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shock?
widespread serious reduction of tissue perfusion (lack of O2 and nutrients
prolonged=impaired cellular functioning
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who's at risk for shock?
- very young, very old
- post MI
- severe dysrythmia
- adrenocortical dysfunction
- recent hemorrhage/blood loss
- burn pts
- massive infection
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early signs of shock?
- agitation
- restlessness
- from cerebral hypoxia
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Hypovolemic Shock
most common
related to internal or external blood or fluid loss
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cardiogenic shock
- related to ischemia or impairment in tissue perfusion bc of:
- MI
- HFailure
- serious arrythmia
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how does distributive shock occur?
- excessive vasodilation
- impaired distribution of blood flow
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Three types of distributive shock?
- Septic
- Anaphylactic
- Neurogenic
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What happens with Anaphylactic shock?
- (Allergen)
- respiratory stress bc of bronchial constriction leading to airway obstruction
- could lead to vascular collapse
acute or life threatening
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Neurogenic Shock?
- (injury)
- loss of vasomotor tone and sympathetic innervation of the heart causes injury to descending sympathetic pathways in the spinal cord
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Septic Shock
- Endotoxins released by bacteria cause:
- vascular pooling
- diminished venous return
- reduced cardiac output
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What is obstructive shock?
- tamponade
- emboli
- or compartment syndrome leads to physical obstruction=impedes filling or outflow=reduced cardiac output
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what can all types of shock lead to?
- SIRS-Systemic Inflammatory Response Syndrome
- MODS - Multiple Organ Dysfunction Syndrome
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what do you do when cardiogenic shock exists with pulmonary edema? (from pump failure)
High Fowler w legs down (to reduce venous return)
decreases further venous return to the left ventricle.
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List five assessment findings that occur in most shock victims
- Tachycardia
- tachypnea,
- hypotension
- cool clamy skin
- decreased in urinary output
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If a client is in cardiogenic shock, what might result from administration of volume-expanding fluids,
what intervention can the nurse expect to perform in the event of such an occurences?
- Pulmonary edema;
- admin cardiotonic drugs such as digitalis preps
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differentiate btwn hypovolemic and cardiogenic shock. How might the nurse determine the existence of cardiogenic shock?
- History of MI with lt ventricular failure
- or possible cardiomyopathy with symptoms of pulmonary edema
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minimum renal output per hour?
30 ml/hr
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List four measurable criteria that are expected of shock crisis.
- BP mean of 80 to 90;
- PO2 >50;
- CVP above 6 cm of H2O;
- urine output less than 30ml/hr
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What is DIC?
- Disseminated Intravascular Coagulation-
- coagulation disorder w paradoxical thrombosis and hemorrhage
Treat with Heparin
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DIC is an acute complication of what?
- hypotension
- septicemia
- (suspected when blood is oozing from 2+ unexpected sites
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Mean arterial pressure
level of pressure in the central arterial bed
- measured indirectly by BP measurement
- measured directly thru arterial catheter insertion
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Cardiac Output= CO
Volume of blood ejected by the left ventricle per unit of time
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stroke volume
Amount of blood ejected per beat x heart rate
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central venous pressure= CVP
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Diagnosis of DIC
- Prothrombin time- prolonged;
- partial thromboplastin time- prolonged;
- fibrinogen-decreased
- platelet coun- decreased;
- fibrin degradation (spilt) products increased
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T-wave
repolarization of ventricle
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intra aortic balloon pump
balloon pump machine to assist heart to pump blood
balloon goes into femoral artery and inflates when heart relaxes-deflates just before systole to send blood into circulation
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Intermittent claudification
most prominent symptom of PAD (peripheral artery disease)(atherosclerosis that interferes with blood flow)
pain due to insufficient blood flow
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cholelithiasis
gallbladder stones
Ca and Cholesterol cause crystals in mucosal lining of gallbladder
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Cholelithiasis causes
- obesity
- oral contraceptives
- cirrhosis
- family history
- Crohn's hyperlipidemia
- DM
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salivary amylase
- Salivary glands
- secreted into GI tract
- digests starch and glycogen
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Volume of blood ejected by
the left ventricle per unit of time
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Amount of blood ejected per
beat x heart rate
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central
venous pressure= CVP
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Diagnosis
of DIC
- Prothrombin time-prolonged;
- partial thromboplastin time- prolonged;
- fibrinogen-decreased
- platelet coun- decreased;
- fibrin degradation (spilt) products increased
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T-wave
repolarization of ventricle
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tissue plasminogen activator
- 1. tissue
- plasminogen activator
- converts plasminogen to
- plasmin which digests the fibrin strands in order to dissolve clots
sourced from liver, plasma, and vascular endothelium
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normal
platelet levels
151,000-400,000
<100,000 concern of severe bleeding
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AV node rate
40-60 min
in lower half of atrial septum gets impulses from SA node
if SA nodes ceases-automaticity foci will start pacemaking
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cardiac
tamponade
- accumulation of fluid in
- pericardial cavity=restricts ventricular filling and cardiac output drops
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acute tamponade
small amount of fluid accumulation
20-50ml
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congestive
heart failure CHF
- heart is unable to pump
- it's own volume
- tachycardia cyanosis
- tachypnea
- profuse sweating
- edema - sudden weight gain
- enlarged liver
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ST segment Post MI
- after an MI, ST Elevation
- is elevated telling us that there is a block of blood flow to the myocardium
- st elevation = block or infarct
- st segment = early ventricular repolarization
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which enzyme is measured for suspected pancreatitis?
- Amylase - high in pancreatitis
- serum and urine levels peak after 4-8 hrs of onset of acute pancreatitis
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Three types of stomach polyps
masses of cells that form on the inside lining of your stomach
- Hyperplastic
- Fundic Gland
- Adenomas
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Hyperplastic Polyps
form as rx to chronic inflammation (gastritis)
unlikely to become cancerous unless bigger than 3/4 inch (2cm)
associated w H. Pylori
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Fundic Gland Polyps
- form in glandular cells in lining of stomach
- in people with rare inherited syndrome -familial adenomatous polyposis
- can become cancerous
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Ademonas
- least common stomach polyp-but most likely to become stomach cancer
- form on glandular cells inside stomach lining
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Pancreatitis
inflammation of pancreas
- cause by:
- Alcoholism
- high triglycerides
- hypercalcemia
- biliary
- infection
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Hyperosmolar Hyperglycemic State
(nonketotic syndrome)
- Hyperglycemia BGL >600
- Hyperosmolarity Plasma osmolarity (>310)
- dehydration
- abscence of ketoacidosis
- depression of the sensorium
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exophthalmos
bulging of the eye out of the orbit "proptosis"
bilateral (graves disease)
- unilateral (orbital tumor)
- eyelids fail to close
- dryness or damage
- redness or irritation
- blindness
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Which disorder causes bronzing of the skin in 90% of cases?
Addison's
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General Adaptation Syndrome
- Enlarged adrenal cortex
- thymus gland atrophy
- peptic/duodenal ulcers
Hans Selye "stress is multifactorial and has a universal, non-specific stress response"
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