M7 Immunity 2 Flashcards
(140 cards)
1
Q
MODS
A
Multiple organ distress syndrome
2
Q
MODS is characterized by
A
failure of a t least 2 major organs
hemostasis cannot be achieved without intervention
3
Q
SIRS leads to _ leads to
A
MODS
Shock
4
Q
Causes for mods
A
Severe injury or illness
Muscle or tissue trauma
Shock
5
Q
Which shock is most common with mods
A
Septic
6
Q
MODS Patho
A
Uncontrolled inflammation
Vasodilation
Protein mediators leak into interstitial space
Coagulation cascade activates
7
Q
Hypotension leads to decreased perfusion/micro emobli
this decreases flow to
A
Lungs
Kidneys
Heart
Liver
8
Q
MODS leads to ARDs
Acute respiratory distress syndrome 101
A
Increased capillary permeability
Fluid moves from vessels to alveoli, edema
Surfactant decreases, alveoli collapse
9
Q
ARDs is indicated by
A
VQ mismatch
Pulmonary hypertension
Increased resp rate
hypoxia
Bilateral infiltrates
10
Q
Cardiac mods symptoms
A
Myocardial depression
BP Drop
Increased HR
Increased permeability causes albumin to go into tissue with fluid
11
Q
Neuro MODS symptoms
A
Confusion agitation combativeness letharby
12
Q
Renal MODS symptoms
A
AKI
RAAS system stimulation
Aldosterone mediated Sodium and water reabsorption
Tubular necrosis
13
Q
GI and MODS
A
Mucosal ischemia
GI Bleed
14
Q
Hepatic and MODS
A
Hepatic Encephalopathy
15
Q
Diagnostics for mods
A
12 lead EGK
Echocardiography
Stress tests
16
Q
Immaging for MODS
A
Xray
CT
MRI
17
Q
Labs for mods
A
Lytes
CBC
Renal panel
Liver panel
Cardiac biomarkers
Thyroid
Coagulation factors
18
Q
MODS medical history
A
recent injury/surgery
chronic illness - aids, copd, cancer etc.
immunosuppressant meds
19
Q
MODS interventions
A
Tissue oxygenation
Volume management
Nutrition management
Organ support
20
Q
Support for organs
A
Dialysis or CRRT
Ventilation
21
Q
When is care withdrawn
A
Three or more organ systems worsen despite intervention
Death is inevitable with doctor judgment
22
Q
Life support major interventions
A
Ventilator
Dialysis
TPN
Blood transfusion
Lab work
23
Q
Withdrawal of care
A
Obtain DNR
Start comfort meds
Care for fam
Talk to social work/chap
document
24
Q
Comfort meds
A
Fentanyl
Hydromorphone
Propofol
25
2 Major contributing infections to sepsis
UTI
Pneumonia
26
Biggest lab value for sepsis
LACTATE
27
What does lactate indicate
Switching from aerobic to anaerobic metabolism = inflammation
28
Skin problems that can lead to spesis
Pressure ulcers
Cellulitis
29
3 Biggest sepsis bacteria
Staph
Strep
E. Coli
30
Why are diabetics at risk for sepsis
Bacteria love sugar
31
Best thing to start first with sepsis
Fluids
32
Hyperbaric therapy used for wounds
why and how
helps wounds health
provides 100% oxygenation to the wound
33
How soon do you need to do CBC and Lactate cultures for sepsis
Within 6h
34
Aminoglycoside drugs names end in
can result in what toxicities
Myocin
Renal
Hearing
35
How to measure Aminoglycoside toxicity...
what labs
First measure Trough
Measure in hour to check Peak
BUN, Creatinine
36
Biggest number indicator of BP
MAP
Less than 65 PROBLEM
37
Is SIRS a disease
NO
its a syndrome, first stage of sepsis
38
Only reason for AIDS patients to get admitted to hospital
Overwhelming infection
39
Type of Pneumonia that is common with AIDS
Pneumocystis Jerovic
(PJP)
40
Once you have AIDS, if your CD4 goes up past 200 can you go back to HIV
NO
41
HIV pregnant mothers can only deliver via
C section
42
Meningitis that affects HIV pts
Cryptococcal meningitis
Very Dangerous
43
Skin cancer most common with HIV AIDS
Kaposi Sarcoma
Red spots all over skin
44
CDC Categories for HIV
Above 500 Cat A
Between 499 and 200 Cat B
Below 200 Cat C
45
ELISA HIV test is same name as
EIA
46
HIV Pneumonia jerovic treatment
Sulfamethoxazole trimethoprime
SMZ TMP
47
HIV Oral candidiasis treatment
Ketoconazole
Nystatin
Mycelex
48
CART
vs
HART
Combination antiretroviral
High antiretroviral
49
Best IV antiemetic
Zofran
50
Decreased cardia contractility results in a drop in stroke volume and cardiac output,
This leads to what other complications
Pulmonary congestion
Drop in body perfusion
Drop in heart perfusion
51
Cardiogenic shock S/S
Systolic BP below 90
Urine output below 30ml/h
Weak pulse
Cold clammy skin
Decreased bowel sounds
52
Mental and resp S/S of shock
confusion, lethargy
dyspnea, tachypnea, cyanosis
53
First line treatment for cardiogenic shock
Oxygenation
Fluids
Pain control
Hemodynamic monitoring
Monitor lab markers
54
Meds for cardiogenic shock
Dobutamine
Amrinone
Digoxin
Diuretics
Antiarrhythmics
55
Nursing management of cardiogenic shock
Monitor hemodynamics
Oxygenation
Admin IV fluids
Safety and comfort
56
Hemodynamic monitoring
I&O
Daily weight
MAP
CO
Swan-Ganz
57
Monitoring Heart changes with cardiac shock
ECG
Lytes
58
Oxygenation interventions with cardiac shock
Monitor respirations
Auscultate lungs
Observe for pink cough sputume
Admin O2
Elevate head
59
Perfusion monitoring with cardiac shock
Neuro checks
BUN/Creatinine
Temp
Arterial pulses
60
What to monitor with pulses
Rate Rhythm Quality
61
If there is a significant change in LOC with cardio shock
Report Immediately
62
Hypovolemic shock chain of path
Drop in volume
Drop in venous return
Drop in stroke volume
Drop in CO
Drop in perfusion
63
Dr. interventions for Hypovol shock
Treat cause
Give fluids
Give vasopressors
64
Nursing interventions for Hypovol shock
Admin fluids safely
Admin O2
65
Position for Hypovol shock
Modified Trendelenburg _/
66
Aneurysm
Abnormal bulging of vessels
67
Aneurysm types
Saccular
Fusiform
68
Major risks for anurisms
SMOKING
HYPERTENSION
Age over 55
Connective tissue disorders
69
Most common pain with anurisms
Left lower quadrant
Intense lower back
70
Other symptoms of anurisms
Syncope
Tachycardia
Hypotension
aka hammorrhage
71
Thoracic aortic aneurysm S/S
Trouble speaking, breathing and swallowing
72
Sharp ripping or tearing pain in anterior of chest shoulder or back indicates
Aneurism rupture
73
Nursing interventions for Aneurism
Prepare for MRI CT or XRay
Monitor for S/S of hypovolemic shock
Perform neuro checks
74
Post aneurism surgery interventions
Frequent vitals
Labs
Urine output
Bowel distension
Skin perfusion
75
labs to monitor post anurism surgery
CBC
76
MODS is a severe form of
Shock
77
Stages of shock
Initial
Compensatory
Progressive (failure of compensation)
Refractory (shift to end of life care)
78
First organ to get hit by MODS
Kidneys
79
Body holds on to sodium and water via what hormone
Aldosterone
80
EARLY signs of shock
1# CONFUSION
hypotension
MAP v
tachycardia
81
Hypoxia S/S
ON TEST
Restlessness
Irritability
Tachycardia
82
#1 reason for ARDS
Pneumonia
Infection
83
Allographt transplants can be received from
Living
or
Cadaver
bodies
84
#1 concern for organ transplants
Rejection
85
Med types for organ transplant
Corticosteroids
Antibiotics
Anticoagulants
Immunosuppressants
86
Most important part of organ transplant meds
Compliance
87
Normal CD4 count
HIV count
800-1000
below 200
88
Do we report HIV to health organizations
Is there and HIV vaccine
YES
YES, not a live one
89
HIV Neuro manifestations
LOC Changes
May be due to ENCEPHALOPATHY
90
Cryptococcus neoformans 101
S/S
Opportunistic neuro disease that prays on HIV patients
Stiff neck
Seizures
Mental changes
Fever
91
Most common HIV infection
S/S
Pneumonia
fever, chills, non productive cough
92
What to assess with HIV patients
Albumin, weight, BMI- malnutrition BIG problem
93
Biggest factor of HIV is viral load, the higher
the greater the progression to AIDS
94
HIV Precaution
Contact and standard
95
Where to take HIV PTs X rays
In room instead of lad to limit exposure
96
If HIV needlestick
Report to ED Immediately
Viral meds start w/in 2h of stick for at least 4 weeks
97
HIV penumonia treatment
Trimethoprim sulfamethoxazole
Pulmonary care - cough, deep breaths, postural drainage Q2H
98
Sulfamethoxazole trimethoprim side effect
Hyperkalemia
99
How to manage HIV Viral load
TAKE MEDS REGULARLY
100
How does HIV pneumonia start
Perianal and oral mucosa infections
Thrush/fungus
Skin integrity
101
HIV GI problems
Oral candidiasis
Diarrhea
Wasting syndrome
102
Most common HIV tests
EIA
Western Blot - confirms EIA
103
HIV Transmission
Sex
IV drugs
Birth
104
HIV Is transmitted in body fluids including
Amniotic fluids
Breast milk
blood
semen
vagina semen
105
#1 med o promote nutrition
MEGACE (Megestrol)
ON TEST
106
10% weight loss
Chronic diarrhea
Weakness
Fever
and NO OTHER CUASE =
HIV wasting syndrome
107
A/B of MODS
metabolic ACIDOSIS
body going into anaerobic metabolism INCREASES lactic acid
108
#1 organ to fail with MODS
Kidneys
109
Compensatory stage of mods S/S
VASOCONSTRICTION
cool clammy skin - body shunts blood from core
acidosis
110
Progressive stage of mods S/S
VASODILATION
hypoperfusion
111
Normal MAP is more than
60
112
Nutritional management for encephalopathy
Small frequent meals
Daily protein between 1.2-1.5 g/kg
protein is good
113
Lytes with encephalopathy
what to do
Hypokalemia
give lactulose
114
With encephalopathy and increasing ammonia first symptom is
LOC - SLEEPINESS
stupor
impaired thinking
115
Second encephalopathy S/S are
neuromuscular
Asterixis - liver shakes
Hyperreflexia
116
Too much lactulose would be indicated by
Diarrhea
Hypokalemia
Dehydration
117
How do you know lactulose is working
2-3 soft stools per day ***
118
For MODS and shock you want MAP to be
Greater than 65
119
Other things to maintain with MODS and shock
pH
Liver/GI function
Kidney function
watch for onset of DIC
120
Once multiple organs start failing
Switch care to comfort
121
If pt is an organ donor keep map at
100
or high as possible
122
Goal of family care
Keep fam informed of situation and process
123
SIRS glucose
Will be over 120 w/o Diabetes or other explanations
124
SIRS age risk categories
Adult over 65
Kid under 1
125
SIRS biggest infection causes
UTIs
Pressure ulcers
126
Most common bacteria types
Staph
Strep
Escherichia Coci
127
Consults for discontinuation of life support
DNR
Social worker
Chaplain
Have Dr. explain
128
SIRS S/S of worsening
Difficulty breathing
Drop in urine output
Hyperglycemia
^in lactic acid
Edema
129
With SIRS we try to prevent
HYPOTENSION
Bottoming out
130
Bad temperatures
OVER 100.4
UNCER 96.8
131
Why does lactic acid increase with SIRS
anaerobic metabolism
132
Treat drop in BP
Saline bolus
Norepi
Dopamine
133
With septic shock. blood pulls to extremities so
Skin will be warm as opposed to EVERY OTHER shock
134
Septic shock risk reduction
Up to date vaccines
Proper wound care
Hand hygiene
NO delays in antibiotics
135
Prior to surgery give _ to maintain hydration
What kind of bath
What med to give 30 min prior
LR
CHG wipe bath
Antibiotic
136
urinary sign of organ rejection
drop in urine output
less than 30ml/hr
137
Labs with low urine
Elevated BUN/Creatinine
138
Organ transplant post op care
VS q15m
check wound
NPO
Hydration
MONITOR PISS OUTPUT less than 30ml/hr
139
post surgery uncontrolled pain
something is wrong
CALL DR
140
Post surgery moving pain
CO2 pain
only treatment is more movement
