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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
shockA state of inadequate tissue perfusion, transition between hemostasis and death
what would you expect the pulse of a patient with acute hemorrhagic, distributive or occlusive shock to be ?weak and slow
what is the first step for hemorrhage management ?Direct pressure
what is the second step for hemorrhage managementElevation
what is the third step for hemorrhage managementarterial pressure points
what is the fourth step for hemorrhage managementsplinting
what is the last step for hemorrhage managementtourniquet application
if you have a patient that is showing S&S of shock, why would you perform the tilt test on your patientto determine the presence of orthostatic hypotension
orthostatic hypotensionDecrease in BP when PT moves from a supine position to sitting or upright position
what type of hemorrhage oozes from wound, clots quickly on it ownCapillary
what type of hemorrhage flows more quickly, and is dark red bloodVenous
this type of hemorrhage flows rapidly, often spurting bright red bloodArterial
first step in the body's response to local hemorrhage?Vascular phase
second step in the body's response to local hemorrhage?Platelet phase
last step in the body's response to local hemorrhageCoagulation
what happens in the vascular phasesmooth muscle contracts, lumen size reduced, arterial BP is primarily regulated by vasoconstriction and vasodilation
what happens in the platelet phasetunica intima is damaged, turbulent blood flow, platelets then stick to collagen on vessel's surface (weak clot) and aggregate
what happens in the coagulation phaseEnzymes released into bloodstream, triggers a series of reactions resulting in the form and release of fibrin, forming clot
what are the medications that affect clottingASA, Heparin, Warfarin
best indicators of shockMOI, Local S&S of injury, Early S&S of shock
epistaxisNose bleed
outward signs of internal hemorrhagehemoptysis, esophageal varices, melena, chronic hemorrhage
esophageal varicesenlarged and engorged esophageal veins
Melenabowel hemorrhage, blood is. digested before release causing it to look black and tarry
Stage one of hemorrhageCompensation, blood loss up to 15%, body can accommodate for loss, no affect on BP, pulse pressure, renal output, catecholamine release, PT may display some anxiety, elevated HR, cool skin
Stage two of hemorrhageEarly decompensation, blood loss 15 - 25%, can no longer maintain BP, catecholamine release , increase peripheral vascular resistance, cool clammy skin, restlessness and thirst
Stage three of hemorrhageLate decompensation, blood loss between 25- 35%, compensatory mechanisms unable to cope, classic signs of shock, tachycardia, decrease BP, urine output, pulse pressure narrows
Stage four of hemorrhageIrreversible, blood loss greater than 35%, pulse may or may not be palpable, PT lethargic, confused moving towards unconscious
The release of accumulated lactic acid, carbon dioxide (carbonic acid), potassium, and rouleaux into the venous circulation is calledCapillary washout
patient who is compensating for massive blood loss will benormotensive
What is the best explanation for the patient's decreasing level of consciousness as it pertains to the increased respiratory ratethe patient goes into respiratory alkalosis constricting the cerebral blood vessels
If the patient's O2 Sats are <92% and they are thought to be in shock, they should receive supplemental oxygen bynonrebreather at 15 liters per minute
An IV solution with an osmotic pressure greater than that of the body's cells is aHypertonic solution
As the body compensates for shock with peripheral vasoconstriction, oxygen delivery to the capillaries decreases, causingAnaerobic metabolism to replace aerobic metabolism
In compensatory shock, the body secretes which of the following hormones to prolong the "fight of flight" responsecatecholamines, glucocorticoids, aldosterone
hypovolemic shockacute blood volume loss resulting from dehydration and hemorrhage (loss of vascular fluid)
what is the most common type of hypovolemic shockHemorrhagic shock
Distributive shockoccurs when peripheral vasodilation without proportional increase in fluid volume.
Cardiogenic shockfailure of the hearts pumping action, may be intrinsic or extrinsic, may present with hypotension, tachycardia and JVD
Obstructive shockimpaired blood return to heart, pericardial tamponade, tension pneumothorax, pulmonary embolus (from previous fracture, recent surgery, use on "pill" in older women)
psychogenic shockis a type of distributive shock. vasovagal, syncope, fainting
neurogenic shockis a type of distributive shock. triad of decreased BP, HR and temp, PT may be LOAx3
septic shockis a type of distributive shock. altered LOA, Tachycardia, Delayed cap refill, Hyperventilation to respiratory arrest, hypoglycaemia due to fever production
what type of shock a PT would have if they have a life threatening infectionSeptic
when should the IV bag be changedwhen there is approx. 150 mLs of solution remaining
Macro drip10, 15, or 20 drops/cc
micro drip60 drops/cc
Crystalloids IV fluidssaline, lactated ringers, dextrose
hypotonic solutionsless solutes than intracellular fluid, fluid shifts INTO cells, used for cellular hydration. lower serum osmolality within the vascular space by causing fluid to shift out of the blood into the cells and tissue spaces. Typically used to treat conditions causing intracellular dehydration, such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.
Isotonic solutionssame tonicity as intracellular fluid, no fluid shift, used for fluid and lyte replacement. These fluids remain within the extracellular compartment and are distributed between intravascular (blood vessels) and interstitial (tissue) spaces, increasing intravascular volume. They are used primarily to treat fluid volume deficit
Hypertonic solutionmore solutes than intracellular fluid, fluid shifts OUT of cells, used for hypovolemia/vascular expansion, increase urine output (post op), DKA. higher solute concentration causes the osmotic pressure gradient to draw water out of cells, increasing extracellular volume. These fluids are often used as volume expanders and may be prescribed for hyponatremia (low sodium). They may also benefit patients with cerebral edema.
Crystalloid solutionsare distinguished by the relative tonicity (before infusion) in relation to plasma and are categorized as isotonic, hypotonic, or hypertonic.
Colloid solutionsAlso known as volume/plasma expanders. Less total volume is required compared to IV fluids. are indicated for patients in malnourished states and patients who cannot tolerate large infusions of fluid.
effects of catecholamines during shockaggravate hypermetabolism by promoting hyperglycemia and hyperlactatemia, and further increase oxygen demands, which can contribute to further organ damage.
The treatment of choice for an acute anaphylactic reaction is to administer:Epinephrine
secondary treatment to be considered post epinephrine administrationDiphenhydramine IM/IV
what is the ratio for Epinephrine1:1000 (1 mg/ml)
what is the max dose for epinephrine0.5 mg
VasopressorsSupport blood pressure in prolonged cases
Beta agonistsHelp reverse some of the bronchspasm
Corticosteroidsimportant in treatment and prevention for inflammation, little benefit initially
Shelby has sustained a laceration to the left side of her neck from a figure skate, In addressing this injury, you shouldapply an occlusive dressing
hypotension due to spinal shockdecreased venous return, decreased afterload, decreased preload
Pulmonary edema is characteristic of what classification of hypoperfusioncardiogenic
As blood volume is lost due to a traumatic injury, the body's response is to:increase heart rate and constrict precapillary sphincters
Your patient has orders to receive 120 cc/hr via a microdrip set. how many gtt/min will that be? How many gtt/second?120:2
A patient who complains of dizziness when sitting up or standing up and who demonstrates a significant increase in pulse rate or decrease in blood pressure is:Orthostatically hypotensive
what are some of the indications for salineIncrease intravascular volume, Irrigation and cooling for burns, Used to treat DKA, septic shock, crush injuries, HHNK