Semester 4 - Exam 3 !!!! > Blend - (In progress) > Flashcards

Blend - (In progress) Flashcards

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1
Q

What is the 1 hr Sepsis Bundle?

A

1 ) Measure lactate levels & remeasure if initial lvl elevated > 2
2) Obtain blood cultures prior to Abx admin
3) Admin bread spectrum Abx
4) Rapid fluid administration 30ml/kg for hypotension or lactate > 4
5 Apply vasopressors if still hypo to maintain MAP > 65 mm Hg

If these interventions are not working, patient is in Septic Shock

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2
Q

Why does lactic acid increase so rapidly in sepsis?

A

Due to hypermetabolic state.
Will aso be due to respiratory alkalosis due to increased RR (important to assess ABG’s)

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3
Q

S/S specific to Septic shock are ;

A

Full bounding pulses
Pink, warm flushed skin
Fever
Tachypnea

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4
Q

S/S specific to Anaphylactic shock are:

A

Cough
Dyspnea
Pruritus
Urticaria
Restlessness
Decreased LOC

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5
Q

S/S specific to Neurogenic shock are:

A

Bradycardia
Syncope
Warm DRY skin
Venous and Arterial dilation
Loss of sympathetic tone

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6
Q

S/S specific to Cardiogenic shock?

A

Weak thready pulse
Crackles, tachypnea

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7
Q

We see hypotension w/ bradycardia in what type of shock?

A

Neurogenic shock

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8
Q

We see dry and warm skin in which type of shock?

A

Neurogenic shock

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9
Q

How do we prevent SIDS?

A
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10
Q

In neurogenic shock there is an imbalance between which two systems?

A

SNS and PSNS

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11
Q

What is a cytokine strom?

A

Severe uncontrolled immune responses where there in an excessive release of cytokines which causes widespread damage and organ failure.

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12
Q

What does a cytokine storm cause?

A

Increased capillary permeability
Vasodilation
Coagulation abnormalities
Tissue damage.

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13
Q

Pooling of blood int he periphery, as seen in distributive shock, causes :

A

Decreased venous return
Decreased stroke volume
Decreased Co which leads to decreased BP and decreased perfusion.

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14
Q

With distributive shock, which compensatory mechanism of the body is lost?

A

Loss of sympathetic tone

distributive shock can also be caused by the release of biochemical mediators released by the cells = vasodilation

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15
Q

Decreased stroke volume and decreased CO associated w/ cardiogenic shock will cause :

A

Pulmonary congestion
Decreased systemic tissue perfusion
Decreased CAD perfusion which will continue to damage the heart (ischemia)

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16
Q

What are non-coronary causes for cardiogenic shock?

A

Conditions that stress the myocardium such as :
Severe hypoxemia
Acidosis
Hypoglyceia
Hypocalcemia
Tension pneumothorax

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17
Q

What type of MI increases the risk of cardiogenic shock?

A

Anterior wall MI

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18
Q

A drop of >2 points from a patient’s baseline on the SOFA score indicate what?

A

Organ dysfunction

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19
Q

What is the target HR for HF patients?

A

<130/80 mm HG

We want to give antiHTN meds to prevent progression in asymptomatic patient sand improve the morbidity in symptomatic patients.

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20
Q

Causes of pericardial effusion :

A

Advanced HF
Pericarditis
metastatic carcinoma
Cardiac surgery
Trauma

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21
Q

Hallmark signs of a cardiac tamponade :

A

Fallin SBP
Narrowing pulse pressure (pulsus paradoxes)
Increased CVP
Distant heart sounds

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22
Q

What are early signs of L. Ventricular failure?

A

Patient cannot clear fluid/crackles in lungs iwht a cough. Eventually the entire lung will be affected .

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23
Q

Decreased pulse pressure, S3 sound and ventricular gallop are signs of :

A

L. sided HF

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24
Q

Wha treatment for asymptomatic SVT?

A

Synchronized cardioversion
Adenosine

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25
What usually causes SVT?
Emotional or physical stress - often suddenly Energy drinks Sleep deprivation Excess caffeine Treat underlying Vagal maneuver Adenosine CC & Beta Blockers
26
How do we treat 3rd degree heart block?
Pacemaker Transcutaneous pacing
27
If Mobitz II leads to severe bradycardia & reduced CO, what's our intervention?
Pacemaker
28
Pulmonary artery pressure monitoring help assess:
Information on the condition of the heart. Filling pressure Etiology of shock Left ventricular function and filling PAWP Pulmonary artery HTN PA catheter = Preload + Pump + Pressure”
29
A CVP of less than 2 mm HG indicate :
Decreased ventricular preload - Hypovolemia Causes : dehydration, excessive blood loss, vomiting, diarrhea, overdiuresis
30
A CVP of more than 6 mm HG indicate :
Elevated right ventricular preload - Hypervolemia Causes : right sided HF, excessive fluid circulating in the body
31
Normal CVP range:
2-6 mm HG
32
What does CVP measure ?
Pressure in R. atrium or Vena Cava
33
Abnormal finding on a exercise stress test:
Chest pain Arrythmias ST segment depression Lack of HR BP elevation
34
Increased lvls of homocysteine indicated increased risk of what?
↑ CAD ↑ Stroke ↑ Peripheral vascular disease ↑ Thrombus
35
C - reactive protein (CRP) Lab indicate > 3 mg/L, what is the patient at risk for?
Increased C reactive protein indicate systemic inflammation - not cardiac specific, however a lab level of > 3 mg/L, indicate increased risk of CV disease
36
BNP Lab indicate > 100, what does this indicate?
HF
37
Creatine Kinase Troponin Myoglobin are examples of what?
Cardiac biomarkers Released when cardiac cells become necrotic and are carried into circulation, Usually caused by ischemia or trauma
38
Cardiac Ablation used to treat :
A-fib A-flutter PVC Some types of SVT.
39
What are causes of secondary pulsesless activity?
Blood loss Low BP Low oxygen Dehydration Electrolyte problems Heart attack Pulmonary embolism Hypothermia Trauma Toxic effect
40
Explain what PEA is.
Electrical system of the heart is working but heart is not pumping, there is no contraction or there is no blood.
41
Long term VT tx w/ EF >35%
Antiarrhythmic - amiodarone # 1 choice
42
Long term VT tx w/ EF <35%
ICD
43
Pulseless VT treatment:
CPR, Defibrillation, EPI, Amiodarone
44
Symptomatic VT treatment :
Synchronized cardioversion
45
QRS > 0.12 sec indicate a :
PVC
46
3 PVS's in a row is considered :
V-tach
47
Prolongation of the PR interval indicate what?
1st degree heart block >0.2 sec - constant
48
Treatment for premature atrial contraction :
Treat underlying e.g reduce caffeine, correct hypokalemia More than 6 per minmay indicate worsening disease state such as a-fib
49
Which rhythm is irregular due to an early P wave?
PAC One PP interval will be shorter than the others
50
The atrial rate is higher in a-flutter or a-fib?
Higher in a-fib : 300-600 bpm a-flutter 250-400 bpm
51
Treatment for A-flutter:
Adenosine trial Synchronized cardioversion Ablation
52
Unstable tachycardia tx:
Synchronized cardioversion
53
Unstable bradycardia usually due to :
Hypoxemia
54
Prolonged QT interval increased the risk for :
Dangerous arrythmia's, esp Torsade's de Pointes Often due to hypokalemia & hypomagnesemia
55
Normal QT interval duration :
0.32-0.40 sec
56
What does ST segment depression indicate?
Myocardial ischemia (angine), not a full infarction Heart muscle isn't getting enough O2
57
QRS complex normal duration :
Usually <0.12 sec in duration
58
What increases the risk of thromboembolism's in patients w/ HF?
↓ mobility ↓ circulation
59
Hepatomegaly is associate with :
Right sided HF
60
What type of HF activates the SNs and the RAAS
LEft sided HF
61
Left sided heart catheterization is used to evaluate what?
Aortic arch and major branches Patency of coronary arteria Function of left ventricle and mitral and aortic valve Usually done through femoral artery Involves contrast dye
62
Right sided heart catheterization is used to evaluate what?
Cardiac biopsy to evaluate cardiomyopathy or transplant rejection Measure pulmonary artery pressure Function of right ventricle and pulmonary artery valve.
63
What lab values to keep an eye out for DIC?
↑ d-dimer ↑ Pt & aptt ↓ fibrogen Platelet count We treat underlying disorder
64
What is the first signs that a patient is developing HIT?
Low platelets → thrombocytopenia Antibodies destroy heparin platelet complex and all platelets are consumed which leads to clotting and thrombus formation
65
What do we treat HIT with?
Argatroban
66
Patients w/ sickle cell disease are at an ↑ risk of what?
Stroke Damaged spleen lung infection Anemia → tachy → HF Kidney injury Skin Ulcers ! Infarction of the eyes → blindness Priapism → impotence Bone pain
67
Patients w/ celiac disease cannot absorb what?
Folate
68
what blood work will we do to diagnose Lupus?
+ antinuclear antibody (ANA) Anti DNA test CBC
69
Gangrene can happen in which condition ?
DIC
70
What is Pancytopenia?
Decrease in all 3 major blood cells usually caused by bone marrow issues, Aplastic anemia
71
What are over the counter herbal supplements that may impair platelet function?
Gingko Bilboa Ginseng Saw Palmetto Vitamin C Vitamin E
72
What type of food can impair platelet function?
Caffeine ETOH Fish oil Garlic Ginger Grape Juice
73
ITP patients may be on long term ________________ treatment and may experience complications such as :
Corticosteroid Osteoporosis Cataract formation Dental caries
74
Patients who had a splenectomy must receive what type of vaccination ?
Pneumococcal, influenza and meningococcal vaccination
75
What disease leads to platelet DESTRUCTION?
ITP Splenectomy may be needed to treat
76
What disease causes platelet CONSUMPTION?
DIC other causes : major bleeding, severe pulmonary embolism
77
A hypercellular bone marrow may lead to what disorder?
Polycythemia Vera Labs will show : ↑ Erythrocytes ↑ Leukocytes ↑ Platelets
78
what are S/S of Polycythemia Vera?
Neuro : HA, Dizziness, Vision changes Abdominal : Early satiety, ab.discomfort/pain CV: ruddy complexion, angina claudication, dyspnea, HTN, Skin : Pruritus Fatigue & night sweats
79
Megaloblastic anemia is associated with :
Folate and vitamin B12 deficiency this deficiency also affect neuro
80
Labs showing ↑ Erythropoietin indicate what?
Anemia
81
Labs showing ↓ Haptoglobin lvls indicate what?
Hemolytic anemia
82
High reticulocyte count of labs indicate what?
RBC destruction (hemolytic anemia)
83
Smooth red tongue indicate what?
Iron deficiency anemia Other signs : brittle & ridged nails and angular chelosis
84
Splenomegaly, Hepatomegaly and lymphadenopathy may be caused by what?
Hemolytic anemia
85
Why is aplastic anemia so dangerous?
All blood cells and platelets are affected This increases Bleeding and infection risks
86
Which medication is given to treat aplastic anemia?
Antithymocyte globulin (ATG) Cyclosporine Filgrastim PRBCs → for anemia Platelets → for thrombocytopenia Bone marrow transplant
87
Secondary ITP caused by :
RA, Lupus
88
Primary ITP caused by :
Aquired immune disorder
89
What is Hypochromia?
Low Hgb in RBC's often seen in Thalassemia
90
Medical management of DIC :
Treat underlying Correct ischemia : ↑ tissue oxygenation Replace fluids, correct electrolyte & admin vasopressors Cryptoprecipate to replace fibrogen
91
What does Aminocaproic Acid do?
Prevents clots from breaking down - why often given in coagulation disorders.
92
True / False For ITP we can start platelet transfusion as therapy.
False - body will destroy transfused platelets
93
What causes acquired primary ITP?
The body creates autoantibodies (IgG) against platelets These antibodies mark platelets for destruction in the spleen 👉 Result: low platelets (thrombocytopenia) → bleeding risk No clear cause 👉 Happens spontaneously Often follows: Viral illness (flu, HIV, HEP C, H. Pylori) Immune system gets “confused” and attacks platelets
94
Patients with what condition should avoid sun exposure?
Lupus, prevent rashes
95
Medical Tx for Lupus?
Monoclonal antibodies Corticosteroids Antimalaria agents NSAIDs
96
Antioxidants are often given to relieve pain in patients with what condition?
Chronic Pancreatitis
97
In patients w/ acute pancreatitis, why should we have calcium gluconate readily available?
To prevent or treat tetany which may result from calcium loss into the peritoneal cavity
98
If patients w/ acute pancreatitis don't respond to conventional tx, how do we combat the increased risk of shock?
* Admin corticosteroids * Evaluate amount of urine output Excess fluid loss and toxins from bacteria of a necrotic pancreas may lead to shock
99
Which medications used in acute pancreatitis?
Cimetidine - to decrease pancreatic activity and inhibit secretion of gastric acids Pantoprazole - when the use of cimetidine is not possible
100
Hep E is most severe in :
Pregnant women
101
What amount of protein per day should patients w/ Hepatic Encephalopathy consume / receive ?
1.2-1.5 g/kg/day
102
Semester 4 - Exam 3 !!!!
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