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44 Cards in this Set

  • Front
  • Back
Which of the following patient profiles can indicate that a patient with pancreatitis also has an active systemic inflammatory response
T35.4, P 90, R 26, WBC 8000
S I RS parameters include two of the following four
T<96.4F or >100.4; <36C or >38C;
RR >20;
P > 90;
WBC <4000 or >12000
Sepsis defn
SIRS +signs of infection
Severe sepsis
Sepsis +1 organ dysfunction
Septic shock
Severe sepsis + volume resistant hypotension. Volume resistance hypo tension in the presence of severe sepsis/SIRS. Vasopressors are required to sustain adequate BP
MODS
Dysfunction of two or more organ systems requiring medical intervention to maintain homeostasis
Vasodilation, vascular permeability, cellular activation and adhesion, and coagulation occur as part of the immune response due to
Activation of mediators
Laboratory values associated with hepatobiliary dysfunction in MODS include increased
Liver enzymes and bilirubin
An increase in patients are O2 demand can be caused by
Bathing and weighing the patient. Routine nursing activities will cause an increase in the metabolic oxygen demands of the pt.
Most common cause of DIC
Endotoxin's from sepsis
DIC etiology
Endotoxin from sepsis. Metabolic acidosis. Hypoperfusion with shock. Massive trauma. Burns. Abruptio placenta, retained placenta, or retain fetus.
Lab values for DIC
Platelet count <50, or 50% drop from norm. PT >12.5. PTT/aPTTT >40 seconds. Fibrinogen <100. FSP/FTP >40. Ddimer >250
That illegal street drug most commonly encountered in the emergency department
Cocaine
Death from acetaminophen overdose is usually as a result of
Hepatic failure
Patients with an overdose of tricyclic antidepressant may show signs of
Seizures, heart failure, shock
Primary MODS
Occurs as a direct result of injury to an organ or organs system and any resuscitation measures
In the patient with MODS, adequate pain control
Improves tissue perfusion and oxygenation
Use of the Gut for nutrition is important for the critically ill patient to
Prevent bacterial translocation to the pulmonary system
Mediator activation in SIRSresults in
Vasodilation, increased vascular permeability, cell activation with adhesions to vessel walls, increased coagulation.
Cascade of organ dysfunction in secondary MODS starts with and goes to
Lungs-ARDS, G.I., CV, liver, renal failure, CNS, hematological dysfunction
The release of biochemical and cellular mediators damages the endothelium of the pulmonary vasculature resulting in increased vascular permeability which contributes to the development of surfactant deficiency, pulmonary hypertension and non-cardiogenic pulmonary edema
True
Primary cardiovascular response to MODS during hyper dynamic phase
Decreased SVR with increased CO. Relative hypovolemia. Tachycardia with hypotension. Decrease our RAP and PAOP
Neurogenic shock may result from
Spinal cord injury above T6. High levels of spinal anesthesia. Pain
Interventions for treating hypovolemic shock may include all of the following except
Chest x-ray
In MODS, cytokines act on the vascular endothelial lining to produce a prothrombotic state
True
Which of the following patient profiles suggests that patient has adequate hemodynamics to support tissue perfusion
Map 70, cVP 12, PAWP 14, CI 2.8 L
Nursing interventions to control sources of infection and the patient with MODS include
Frequent oral care and position changes
The hyper dynamic phase of the cardiovascular response to MODS includes
mAP 60, CVP 5, PAOP 8, CI 2.8 L
Patients with MO DS with renal involvement may present with the following signs
Pulmonary edema, urinary output less than 0.5 ML/KG/HR, fluid overload, All the above.
The cascade of organ dysfunction and secondary MODS usually starts with the lungs, and exhibits as acute respiratory distress syndrome or ARDS
True
Which patient profile suggests that the patient has adequate hemodynamics to support tissue perfusion
Decreased SVR with increased cardiac output
Circulation and perfusion of the – is selectively decreased during low flow states to preserve perfusion of the major organ systems
Splanchnic bed
Patients with MODSmay have blood glass analysis that reflects
Early respiratory alkalosis, hypoxemia, progressing to metabolic acidosis
Gastrointestinal dysfunction in MODS can be evidenced by
And ileus and increase stool bacteria count
The cardiovascular system initially responds to MODS by
Decreasing SVR
The evidence based vasoppressors used within the first six hours of sepsis therapy are
Dopamine and norepinephrine
Mediator activation in SIRS results in which four mechanisms of inflammatory response
Vasodilation, increased vascular permeability, cell activation with adhesions to vessel walls, increased coagulation
The typical sequela in organ dysfunction in MODS is
Pulmonary, G.I., cardiac, hepatic, and/or renal
The distinguishing feature of systemic inflammatory response syndrome is severe and infection
False
Which of the following best describes the purpose of inflammation in the body
It brings immune cells and nutrients to the injured area
Central nervous system symptoms of alcohol overdose me.
Seizure
All the following are true about the initial stage of shock except which statement. Tissue perfusion is inadequate. Cardiac output is increased. Lactic acid levels begin to increase. A decreased cardiac output can lead to cell damage
Cardiac output is increased
During the compensatory phase of shock, the compensatory mechanisms are activated and attempt to return the cells to a pre-shock state. Which of the following organ systems control the compensatory mechanism
Endocrine system and neurologic System
To compensate for cellular acidosis caused by shock, chemo receptors in the brainstem stimulate an increase in the rate and depth of respirations. This leads to a
Decrease in PaCO2 and respiratory alkalosis