week 13: multiple interacting systems

Question 1

shock

Answer 1

condition during which the cardiovascular system fails to perfuse the tissues adequately; causes general and widespread impairment of cellular metabolism.

Question 2

common pathways in all types of shock

Answer 2

Impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients
Frequently coupled with an increased demand and consumption of oxygen and nutrients
Decreased removal of cellular waste products

Question 3

classes of shock

Answer 3

cardiogenic, neurogenic or vasogenic, anaphylactic, septic, hypovolemic

Question 4

shock cm

Answer 4

Weak, cold, hot, nauseated, dizzy, confused, afraid, thirsty, short of breath, and generally “feeling sick”
Decreased blood pressure, cardiac output, and urinary output
Increased respiratory rate

Question 5

shock tx

Answer 5

Oxygenation: Absolute necessity in all shock states
Correct or remove underlying cause
Provide supportive therapy

Question 6

cardiogenic shock causes

Answer 6

myocardial ischemia, myocardial infarction

Question 7

cardiogenic shock

Answer 7

Inability of the heart to pump adequate blood to tissues and end organs from any cause

Question 8

as cardiac output decreases compensatory adaptive responses are activated:

Answer 8

Renin-angiotensin, neurohormonal, and sympathetic nervous system.

Question 9

cardiogenic shock cm

Answer 9

Chest pain, dyspnea, and faintness, along with feelings of impending doom

Question 10

cardiogenic shock hallmarks

Answer 10

Tachycardia, tachypnea, hypotension, jugular venous distention, dysrhythmia, and low measured cardiac output

Question 11

cardiogenic shock tx

Answer 11

Intraaortic balloon counterpulsation (IABP) or percutaneous or ventricular assist devices (VADS)
Fibrinolytic therapies: To disintegrate coronary thrombus
Percutaneous interventions: Balloon angioplasty, stent placement, and thrombectomies
Surgery: Coronary artery bypass, ventriculoplasty, or heart transplantation
Cardiosupportive drug and fluid regimens
Continuous hemodynamic monitoring

Question 12

hypovolemic shock

Answer 12

insufficient intravascular fluid volume

Question 13

causes of hypovolemic shock include

Answer 13

hemorrhage, burns, emesis, diuresis, diaphoresis, diabetes

Question 14

what compensates hypovolemic shock

Answer 14

compensatory vasoconstriction, increased systemic vascular resistance

Question 15

hypovolemic shock clinical manifestations

Answer 15

poor skin turgor, thirst, oliguria
low systemic and pulmonary pressure
rapid heart rates

Question 16

hypovolemic shock tx

Answer 16

prompt control of hemorrhage

fluid replacement

Question 17

neurogenic shock

Answer 17

Widespread vasodilation occurs from an imbalance between parasympathetic and sympathetic stimulation.

Question 18

neurogenic shock causes persistent

Answer 18

vasodilation, and creates relative hypovolemia

Question 19

causes of neurogenic shock

Answer 19

trauma, severe pain and stress, anesthesia, and depressant drugs

Question 20

neurogenic shock clinical manifestations

Answer 20

very low SVR, bradycardia

Question 21

neurogenic shock tx

Answer 21

decrease pain level

Question 22

anaphylactic shock

Answer 22

outcome of widespread hypersensitivity to an allergen that triggers a reaction known as anaphylaxis

Question 23

widespread hypersensitivity rxn leads to

Answer 23

vasodilation, peripheral pooling, relative hypovolemia

Question 24

anaphylactic shock cm

Answer 24

Anxiety, difficulty breathing, gastrointestinal (GI) cramps, edema, hives (urticaria), sensations of burning or itching of the skin, fever, and hemolysis.

Question 25

anaphylactic shock tx

Answer 25

Begins with the removal of the antigen, if possible. Epinephrine: Decreases mast cell and basophil degranulation, causing vasoconstriction; reverses airway constriction. Intravenous (IV) volume expanders (lactated Ringer solution): Reverses relative hypovolemia. Antihistamines and steroids: Stops inflammatory reaction.

Question 26

septic shock most common infection sites

Answer 26

lungs, bloodstream, intravascular catheter, intraabdominal, urinary tract, and surgical wound.

Question 27

septic shock progression

Answer 27

systemic inflammatory response syndrome sepsis severe sepsis septic shock

Question 28

septic shock cm

Answer 28

Persistent low arterial pressure, low tissue perfusion, low SVR from vasodilation, and an alteration in oxygen extraction by all cells.

Question 29

septic shock tx

Answer 29

Check lactate level; obtain blood cultures; start antibiotic and vasopressor medications; implement fluid challenge; and achieve goals for blood pressure, central venous pressure, and central venous oxygen saturation.

Question 30

macule

Answer 30

flat circumscribed area that is a change in the colour of the skin less than 1cm diameter

Question 31

patch

Answer 31

flat, nonpalpable irregular shaped molecule more than 1cm diameter

Question 32

papule

Answer 32

an elevated, firm, circumscribed area less than 1cm

Question 33

plaque

Answer 33

elevated, firm, and rough lesion with flat top surface area greater than 1cm

Question 34

benign skin tumours

Answer 34

seborrheic keratosis actinic keratosis nevi

Question 35

malignant skin tumours

Answer 35

basal cell cercinoma squamous cell carcinoma malignant melanoma

Question 36

first degree burns

Answer 36

A.K.A. partial (superficial) thickness injury involving only epidermis Skin maintains water vapor and bacterial barrier functions

Question 37

first degree burns s&s

Answer 37

Local pain and erythema, no blisters for ~24hrs | Extensive burn may cause chills, headache, localized edema and N &

Question 38

superficial partial sickeness second degree burns

Answer 38

fluid-filled blisters appear immediately, pain due to exposures of nerve endings to air if blisters break open heal in 3-4 weeks if well nourished and no complications usually no scar (depends on skin type)

Question 39

deep partial thickness second degree burns

Answer 39

usually involves entire dermis (hair follicles are preserved) looks waxy white surrounded by superficial partial-thickness injury usually can’t distinguish between this burn and 3rd degree until day 7 when skin buds appear take weeks to heal tx. autograft lots of scarring potential for infection

Question 40

third degree burns

Answer 40

A.K.A. full thickness burns Destruction of entire epidermis, dermis & often underlying tissues (subcutaneous, muscle, bone) Elasticity of dermis is destroyed (dry, leathery appearance) Edema - distal circulation may be affected in areas of circumferential burns so... Escharotomies to relieve pressure - painless d/t destroyed nerve endings

Question 41

severity of burns is affected by

Answer 41

age, medical hx, extent and depth of injury, involved body area

Question 42

within several hours, capillar integrity is lost due to the release of

Answer 42

histamin and prostaglandin

Question 43

burns exceeding 20% TBSA are considered

Answer 43

major

Question 44

three main areas of burn patho

Answer 44

``` cardiovascular and systemic response cellular response - metabolic - immunologic evaporative water loss ```

Question 45

fluid passes from intravascular system to

Answer 45

interstitial system

Question 46

hallmark of burn shock

Answer 46

inadequate perfusion

Question 47

basal fluid replacements per day

Answer 47

1500ml/day/m2 body surface area = | 24 hour requirement

Question 48

evaporated water loss

Answer 48

(25 + % total body surface area burn) | X (2 m2 body surface area) = ml/hr

Question 49

total hourly maintenance fluids

Answer 49

basal fluid requirements per day / 24 hours + evaporated water loss per hour = ml/hr

Question 50

end point of burn shock

Answer 50

ndividual has adequate urine output for 2 hours + (30 ml/hr)

Question 51

cellular effects of burns

Answer 51

altered cell membrane permeability, loss of normal electrolyte homeostasis - contributes to shock Transmembrane changes also occur in undamaged cells

Question 52

immunologic response to burns

Answer 52

result is immunosuppression with inc. susceptibility to potentially fatal systemic burn wound sepsis Cytokines are identified in immed. postburn period which contribute to the immune response as well as healing Cortisol is released as a stress response which can increase risk for infection

Question 53

three elements of burns survival

Answer 53

meticulous wound management adequate fluids and nutrition earlier surgical excision and grafting

Question 54

burns dx and tx

Answer 54

``` Rule of Nines BUN, creatinine clearance urine output CBC, electrolytes Narcotics for pain relief Remove rings and jewelry ASAP O2 administration Hydration ```