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Flashcards in Med Surg III ABG & Shock Deck (46):
1

Normal level of Anion Gap

8 - 14 mEq/L

2

what causes increase in Anion Gap

lactic acidosis or DKA

3

what causes decrease in Anion Gap

hypermagnesemia and anemic states

4

hypoventilation causes

respiratory acidosis

5

hyperventilation causes

respiratory alkalosis

6

what causes metabolic acidosis

severe diarrhea, renal disease, DKS, ARF, Kussmaul resp

7

what causes metabolic alkalosis

prolonged vomiting, suctioning, ingestion of baking soda and oral antacids, laxatives, enemas

8

clinical manifestations of acidosis

drowsy, disoriented, HA, coma, low BP, dysrhythmias, warm flushed skin, seizures, hypoventilation

9

clinical manifestations of alkalosis

lethargy, confusion, tachycardia, dysrhythmias, N/V, anorexia, tetany, tremors, seizures, hyperventilation

10

normal Hgb levels

men 14 - 18 g/dL, women 12 - 16 g/dL

11

normal hct levels

men 42% - 52%, women 37% - 47%

12

compensatory stage

early, blood flow to heart and brain maintained, increase BP, increased Na and water, watch labs for this

13

progressive stage

begins as compensatory mechanism fail, Need aggressive intervention to prevent MODS

14

refractory stage

late and often irreversible, Need vasoactive drugs (Midrin, Dobutamine, Dopamine, levonfed)

15

drugs for cardiogenic shock

vasodilators, inotropics, diuretics (Nitroglycerin, Nitroprusside)

16

drugs for septic shock

inotropics and antibiotics

17

drugs for anaphylactic shock

epinephrine

18

drugs for neurogenic shock

inotropics

19

what is the primary treatment for hypovolemic and distributive shock

fluid administration and identify, treat, and eliminate cause of fluid loss

20

When should colloids be avoided

when there is an increase in capillary permeability, as in sepsis and septic shock, anaphylactic shock, and early burn injury

21

what are isotonic solutions that are commonly infused

Lactated Ringers and 0.9% normal saline

22

When should Lactated Ringers be avoided

pt's with impaired liver function or severe lactic acidosis

23

which solutions are not used for fluid resuscitation

5% dextrose in water and 0.45% normal saline

24

When is albumin and plasma protein fraction appropriate

when volume loss is caused by a loss of plasma rather than blood, such as burn injury, peritonitis, and bowel obstruction

25

When is fresh frozen plasma given

when massive transfusions are infused, it is given to restore coagulation factors (1 unit for every 4 - 5 units of packed red blood cells)

26

When are platelets given

to control bleeding caused by low platelet counts (< 50,000/microliter)

27

why evaluate the Hct level

if low = blood loss, if high = fluid loss (need to know so the fluid that is lost can be replaced)

28

early, goal directed therapy for septic shock

IV fluids, vasopressors, and dobutamine, packed red blood cells, or both

29

primary MODS

direct injury to an organ from shock, trauma, burn injury, or infection

30

secondary MODS

a consequence of widespread systemic inflammation that results in dysfunction of organs not involved with the initial insult

31

target level of serum lactate

< 2.2 mEq/L

32

target level of MAP

65 mm Hg or greater

33

target level of CVP

8 mm Hg or greater

34

hemodynamic values associated with initial stage of septic shock

high heart rate, low right arterial pressure

35

dobutamine

increases contractile force of heart in cardiogenic shock

36

dopamine

used in low cardiac output states to increase BP

37

nipride

reduces vascular resistance

38

5 types of shock

1. cardiogenic 2. hypovolemic 3. neurogenic 4. anaphylactic 5. septic

39

Which type of shock do these s/s suggest?
dec cap refill, tachypnea, cyanosis, crackles, rhonchi, cool, clammy, dec. renal blood flow, dec. urine output, dec bowel sounds, n/v, incr. glucose and BUN, dysrhythmias, increase pulse, decrease blood pressure

cardiogenic shock

40

why do the kidneys secrete renin when bp is decreased

renin is a vasoconstrictor and its a compensation mechanism

41

Which type of shock do these s/s suggest? dec. cap refill, tachypnea, decreased urine output, cool clammy skin, increased pulse, no bowel sounds, decreased HgB and Hct.

hypovolemic shock

42

which type of shock do these s/s suggest? change in temp, bradycardia, loss of reflexes, bladder/bowel dysfunction, flaccid paralysis below lesion

neurogenic shock

43

which type of shock do these s/s suggest? swelling of lips/tongue, sob, wheezing, stridor, flushing, uticaria, pruitis, confusion, n/v, diarrhea, hist of allergies

anaphylactic shock

44

which type of shock do these s/s suggest? change in temperature, hyperventilation, change from respiratory alkalosis to respiratory acidosis, hypoxia, ARDS, pulmonary hypertension, decrease urine output, positive blood cultures, vasodilation and maldistribution of circulating volume?

septic shock

45

causes of respiratory acidosis

asthma, bronchitis, emphysema, hypoventilation, pneumonia,PE

46

causes of respiratory alkalosis

fever, hyperventilation, hypoxia, hysteria, pain