M5 Perfusion 4 Flashcards
(134 cards)
1
Q
4 stages of shock
A
initial
compensatory
progressive
refractory
2
Q
What to do with MODS in end stage
A
Shift care from pt to family
Gotta have that talk
3
Q
Compensatory shock S/S
A
Compensation
Tachycardia
Cold/clammy skin
Circulation is now shunted just to vital organs
4
Q
kidneys will die due to poor perfusion within
S/S
A
20MIN
oliguria
anuria
5
Q
Cardiogenic shock 101
A
Not providing enough oxygenated blood to organs
6
Q
Most common cause of septic shock
A
UTIs!!!
7
Q
Biggest septic shock S/S
A
LACTATE LEVEL ELEVATED
Altered consciousness
8
Q
Restlessness
Irritability
Tachycardia
=
____
on TEST
A
HYPOXIA
9
Q
hypoxia 1st check
A
Pulse oxymetry
10
Q
VTE=
A
Pulmonary embolism
or
DVT
11
Q
Rx interventions for Cardiogenic shock
A
pressors
Dobutamine
Dopamine
Ionocore
blood pressure support
12
Q
Body systems that will kick in at shock
A
Epi/Norepi
RAAS
13
Q
Aldosterone =
A
sodium and water excretion
potassium retention
14
Q
How often to do vitals for CarioShock patients on BP meds
A
q15m
15
Q
Other cardiogenic shock meds
A
pressors
digoxin
diuretics
16
Q
Only progressive cardiogenic shock solution
A
Transplant
17
Q
Hypovolemic shock 101
A
low volume
15% of intravascular volume loss
according to instructor
18
Q
Biggest causes of hypovolemic shock
A
Hemorrhage
Burns
19
Q
Total body edema
A
ANASARCA
20
Q
urinary output after burn
initial
progressive
A
Low
oliguria
anuria
then high after 72h
21
Q
After 72h during the high output what are we worried about
A
Hypervolemia
fluid is rushing back into vessels from body
22
Q
What to give when pt has hypervolemia
A
Diuretic
23
Q
Why do we do isotonic solutions when transufing
A
Same as blood
Will stay where you put it
24
Q
ADH =
A
H2O
25
Not enough ADH with diabetes insipidus, pt will
pee out all volume
hypovolemic shock
26
To prevent this with diabetes insipidus, give
Desmopressin
27
Due to shock, blood will shunt to brain and heart
Stomach will become
what to do
Paralytic
NG suction
28
Nursing management for hypovolemic shock of elderly and very young
slow infusion
easy to toss pt into hypervolemia
29
Modified trendeleberg
Supine but legs are up
_/
30
Aneurisms
Bulge or ballooning of blood vessel
31
2 types of anurism
Saccular - small on one side, like a hernia
Fusiform - vessel expands on both sides
32
Aneurism in upper aorta
Difficulty swallowing
Difficulty speaking
Heart burn
33
Age of most common aneurisms
Other risk factors
55 and older
FAMILY HISTORY BIG
connective tissue problems
smoking
hypertension
34
To prevent aneurisms manage
Hypertension
35
Most prone demographic for aneurisms
White male
36
Gut problems are usually what triage category
Emergent
may be bleed
may be infection
37
When you auscultate and feel belly, an abdominal aortic aneurism will feel and sound like
Bruit
38
Procedures to prevent large aneurisms
Surgery - sowing a mesh graft inside the aneurism to reinforce the area
Nonsurgical - endovascular deployment of that mesh, done at cath lab
39
What s/s indicates a worsening
WORST back burning pain
Pain in groin area
Impending doom
aneurism is dissecting (stretching with every beat)
most likely will die
40
S/S of hermorrhage
Tachycardia
Low bp
MAP drop
diaphoresis
cold/clammy skin
Tachypnea
41
Who ALWAYS does the first dressing change
The surgeon
42
Core measure for surgery
antibiotics 30 min before cut
43
ASD Atrio septal defect
Abnormal communication between left and right atria
44
3 types of ASD
Ostium Primum
Ostium Secundum
Sinus Venosus
45
Ostium Primum ASD
Abnormal opening at bottom of atrial septum
46
Ostium secundum ASD
abnormal opening at middle of atrial septum
47
Sinus venosus ASD
Abnormal opening at top of atrial septum
48
Atrial Septal Defect 101
Left to right shunt
Blood flows from high pressure left to low pressure right atrium
Increased pulmonary flow lead to elevated pulmonary pressure
49
Increase in right atrum pressure =
increase in right ventricle volume overload and dilation
50
S/S of ASD
mostly asymptomatic
CHF in third or fourth decade of life
Resp infections
Poor weight gain
Poor exercise tolerance
51
Diagnosing ASD
Auscultate
CXR
ECG
Cardiac cath
52
ASD Auscultate
Soft systolic murmur
53
ASD CXR
Increased pulmonary markings
54
ASD ECG
Right access deviation
Right ventricular hypertrophy
Right bundle branch block
55
ASD Cardiac cath
Used to close with Atrial Occlusive Device
56
Spontaneous ASD closures happen at age
2
57
Treat ASD with what meds
Anti-congestives
Digoxin
Laxis
for CHF
Atrial occlusion device placement surgery
58
After Atrial occlusion device
do ineffective endocarditis prophylaxis for 6 months
59
ASD complications
Ineffective endocarditis
Embolic stroke
Pulmonary hypertension
Arrhythmias
60
Risk factors for ASD
Down syndrome
Fetal Alcohol syndrome
61
COA
Coarctation of the aorta 101
narrowing of the aortic arch
increases left ventricle workload and (systolic BP)
62
Neonates and older children overcoming COA
Neonate perfuse lower body through Patent ductus arteriosus PDA
Older children develop collateral vessels to bypass the coarctation
63
Patent ductus atrial
Pulmonary artery to aorta
64
COA manifestations neonates
Asymptomatic until PDA starts closing
then
Severe CHF
Poor lower perfusion (pedal pulses)
High upper uplses
Tachypnea
Acidosis
Circulatory shock
65
COA manifestations childre/adolescnets
hypertension in upper extremities
weak femoral pulses
nose bleeds
headaches
leg cramps
66
Diagnosing COA
Auscultation
ECG
CXR
67
COA Auscultation
nonspecific ejection murmur
68
COA CXR
Cardiomegaly
Pulmonary edema
Pulmonary venous congestion
69
COA ECG
Right ventricle hypertrophy in infants
Left ventricle hypertrophy in older children
70
Meds for COA
PGE1
Prostaglandin E1 infusion Alprostadil
Inotropics
Digoxin Lasix
71
Interventions for COA
Intubation
Endocarditis prophylaxes
Balloon angioplasty
72
Surgery for COA
Subclavian flap repair
End to end anastomosis
Dacron patch repair
73
COA Complications
Hypertension
CHF
Cerebral hemorrhage
Left ventricular failure
Aortic tear
Berry Aneurysm
74
COA Nursing inteventions
Observe
Heartbeat
Peripheral pulses
Skin color/warmth
assess cyanosis
assess CHF
75
Assess cyanosis COA
Circumoral
Mucous membranes
Clubbing
76
Assess CHF COA
Periorbital edema Tachycardia
Tachypnea
Oliguria
Hepatomegaly
77
Nursing interventions for COA
Collaborative therapy
Give treatment for afterload
Give diuretics
78
Nursing pulmonary interventions for COA
Monitor breathing
Fowlers position
Rest
Nutrition
Oxygen
Avoid sick people
79
Nursing nutrition interventions for COA
High nutrients
Monitor height and weight (DAILY weight)
I&O
Small frequent feed
80
Diuretic use in children
Will be thirsty
Fluids are NOT restricted in COA
81
Patent ductus arteriosus 101
Normal fetal connection between pulmonary artery and aorta
Bypasses lungs during gestation
82
PDA's are common in premature neonates who weigh less than
1500 grams
83
How long for PDA to close after birth
48h partial
4-6w complete
84
What ductus arteriosus fails to close
high pressure aortic blood goes into low pressure pulmonary artery
=
Pulmonary over circulation
=
volume overload in left ventricle
85
S/S of PDA
Lung heart
small - asymptomatic
large
Acyanotic!!!
CHF
Tachypnea
Resp infection
86
Body S/S of PDA
Poor weight gain
Failure to thrive
Feeding difficulties
Exercise intolerance
87
PDA Auscultation
Continuous murmur
LEFT UPPER STERNAL BORDER
88
PDA pulses
Bounding
89
PDA CXR
cardiomegaly
90
PDA ECG
Left Ventricular Hypertrophy
91
PDA with symptomatic neonate give
Indomethacin IV *
NSAIDs*
if working throughout lifetime = good
if not = surgery
92
Monitoring with PDA
Cardiac output (PULSES)
Growth/development
Reassess PDA for closure
93
Prophylaxis for PDA
Cardiac output (PULSES)
Growth/development
Reassess PDA for closure
94
Prophylaxis for PDA
Endocarditis prophylaxis after surgery or coil occlusion
95
Other meds for PDA
Diuretics
Furosemide
Spironolactone
96
Complications of PDA
CHF
Pulmonary edema
Ineffective endocarditis
Pneumonia
97
Nursing interventions for PDA
assess
Vitals
ECG
Lytes
I&O
98
Side effects of indomethacin
Diarrhea
Jaundice
Bleeding
Renal dysfunction
99
After surgery PDA, nursing interventions
Venous pressure cath assessment
Arterial line assessment
assess vitals, I&O, arterial venous pressure
100
PDA management goals
Reduce pulmonary vascular resistance
Maintain activity
Weight and height (GROWTH CHART)
101
PDA and ToF will both need
due to infection potential
Dental prophylaxis with antibiotics
102
Ventricular septal defect 101
VSD
Abnormal communication between right and left ventricle
103
Blood travel in VSD
High pressure left ventricle to low pressure right ventricle
=
Increased pulmonary pressure
104
In very bad VSD
pressure is so high that it reverses circulation resulting in cyanosis
105
Spontaneous closures of small VSDs happen during
1st year
106
Large VSD S/S
CHF
Upper resp infections
Poor weight
Feeding problems
Exercise intolerance
107
VSD Adult symptoms
SOB
Fatigue
Swelling of legs/abdomen
Arrhythmias
108
VSD Auscultation
Harsh systolic regurgitation murmurs
LEFT LOWER STENAL BORDER
109
VSD CXR
Cardiomegaly
Increased pulmonary markings
110
VSD ECG
biventricular hypertrophy
111
VSD and cardiac cath
Needed to ID size of shunt and if it can be closed
112
Pills for VSD
Digoxin
Diuretics - furosemide, spironolactone
ACE inhibitors
113
How do you know digoxin is working
Cardiac output increase
114
Dig toxicity values
S/S
0.5-2.0
early
N/V
Anorexia
late
Visual problems (YELLOW)
115
Dig and Low K
Toxicity
116
Digoxin antidote
Digibind
117
Oxygen and VSD
AVOID
118
formula and VSD
Increase caloric intake
Fortified formula
119
Treatment of choice for VSD
OPEN HEART SURGERY
120
Surgical interventions and VSD
Ventricular Occlusive Device
Usually before 1y
Endocarditis prophylaxes after
121
Long term follow ups for VSD
Ventricular function monitoring
Monitor for
sub aortic membrane/double chambered RV
122
VSD Complications
CHF
Resp infection
Failure to thrive
Aortic insufficiency
Eisenmenger's syndrome*
123
Biggest Symptom of ToF
Acute Cyanosis
May progress through life
124
When to interfere with baby heart defects
Symptoms are greater than baby can accommodate
125
Systolic murmur happen during S=
squeeze
126
Tet spells
cyanosis and hypoxia during crying or feeding
127
Tet spells happen during
Crying and feeding
128
Tet spells during feeding =
failure to thrive
129
To adjust for ToF toddlers will naturally
squat
knee to chest
INDICATOR of ToF
130
Is ToF genetic
YES
131
Simple treatment for pulmonary stenosis
Angioplasty
132
For the lifetime of a ToF patient they will need prophylactic _ for procedures due to...
antibiotics
heart stents collecting bacteria
133
Major Med for ToF
Progstoglandin E
134
Eisenmenger syndrome
reversal of L-R shunt to a R-L shunt, with cyanosis and clubbing***
