Medsurge quiz 2

What are the four types of shock and how do they happen?

•Distributive shock

•A result of a decreased systemic vascular resistance (SVR) and perfusion.

•Hypovolemic shock

•A result of loss of 25-30% of circulating blood volume.

•Cardiogenic shock

•Systemic hypoperfusion as a result of decreased cardiac output.

•Obstructive shock:

•Occurs when blood flow is blocked disrupting circulation to the major arteries.

What are the 4 subcategories of distributive shock?

•Septic shock

•Occurs as a result of the release of inflammatory cytokines which cause damage to the internal layer of blood vessels and initiates clotting mechanisms.

•Anaphylactic shock

•Occurs in response to severe hypersensitivity to an allergen (food, medication, bee sting etc.) mediated by IgE increasing vascular permeability and vasodilation and a decreased SVR..

•Neurogenic shock

•Occurs due to autonomic dysregulation caused by a spinal cord injury above the level of T6.

•Toxic shock

•Involves infection from Staphylococcus aureus causing excessive activation of cytokines and inflammatory cells.

What are the stages of shock?

•Initial Stage

•Too little oxygen in the blood to feed organs body switches from aerobic to anerobic metabolism

•Increased lactic acid

•Compensatory Stage

•Aldosterone released to maintain BP

•Vasoconstriction to shunt blood to vital organs

•Increased HR

•Sympathetic nervous system releases catecholamines to compensate for low oxygen.

•Progressive Stage

•Oliguria

•Altered level of consciousness

•Pallor, cool clammy skin

•Electrolyte imbalance

•Hypotension

•Refractory Stage

•Irreversible cellular and organ failure and Impending death

What are the signs of shock in each stage?

•Initial

•Subtle clinical manifestations

•Pale skin

•Client reports feeling unwell or anxious

•Compensatory

•Sympathetic nervous system is activated

•Tachycardia

•Tachypnea

•Decreased peripheral pulses

•BP may remain stable or fluctuate

•Increased capillary refill time

•Progressive

•Client’s condition deteriorates

•Altered level of consciousness

•Weak pulses

•Skin pale or ashen

•Increased capillary refill time

•Oliguria or anuria

•Refractory

•Death is imminent

•Client comatose

•Hypotension not responsive to vasopressors

•Renal failure resulting in anuria

•Respiratory failure despite oxygen therapy

What is Cardiac Tamponade and the stages of it?

•An accumulation of fluid around the heart

•3 Phases

•Phase 1: accumulated fluid in the pericardial space, ventricles harden and cannot relax

•Phase 2: CO is decreased due to SVP not filling the heart

•Phase 3: Decreased CO to the point of circulatory failure

How does cardiac tamponade begin?

Cardiac tamponade begins with a rapid accumulation of 200-300 mL of fluid around the heart

If the accumulation of fluid is slow, the client may not present with manifestations until a high volume is reached and produce hemodynamic changes. If the fluid accumulation occurs quickly, the client will not be able to tolerate the condition and will go into cardiac arrest.

What is Beck’s Triad?

Hypotension, JVD, and Muffled heart sounds.

What is Pulsus Paradoxus?

•Fall of systolic blood pressure by greater than 10 mm Hg during inspiration

In pulsus paradoxus the Korotkoff sounds disappear with inspiration and return with expiration.

How are Pulsus Paradoxus and cardiac tamponade related?

Pulsus paradoxus can indicate that a pericardial effusion is the cause of the cardiac tamponade

What is the best way to diagnose Cardiac Tamponade?

The echocardiogram is the best method to diagnose cardiac tamponade This can both confirm a pericardial effusion and determine the size of the effusion.

ECG and Chest x-ray only show one of these

What are some treatments for Cardiac Tamponade?

•Position client in bed with feet elevated

•Provide oxygen

•Volume resuscitation

•Vasopressors

•Pericardiocentesis

•Surgery- pericardial window

What is a CABG?

CABG is a procedure that restores blood flow to the heart muscle caused by narrowing of the coronary arteries.Plaque (calcium and fatty deposits) clog the arteries restricting blood flow to the heart.

Restricted blood flow causes angina or chest pain.

What happens during a CABG?

During CABG surgery blood vessels are taken from a vein in the leg, chest, or arm and grafted onto a section of the aorta and an area distal to the coronary artery blockage. The graft opens the artery to allow a clear blood flow to the heart muscle. Many times multiple graphs are used if there are multiple blockages.

What is a Valve Replacement?

Valve replacement is done when a heart valve is no longer working properly. Valves allow the blood flow to pass to and from each chamber efficiently.

The most commonly replaced valves are aortic and mitral valves

What is the most common test to diagnose valvular heart disease?

An Echocardiogram

What treatment is the least invasive to remove a damaged aortic valve?

TAVR is a minimally invasive option to removed the damaged aortic valve. The other option is open heart surgery

What is Cardiopulmonary arrest?

An electrical malfunction within the heart and a sudden cessation of cardiac function, death can occur within minutes.

What Rhythms are shockable?

V-fib, V-tachycardia

What rhythms are not shockable?

Cardiac Asystole and Pulseless electrical activity

During shock how much fluid resuscitation should be done and for how long

30mL/kg during the first 3 hours

How many forms of V-tachycardia are there and what happens during them?

Sustained: V-tachycardia lasts longer than 30 seconds

Nonsustained: V-tachycardia is intermittent and only lasts a few seconds

What interventions should be done ASAP during cardiac arrest?

CPR and defibrillation

What is the LEAN mneumonic

It is the medication in order to be used during cardiopulmonary arrest

•L – Lidocaine

•E – Epinephrine

•A – Atropine

•N – Narcan

What is AAA and how does it occur?

AAA is a dilation of the aorta greater than 30 mm in diameter. If the diameter is greater than 55 mm, it is considered large and requires urgent treatment.

AAA occurs when the aorta wall is weakened and thinning of the media and adventitia occur due to the loss of vascular smooth muscle. If the pressure of the blood exceeds the wall strength, then the risk of rupture increases.

Is a ruptured AAA important?

Yes, A ruptured AAA is a life-threatening even, requiring immediate medical and surgical intervention. Very high mortality rate (greater than 90%)

What are signs of bleeding from a ruptured AAA

Cullen’s sign: umbilical ecchymosis (is a bluish or purplish discoloration around the belly button)

Turner’s sign: flank ecchymosis (bruising on the flanks sides between ribs and hips)

What is EVAR and how does it help with AAA?

Endovascular Aneurysm Repair (EVAR

EVAR is the insertion of a bifurcated graft, which is divided into 2 branches via the femoral and iliac arteries, then the graft is attached with stents at the normal aorta at the level of the renal and iliac arterial walls. The graft is covered to protect it from the intestines.

What is SIRS and how does it happen?

Systemic Inflammatory Response Syndrome is caused by tissue injury or infection, it can cause inadequate perfusion and organ failure.

What does SIRS look like?

•Body temperature: less than 36° C or greater than 38° C

•Heart rate: greater than 90 bpm

•Tachypnea: greater than 20 bpm or PaCO₂ less than 32 mm Hg

•WBC: less than 4,000/mm³ or greater than 12,000/mm³ or greater than 10% immature (band) forms

How is SIRS treated?

wound debrideent, abscess drainage.

what is MODS and why is it deadly?

Multiple Organ Dysfunction Syndrome: An extreme response after injury, sepsis or burns that leads to the constant release of immune mediators in the blood causing altered organ function and failure

What labs are done for MODS

SOFA Score: assesses the performance of several organ systems in the body and assigns a score based on the data obtained in each category. The higher the SOFA score, the higher the likelihood of mortality

What is DIC?

A condition in which the blood clots throughout the body, blocking small blood vessels, leading to organ failure.

DIC is a hypercoagulable state in the body. Thrombosis and hemorrhage occur at the same time.

Leaking of heparin into the tissue can cause compartment syndome.

What is TACO and what can occur from it?

Transfusion-associated circulatory overload (TACO) can occur when there is too much fluid or circulatory overload resulting in pulmonary edema.

What are signs of DIC

•Bleeding around wounds, at surgical sites, and venipuncture sites

•Ecchymosis

•Hematoma

•Petechiae

•Tissue necrosis

•Dyspnea

•Epistaxis

•Conjunctival bleeding

What are some labs for DIC?

•PT/PTT (increased)

•D-Dimer (increased)

•Fibrinogen (decreased)

•Platelet count (decreased)

What are treatments for DIC?

•Fresh frozen plasma

•Whole blood

•Anticoagulants

•IV Fluids