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N232 - FINAL EXAM > SIRS, DIC, ARDS & VENTILATORS > Flashcards

SIRS, DIC, ARDS & VENTILATORS Flashcards

1
Q

SIRS occurs due to a widespread, _______ release of ________ in response to an
acute physiologic insult or injury.

A
  • SYSTEMIC (rather than localized)

* chemical mediators of inflammation

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2
Q

Almost all ____ patients have SIRS, however, not all SIRS patients are ______.

A
  • Septic

* Septic

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3
Q

For SIRS, what do you wan to treat? What other two things should be included?

A
  • Underlying cause (example: infection)

* Include DVT and Stress ulcer prophylaxis

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4
Q

What four Items are look at to diagnose SIRS? How many of the 4 are needed?

A
  • TEMP
  • RR
  • HR
  • WBC

At least two of the four

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5
Q

The temperature criteria for sirs is Less than ____ and greater than _____.
The RR Criteria is _____ ?
The HR criteria is ____?
WBC criteria is less than _____, greater than ____ or More than ______ are ______.

A
  • Less Than 36 degrees C (96.8) and Greater than 38.3 degrees C (101).
  • Tachypnea (>/= 20/min)
  • Tachycardia (>/=90/Min)
  • WBC =4,000 or >/= 12,000 OR >10% wbc are immature
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6
Q

QUICK SEPSIS ORGAN FAILURE

ASSESSMENT - (Qsofa) what are the criteria for this assessment.

A

ALF

  • Altered mental status - (GCS <15)
  • Low BP (SBP=<100)
  • Fast RR (RR>=22)
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7
Q

DIC- A syndrome where _____ and _____occur as a result of an abnormal overstimulation of the normal coagulation process due to what 3 things?

A
  • Thrombosis (Clotting) and Hemorrhage

* Severe injury, illness, sepsis,

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8
Q

Major initiating factors of DIC are the release of _________ secondary to extensive injury to tissues, leading to more _____being produced. This causes extensive_____. Because all the _____ are being used, this can result in ______.

A
  • tissue factor (thromboplastin)
  • Fibrin
  • Clotting throughout capillaries
  • Clotting factors (Platelets)
  • Hemorrhage
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9
Q

The extensive formation of clots can lead to what three things?

A

*Ischemia, necrosis, organ damage.

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10
Q

First sign of DIC?

A
  • Bleeding/oozing blood

* Petechiae and ecchymoses can be seen as well.

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11
Q

Labs for diagnosing DIC:

  1. Platlets
  2. PT ?
  3. PTT ?
  4. Plasma fibrinogen?
  5. D-dimer levels and FDP?
A
  1. Thrombocytopenia (< 100,000)
  2. prolonged (due to consumption of coag factors)
  3. prolonged (due to consumption of coag factors)
  4. decreased(due to consumption of coag factors)
  5. Elevated (Fibrin being formed)
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12
Q

Treatment for DIC? 3 things.

A
  1. Underlying causes
  2. Replacement blood products
  3. Anticoagulants
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13
Q

A clinical syndrome characterized by the development of progressive physiologic dysfunction in 2 or more organs, or organ systems, that is induced by a variety of acute physiologic insults. What is this? where does this usually begin? What is key?

A
  • MODS - (progressive stage of shock)
  • Lungs, others follow
  • Prevention
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14
Q

SIRS + known or suspected infection

A

Sepsis

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15
Q

A hallmark sign and symptom found in ARDS is refractory _____. No improvement even when on _____.

A
  • refractory hypoxemia

* 100% oxygen

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16
Q

An Xray showing of ARDS would show what?

A

Dense pulmonary infiltrates on x-ray (“white-out”). Bilaterally.

17
Q

The most common cause of ARDS is ______? With this, the _____ Cells that are present with the inflammation travel to the lungs and damage the ______ _____membrane leading to fluid to leak in the ____ ___.

A
  • Sepsis
  • Immune cells
  • alveolar capillary
  • Alveolar Sacs
18
Q

Pulmonary edema in ARDS will be unrelated to _____. What is a way to determine this?

A
  • cardiac issues

* Pulmonary Artery wedge pressure Less than 18 and normal BNP

19
Q

5 characteristics of ARDS?

A

*Dyspnea
*Refractory hypoxemia
*Decreased pulmonary compliance
*Non-cardiac pulmonary edema
Dense pulmonary infiltrates on CXR

20
Q

What will CV look like in ARDS?

A
  • Tachycardia

* Dysrhythmias

21
Q

Two main goals of treatment for ARDS? Positioning?

A

Maintain oxygenation
• Improve alveolar ventilation
*Prone positioning

22
Q

ALWAYS _____ vasoactive medications. What is the MAP goal?

A
  • Titrate

* >65 w/ ALINE

23
Q

AVERAGE PRESSURE IN A PERSON’S

ARTERIES

A

MAP

24
Q

Transducer for an A-Line should be kept at the _____. Where is this located? What does this match?

A

*Phlebostatic Axis
*4th intercostal space – mid
anterior posterior diameter
*Right atrium

25
Q

3 sedatives used for ventilated patients? 2 paralytics? How do you assess these

A

Lorazepam (Ativan)
Midazolam (Versed)
Propofol (Diprivan)

vecuronium
pancuronium

Train of 4s

26
Q

Inotropic - Increase _______ and increase ______ on the heart. 4 of them?

A

*Cardiac output and O2 demands of heart

*MEDD
Milrinone 
Epi
Dobutamin
Dopamine
27
Q

After ET tube is in, what to do:
Check for ______ bilaterally.
Get an order for the initial _____ _____
____ prn (as per orders)
Soft_____ _____ is needed
Call for chest x-ray to _________ (if this is not ordered ask for it – it is a standard)
Provide emotional support as needed / ensure the family has been notifies of ________

A
  • Breath sounds bilaterally
  • Ventilator Settings
  • Sedation
  • Soft Wrist restraints
  • confirm position of ET tube.
  • Notify family of change in condition
28
Q

Ventilation setting offering maximum support

A

AC - Assist control

Can cause overload

29
Q

a mode whereby mandatory breaths are delivered at a set frequency, tidal volume, and inspiratory flow rate. However, the patient can breathe spontaneously between the machine-delivered breaths.

A

Intermittent Mandatory ventilation

*watch for hyperventilation

30
Q

is used when weaning patients from the ventilator

A

SIMV - synchronized mandatory ventilation

31
Q

is a constant level of positive inspiratory pressure that makes it easier for a patient to take a breath. Decreases work of what? When is this often added?

A
  • Pressure Support
  • Breathing through an artificial airway
  • The weaning process
32
Q

PEEP Provides positive pressure at the ____. What does this prevent? What does this improve? When can this be added?

A
  • end of expiration
  • Alveoli from collapsing
  • Oxygenation
  • Any ventilation setting.
33
Q

If the client is not oxygenating or appears in distress. 1st. _____. 2. _______ 3. remember this 4.
Confirm tube placement by?

A
  1. Bag the client
  2. Call for help
  3. When in distress do not assess
  4. listening for bilateral breath sounds.

N232 - FINAL EXAM (4 decks)

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