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52 Cards in this Set
- Front
- Back
Cardiac output formula
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CO = HR X SV
Normal = 4.0 to 8.0 Liters/min |
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Left ventricle resistance to eject blood from heart
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SVR
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Reflects volume in R side of the heart
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Central Venous Pressure
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Volume of left side of heart
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Pulmonary Artery Pressure
PAS = systolic PAD = diastolic |
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Volume of filling of ventricle (heart stretch)
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Preload
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Resistance Left ventricle must overcome to circulate blood (as it contracts)
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Afterload
*increased in HTN, Vasoconstriction |
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Difference between systolic and diastolic BP
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Pulse Pressure
Norm = 30mm - 40mm |
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Average pressure which blood moves through the vasculature
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Mean Arterial Pressure
Norm = 70 - 105 mmHg |
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MAP Formula
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systolic + (diastolic X 2) / 3
*next to BP on monitor |
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Volume that leaves the heart when L ventricle contracts
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Stroke Volume
Normal = 70ml |
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Signs of Shock (decrease in Mean Arterial Pressure)
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Early
Compensatory Signs Progressive Signs Refractory Signs |
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Actual vs Relative Hypovolemic Shock
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Actual: blood or fluid leaving the body
• Intravascular volume deficit from an external source • Ex: hemorrhagic and dehydration Relative: the fluid is in the body but in the wrong place • Intravascular volume deficit secondary to fluid shift into the interstium • Ex: burns and ascites |
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Type of actual hypovolemic shock
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Hemorrhagic Shock
*acute loss of blood volume |
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Treatment of the 4 types of Hemorrhage
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• Class One
1. Less than 750ml’s blood loss 2. Normal vitals but anxious 3. Treat with crystalloids (LR and Normal Saline 0.9%NSS) • Class Two 1. 750-1500 ml’s blood loss 2. Heart rate high, BP normal delayed capillary refill, 20-30 bpm, 20-30 ml’s per hour urine output(decreased), still anxious 3. Treat with crystalloids • Class Three 1. 1500-2000 ml’s blood loss 2. Heart rate 121-140, BP low, delayed capillary refill, 30-40bpm, 5-15 ml’s urine output per hour(decreased) but now confused 3. Treat with crystalloids and blood • Class Four 1. >2000 ml’s blood loss 2. Heart rate>140, BP 50-60 > 35 bpm, scant to no urine output per hour, now lethargic 3. Treat with crystalloids and blood |
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Management of Hemorrage
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* control the source
* Restore O2 transport * Provide metabolic/nutritional support * Support individual organs/systems * Control pain |
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Management of Acute Hemorrage
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AirwayBreathingCirculationDisabilityExposure
• Give 02 to maintain pO2>80mmHg and O2 sats >94%; begin with 40% O2 via face mask • Use the modified trendelenburg position( lower the head of the bed 20 degrees) to increase circulation • Also can use pressurized suits such as PASG or MAST • Ensure adequate vascular access by 2 large bore IV’s and type and cross blood type |
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Indicated for anemia, O2 carrying capacity deficit, bleeding and surgery
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Blood Transfusions:
• 15 ml’s per every 15 mins usually to be given over no more than 4 hours • Usualliy if it goes ok for the first 15 mins things are ok • If a massive transfusion warm blood to prevent dysrhythmias and give platelets or fresh frozen plasma for every 10 units of RBC’s |
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Types of Transfusion Reactions
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Acute Hemolytic
Febrile Allergic Overload Sepsis |
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Types of blood components
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Packed red blood cells
• Increase O2 carrying capacity • 1 unit increases hemoglobin 1g and hematocrit 2-3% • Normal hemoglobin in 11-13% Whole blood • Contains everything Platelets: • Give when low or a massive bleed • Aides in clotting should be >10,000 Fresh Frozen Plasma • Gives coagulation factors Albumin • For volume expansion • A colloid so it draws fluid into the blood vessels • Human plasma that is heated Cryoprecipitate • Fibrinogen, factor 1-8 and von Wildebran factor Artificial Polyheme • May cause an MI because it increases blood viscosity |
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Blood transfusion procedures
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• Consent signed
• Determine pt’s allergies and previous transfusion reactions • Need orders *check dr’s order* • Educate the pt • Wash hands • check cross match with another nurse looking 4 ABO group, RH type, client’s name, hospital #, and expiration date * on blood bag & client’s ID * • administer immediately after receiving • don’t warm unless risk of hypothermic response (then only with specific blood warmer) • hang only with NSS * never add any meds to blood products* • infuse over NO MORE than 4 hours • take baseline vitals and 15 mins after • use an 18 gauge needle • change blood filter and tubing after every unit of blood • Severe reactions most likely first 15 mins & first 50 ccs |
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What do you do if transfusion reaction?
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STOP blood
*maintaine line with NSS *Should occur within the 1st 15 mins or 50cc’s *Change IV tubing *Treat shock if present with Epi O2 and fluids *Recheck cross match record with unit |
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Types of Transfusion reactions
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Acute Hemolytic
• most severe • causes cardiac arrest • caused by ABO incompatibility reaction, destroys RBC’s • s/s: fever, chills, flushing, tachycardia, hypotension, vascular collapse, low back pain • to determine if the patient has this a urine sample in needed to check for hemoglobin uremia Febrile • most common • a reaction to the antibodies in the donors WBC’s in the blood • more common in those who have had a previous blood transfusion • s/s: fever and chills w/o cardiac collapse • treat by giving washed RBC’s Allergic • mild reaction • sensitive to foreign proteins • s/s: hives, uticaria, fever, flushing • may treat with benedryl prior to prevent Volume Overload • too much preload • blood is a colloid so it draws fluid into the blood • give at a slower rate • give Lasix to help with fluid • s/s: pulmonary congestion, SOB, distended neck veins, railsm pink frothy sputum, restlessness, and hypertension • treat by increasing the head of bed, morphine administration, give 02 Bacteremia/sepsis • very rare • bacterial cont. blood • Infusion infection • Fever, chills, vomiting, diarrhea, shock • Treat with extra antibiotics, fluids, and vasopressors to increase the BP and send extra blood back to the lab |
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Transfusion Reaction with facial flushing, hives/rash/urticaria, pruritus, severe SOB, bronchospasm
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Allergic
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Transfusion Reaction with low back pain, hypotension, burning sensation along vein, fever & chills, chest pain, tachypnea, tachycardia, apprehension, hemoglobinuria, immediate onset
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Hemolytic
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Transfusion Reaction with chills, fever, h/a, flushing, nausea, vomiting, increased anxiety, tachycardia, tachypnea
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Febrile
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Do if suspected hemolytic reaction
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Obtain 2 blood samples distal to infusion site
Obtain first UA test for hemoglobinuria Give Mannitol with suspected renal involvement Monitor fluid/electrolyte balance Evaluate serum calcium levels |
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Types of Shock
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Hypovolemic
--actual --Relative Cardiogenic Distributive (circulatory) --Neurogenic --Septic --Anaphylactic |
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Type of Shock which is an antigen/antibody reaction
**and the sooner the symptoms appear the worse the reaction |
Anaphylactic Shock
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Types of Distributive (circulatory shock)
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Anaphylactic
Septic Neurogenic |
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Do to prepare for transfusion
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• Have Epi near
• O2 available • Plan to withdraw blood • Urine sample • Insert a foley |
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Type of Shock in which
All the volume is there but the heart can not pump it out Decreased stroke volume Pump failure is the cause not a problem in the vascularity |
Cardiogenic Shock
Ex: myocardial infarction, pericardial tamponade, and cardiomyopathies |
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S&S of Cardiogenic Shock
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• Crackles in lungs especially the bases
* Pink frothy sputum • Chest pain • S3 and s4 heart sounds (Extra Heart Sounds – Gallops) • Dysthrythmias • Decreased CO • Increased SVR |
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Treatment for Cardiogenic Shock
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Limit fluids
IV's at KVO - Fluids of choice low in sodium Drugs: • Inotropic agents: increase the force of contractions 1. Digoxin IV if levels are subtherapeutic; only push 2. Dobutamine IV drip • Preload and Afterload reducing agents 1. Diuretics such as Lasix (reduce preload) 2. IVP Morphine (decreases afterload) 3. Nitroglycerine drip (vasodilator) *may also treat with oxygen Temporary Mechanical Devices to treat with: Intra aortic ballon pump (IABP) • Cath with balloon inserted into aorta • Balloon inflates during LV diastole • Decreases LV afterload • Increases coronary artery perfusion VAD(ventricular assist device) • short term • external pumps may lead to coag problems |
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S&S of Anaphylactic Shock
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• uneasiness
• uticaria (1st sign) • hypotension • tachycardia • wheezing dyspnea • stridor • vomiting • incontinence * Edema of lips, tongur, periorbits |
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Treatment for Anaphylactic Shock:
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• remove source
• ephinephrine • airway open • teach family to avoid, carry epi pen and wear a medical alert bracelet |
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Shock that results from microorganism invasion
**most are gram negative |
Septic Shock
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S&S of Septic Shock
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Differential S/S:
• temp may be high or low • WBC’s > 12,000 or <4,000 with bands >10% • Increased urine output • N/V • Increased respiratory rate • Bounding pulses • Sweating In Hyperdynamic Phase S/S: • decreased BP or normal • decreased SVR • Increased CO In Hypodynamic Phase • Irreversible • Decreased BP • Increased SVR due to blood vessels clamp down to get blood to vital areas • Decreased CO |
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Treatment of Septic Shock
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• Identify the source by C&S’ing everything “PAN” culture
• Antibiotics • Vasopressors such as dopamine and norepinephrine (Levophed) to decrease the HR and increase BP • Also may give Xigis to prevent death from Severe Septic Shock |
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Septic Shock but unable to find cause
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Systemic imflamatory response
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Rare type of shock that results from acute loss of sympathetic tone, begins within minutes and can last for weeks
Etiology • Spinal cord injury above T6 • Spinal anesthesia • Drugs • Stress/pain |
Neurogenic Shock
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S&S of neurogenic shock
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• Decreased BP
• Decreased HR • Decreased CO • Decreased SVR • Poikilothermia: warm dry flushed skin d/t loss of tone (take temp of environment) • Usually hypothermic |
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Treatment for neurogenic shock
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• judicious use of fluids
• vasopressors to increase BP • Atropine IVP and maybe Isuprel IV drip to increase HR • Cautious ambient temp regulation |
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An abnormality of the circulatory system that results in inadequate cellular perfusion (BP not adequate to take O2 to organs)
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Shock
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Type of shock that causes decreased intravascular volume
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Hypovolemic
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Type of shock that causes decreased stroke volume (not a good cardiac output)
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Cardiogenic shock
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Type of shock that causes decreased Systemic Vascular Resistance (SVR) - vessels enlarging due to no resistance
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Distributive
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Types of Distributive Shock (some volume of blood but not enough to get it to body)
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Neurogenic
Septic Anaphylactic |
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Blood loss volume in classes of hemorrage
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Class I: <750mls
(crystalloid- LR or NSS) Class II: 750 - 1500mls (crystalloid) Class III: 1500 - 2000mls (crystalloid & blood) Class IV: >2000mls (crystalloid & blood (colloid)) |
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Blood types
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A+or-
B+or- AB+or- O+or- |
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What does + or - mean on blood type
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If the patient has the Rh antibodies or not
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Universal Donor
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O-
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Universal Recipient
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AB+
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