Q
Diagnostics and Lab test for neuro shock
A
12 lead EKG
CT MRI of brain
ABG
lytes
CBC
Urinalysis
21
Q
Diagnostics and labs for anaphylactic shock
A
12 lead EKG
sensitization test
ABG
Lytes
CBC
Urinalysis
22
Q
Diagnostics and labs for septic shock
A
12 lead EGK
Same as hypovolemic
23
Q
Diagnostics and labs for septic shock
A
12 lead EGK
Same as hypovolemic+
Serum lactate
Pro-calcitonin
Coagulation factors
Blood/other CULTURES
24
Q
Hypovolemic shock is defined as a loss of _% of intravascular volume
A
15
25
Difference between hypovolemic and cardiogenic shock
Fluid volume and cardiac health
26
S/S of hypovolemic shock
cardiac
resp
integument
rapid pulse
low BP-high SVR
rapid respirations-low preload
poor skin turgor, tenting, thirst
27
Hypovolemic shock management
Replace volume with
BLOOD, COLLOIDS or CRYSTALLOIDS
28
What hormone to give to hypovolemic shock PTs
ADH
Antidiuretic Hormone
29
Treat acute massive blood loss with
What is the _% for acute blood less
Whole blood
Know blood admin procedures
More than 30% of total volume
30
Depending on what is low during hypovolemic shock, what other blood components can we give
Plasma protein fraction
Fresh-frozen plasma
Packed RBCs
31
Colloids 101
what kind of pressure
Expand plasma by drawing body cell molecules in to blood vessels
Oncotic
32
When to use colloids
When up to 1/3 of adult blood volume is lost
33
Colloid types
nonblood
we can administer
Dextran
Hespan
34
Natural colloids in blood
Albumin
Plasma protein fraction
Serum globulin
35
Crystalloids 101
Types
Intravenous solutions that contain lytes
replace fluids and promote urine output
Isotonic
Hypotonic
Hypertonic
36
Crystalloid solution examples
NS
LR
Plasmalyte
37
Neuro shock patho
Sympathetic v/parasympathetic ^ = v in vascular tone = v SVR = v cardiac output = v tissue perfusion = Impaired Cellular Metabolism
38
Neuro shock risk factors
Spinal trauma
Regional anesthesia
Autonomic nervous system drugs
39
Neuro shock S/S
heart
skin
v cardiac output
hypotension
bradycardia
cold
Dusky
40
Volume replacement for neuro shock
Crystalloid
Colloid
41
Meds for neuro shock
Vasopressors
Corticosteroids
42
Other neuro shock interventions
Cardiac pacing
GCS (Glasgow coma) scale
Ventilation/intubation
43
Another name for neuro shock
Vasogenic due to dilation
44
When the medulla does not get enough O2 or GLUCOSE we get
neurogenic shock
45
SVR
Systemic vascular resistance
Resistance of blood vessels
Used to create blood pressure
46
Cardiogenic shock 101
Decreased cardiac output
Impaired cellular metabolism
Hypoxia in presence of adequate volume
47
Causes for cardiogenic shock
HF
Dysrhythmias
Valve dysfunction
Myocardial infection
Massive emboli
Cardiac temponade
48
Cardiac temponade
Space around heart fills with fluid
49
Cardiogenic shock risk factors
Age
MI/HF history
DM
CAD
50
Cardiogenic shock S/S
neuro
resp
integ
cardiac
GI
LOC
Tachypnea, dyspnea due to pulmonary edema
dusky skin
hypotension BELOW 60
Oliguria
51
Managing cardiogenic shock
Meds
Vasodilator - nitro
Vasopressor - dopamine
Beta-agonist - increase contraction force
Morphine - improve coronary perfusion
52
Volume replacement with cardiogenic shock
Crystalloid/colloid
53
Managing airway and cardiogenic shock
Intubation
54
Surgeries and procedures for cardiogenic shock
Intra aortic balloon
VAD
Revascularization (bypass surgery)
55
Septic shock 101
Gram positive TLR2 receptor or gram negative TLR 4 receptor activation = Macrophage engagement = SIRS=w/c shock=MODS
56
SIRS
Systemic inflammation response syndrome
S/S
Fever
Tachycardia
Tachypnea
Leukocytosis
57
MODS
Multiple organ disfunction
58
w/c shock s/s
1st warm shock
2nd cold shock
vasodilation
hypotension
hypoperfusion
inflammation
Myocardial depression
Worsening tissue hypoperfusion
59
Most common sites of entry for septic shock
Lung
Urinary
GI
Wound
Vascular cath
60
Risk factors for septic shock
age
nutrition
Hx (trauma surgery caths, HF, DM)
Immunosuppression - AIDS, steroids, chemo, post-organ transplant
61
Early septic shock S/S
heart
GU
Skin
Neuro
Tachycardia
^ Cardiac output
Hypo OR hyperthermia
Deranged renal system
Jaundice
Deterioration of mental status
62
Labs for septic shock
Culture
C-reactive proteins
Serum lactate
Pro-calcitonin
Coagulation factors
63
Fluids for Septic shock
Crystalloids
Colloids
64
Meds for septic shock
Antibiotics (central line cath)
Vasopressors
Steroids
Beta-agonists
Antipyretics
Insulin
65
Septic shock airway management
Intubation
66
Anaphylactic shock 101
Hypersensitivity reaction
vasodilation and hypovolemia=decreased perfusion and impaired metabolism
67
Most common allergens causing anaphylactic shock
Insect bites
Shellfish
Peanuts
Latex
Meds (pcn)
68
What else is a big allergen that can happen in hospitals
blood transfusion
69
Anaphylactic shock S/S
neuro
resp
integument
GI/GU
loc
Stridor/Wheezing
Pruritus
Hives
Swollen lips/tongue
Abdominal cramps, oliguria
70
Cardio S/S of anaphylactic shock
BP drop
SVR drop
Increased Cardiac Output
71
Meds for anaphylactic shock
Antihistamines
Bronchodilators
Corticosteroids
Vasopressors
72
Airway management and anaphylactic shock
intubation/ventilation
73
Fluid replacement to give in anaphlectic shock
Crystalloids/colloids
74
1st things to remove in anaphylectic shock
ANTIGEN
75
Vasoconstrictor/sympathomimetic for shock 101
Act on alpha-adrenergic receptors
raise blood pressure
positive inotropic effect
76
Vasoconstrictor/sympathomimetic meds
Norepinephrine
(Levophe, Levaterenol)
77
Vasoconstrictor/sympathomimetic adverse effects
tachycardia
hypertension
78
Vasoconstrictor/vasopressors 101
Good for early stages
Activates sympathetic system
raises BP and increases contractions
79
Purpose of vasopressor meds
Maintain blood flow to vital organs heart brain
decrease flow to other organs
kidneys liver
80
Monitoring for vasopressors
discontinue as soon as
continuous
pt is stable
81
How to discontinue vasopressors
GRADUALY
prevents rebound hypotension
82
Vasoconstrictor/vasopressors drugs
Norepinephrine (levophed) - alpha/beta agonist
Phenylephrine - alpha agonist
DDAVP- antidiuretic agent
83
Only use Sympathomimetic vasocontrictors or vasopressors when
Fluid and Lyte replacement has FAILED
84
What to monitor when pt on vasopressors
BP
HR
ECGs
Urine Output
GLAUCOMA
85
Extravasation of vasopressors and dopamine causes
Tissue necrosis
Titrate dose based on BP
86
What must be injected at Extravasation site immediately
Phentolamine (regitine)
87
Teach pt to monitor extravaccation via reporting
Pain and burning at IV site
Blanching and blueness of fingers
Chest pain or palpitations
88
Inotropic drugs 101
Strengthen contractions
Increase cardiac output
89
Inotropic drug names
Digoxin
Dobutamine
Dopamine
90
Prototype inotropic agent
treats what shock types
Dopamine
HYPERvolemic
Cardiogenic
91
Dopamine activates what receptrs
Both Alpha and Beta
92
Inotropic drug digoxin
increases contractility
gets essential oxygen to critical tissue quickly
93
Inotropic drug dobutamine
Beta 1 agent
increases contractility
best for HF
Half life - 2MIN
IV ONLY
94
What to monitor for Inotropic drugs
BP
Telemetry
IV site
RENAL function
95
Because inotropic drugs work on heart pt will have continues _ monitoring
Cardiac
96
What to teach pt to report on Inotropics
Chest pain/palpitations
SOB
burning/pain at IV site
numbness or tingling in extremities
97
Sympathomimetic for anaphylaxis 101
Epinephrine (Adrenalin)
Nonselective adrenergic agonist
Supports system by preventing hyperresponse
98
Assessment for epinephrine use in anaphylactic shock
Vitals
Lungs
Renal (BUN, creatinine)
LOC
99
Goals for patient with anaphylactic shock
Client will report itching SOB
Maintain urine output at 50ml/hr
Maintain Systolic BP at 90mmHg
Client will remain A&O
100
Preload
Venous blood return to the heart
101
Substances to increase blood volume
PRBCs
Albumin
Normal saline
102
Substances to decrease blood volume
Diuretics
Ace inhibitors
103
Substances to increase venous dilation
Nitroglycerine
Ca+ channel blockers
Clonidine
Morphine
104
Substances to decrease venous dilation
Dobutamine
105
Contractility
Forcefulness of contractions
106
Substances that increase contractility
Digoxin
Dobutamine-dopamine
Milrinone
107
Afterload
Work required to open aortic valve and eject blood
RESISTANCE to flow in arteries
108
Substances that increase afterload
HIGH dose of dopamine
109
Substances that lower afterload
Ace inhibitors
Nitro
Ca+ channel blockers
Beta blockers
110
Normal heart rate
60-100 bpm
111
Substances that lower HR
Beta blockers
Ca+ channel blockers
112
Substances that increase HR
Atropine
Dopamine
113
5 steps of the electrical pathway of the heart
SA node
AV node
Bundle of His
Left/right bundle branches
Purkinje fibers
114
Atrial depolarization initiated by the SA node causes the _ wave
P
115
After depolarization the impulse in delayed at the AV node
this is the _ segment
actually ends at _
PR segment
PQ
116
Ventricular depolarization begins at the apex, causing the _ complex.
This is also where... occures
QRS
Atrial repolarization
117
the _ segment marks ventricular depolarization
ST segment
118
Then ventricular repolarization begins at apex casing the _ wave
T
119
MI
CRUSHING s/s
Chest pain
Radiating to left arm jaw back
Unrelieved by nitro
Sweating
Hard to breath
Increase in HR and BP
N/S
Getting anxious
120
MI s/s women excpetion
No chest pain
paint is lower, just above abdomen
121
MI and diabetic neuropathy
Silent MI due to damaged nerves not feeling pain
122
Labs 1hr with MI
Myoglobin in blood
123
Labs 2-4hr with MI
Troponin is released at 0-0.4ng/ml
124
Labs 4-6hr with MI
CKMB is released at 0-0.4ng/ml
125
24-36h post MI
Inflammation and neutrophils
Could lead to
Pericarditis (Friction rub)
Pump failure
Cardiogenic shock
Arrhythmias
126
STEMI
ST elevated myocardial infarction
on EKG
ST segment elevated
127
NSTEMI
Non-ST elevated myocardial infarction
on EKG
ST will depress or invert
128
If ST slopes down or stays horizontal before coming up for the T, this indicates
Ischemia
129
MI first meds
AONM
Aspirin
O2
Nitro
Morphine
130
With MI time is
Muscle
131
What to assess in MIs
Chest pain
Cardiovascular system
Bedside monitoring
Blood ressure
Resp sounds
132
What to assess for in cardiovascular system with MI
12 lead EKG
ST elevation/depression
T waves
133
What is continuous bedside monitoring for MIs
Telemetry
134
What lung sounds will you hear in MIs
crackles
fluid overload due to heart dying
blood is backing up
135
basic interventions for MI
O2 2-4L
Working IV
Bedrest
136
MI labs
Troponin
CKMB
137
What to do in first 10 min of MI pt arrival
Vitals
O2 sta
IV access
12 lead ECG
Blood sample
138
Fibrinolytic therapy is used for what MIs
when to be given
STEMI
within 12h of symptom onset
139
Fibrinolytic MOA
Breaking down of clots
140
Fibrinolytic med contradictions
Post OP
Hemorrhage
Ulcers
Pregnancy
141
Acute Angina means
Artery Blockage
Cardiac Complication
142
Most common anticoagulants
Heparin
Lovenox
143
What to monitor with Antigcoagulants
PTT
Normal 25-35
Therapeutic 60-80
144
Antiplatelet meds 101
Decrease platelet aggregation
Aspirin
Plavix
145
Aspirin
Plavix
side effects
asa GI bleed
Plavix - Thrombocytopenia purpura
146
Stop antiplatelet meds like aspirin and plavix how many days before surgery
5-7
147
Morphine for chest pain route
IV ONLY
148
Nitroglycerin 101
Vasodilates coronary arteries
Increases blood flow
149
Nitro watch for
Headache
Flushing
Dizziness
150
How to monitor pt on nitro
MUST monitor
BP
EKG
Chest pain
151
Ace inhibitors 101
"April"
Blocks RAAS system
Vasodilator
Decreases BP and workload
152
ACE side effects
Nagging cough
K+ increase
153
Arbs ArTan 101
side effects
Specifically block angiotension II part of RAAS
Vasodilators
also increase K+
154
Statins 101
Lower cholesterol LDL
increases HDL
155
What to monitor with Statins
MUSCLE Pain
CPK level - indicate muscle breakdown
LIVER function
156
Ca+ channel blockers 101
Blocks calcium from entering smooth myocardial muscles = vasodilation
157
Ca+ channel blocker meds
Norvasc
Cardizem
158
Ca+ channel med side effects
Hypotension
Gum enlargement (oral hygiene)
159
Peak or hyper acute Ts indicate
MI
160
EBT
Electron Bean CT
Echocardiography
Detects Heart Disease in earliest stages 2-6
Only detects later stages only 5-6
161
Other forms of heart health monitoring include
Heart cath
Exercise stress test
162
Tetralogy of fallot
PRAV
CYANOSIS
Ventral septal defect
Aortic override
Pulmonary stenosis
Right ventricular hypertrophy
163
The degree of CYANOSIS with tetralogy of fallot depends on the
Size of the ventricular septal defect
Degree of ventricular outflow obstruction
164
Obstruction of blood flow from right ventricle to the pulmonary artery results in deoxygenated blood being shunted across the ... and in to the
Ventricular septal defect
Aorta
165
Ventricular outflow obstruction can occur at any of the 3 levels
Pulmonary valve stenosis
Infundibular stenosis
Supra-valvular stenosis
166
In tetralogy of fallot the right ventricle eventually becomes
Hypertrophied
167
At birth with tetralogy of fallot TOF, neonates O2 sat is
Normal, then decreases
168
When is cyanosis initially observed in TOF
crying and exertion
169
Other TOF S/S
Polycythemia (^RBC)
Exercise intolerance
Tachypnea
LOC
170
TOF home treatment
Soothe
place in knee to chest position
171
TOF hospital treatment
Knee to chest
Morphine sedation
O2
Beta-blockers
Phenylephrine to increase vascular perfusion
172
Diagnosing TOF
Auscultation
CRX
ECG
Cardiac cath
173
Auscultation and TOF
Harsh systolic ejection mrmur
174
CXR and TOF
Boot shaped heart
(right vent hypertrophy)
175
ECG and TOF
Doppler study and color flow mapping
176
Cardiac catheterization and TOF MOST DIFINITIVE DIAGNOSTIC
before surgery to ID number of septal defects
177
Med management of TOF
O2 sat
Growth and development
Monitor hyper cyanotic spells
Endocarditis prophylaxis
Restrict stranuous activity
178
Life long TOF care
Assess R ventricular outflow
Monitor exercise tolerance
Monitor arrhythmias
179
TOF complications
Hypoxia
Hyper cyanotic spells
CHR
Polycythemia
Arrhythmias
180
Nursing and TOF
Assess vitals pulses cap refil (standing sitting lying)
Monitor cyanotic attacks
Knee-chest
Monitor during exercise
Monitor intake and output
181
VSD Ventricular septal defect
Hole in the wall of 2 ventricles
182
Pulmonary stenosis
Narrowing of pulmonary valve resulting in low blood volume reaching lungs
183
Right ventricular hypertrophy
Right ventricle muscle thickens up
184
Overriding aorta
Aorta located over VSD, as such O2 poor blood gets in to aorta
185
Mothers risk factors for TOF
Rubella
Viral infections
Poor nutrition
Age over 40
Diabetes
186
tet
blue spells due to acute cyanosis or hypoxia
187
TOF can result in
Emboli
Seizures
LOC
188
TOF psych problems
Stress
Depression
Substance abuse
School problems
Non-compliance with meds in teens
189
During crying or feeding TOF baby's skin will turn "tet"
Blue
190
TOF treatment
Beta blockers
O2
squatting - increases afterload
fluids
191
TOF surgeries
VSD closure
Complete repair
Palliative shunt
Modified blalock - accesses pulmonary artery but also distorts it
192
Consequences of total correction surgery
less than 3% mortality
CHF
heart block
sudden death
193
What to monitor for in TOF correction surgery post op
S/S of rejection
Infection
side effects of immunosuppression meds
