CPRP Exam 3 with complete solutions

What is Shock? - Answer- critical condition brought on by the sudden drop in blood flow through the body Decrese in blood flow means? - Answer- Decrease in oxygen 4 types of shock - Answer- Distributive Shock Cardiogenic Shock Hypovoliemic Shock Obstructive Shock What is Distributive shock? - Answer- Significant drop in peripheral vascular resistance leading to hypotension Wht is Cardiogenic shock - Answer- Failure of the circulatory system due to decreased cardiac output by left right or biventricular failure. Cardiogenic shock most common cause? - Answer- MI What is hypovolemic shock? - Answer- Decreased intravascular volume or decreased preload which lowers CO What is obstructive shock? - Answer- Extracardiac causes of cardiac pump failure Pathophysiology of sepsis? - Answer- Over response to infection. increased inflammation increased coagulation, decreased fibrinolysis Does microcirculatory dysfunction lead to tissue hypoxia in sepsis? T or F - Answer- True Sepsis process? - Answer- 1. Infection 2. Sepsis 3. Severe Sepsis 4. Septic Shock 5. Multiple organ dysfunction syndrome (MODS) 6. Death :( 10 Clinical manifestations of sepsis - Answer- 1. Hypertension 2. Hypoxemia 3. Fever 4. Decreased urinary output 5. Poor perfusion 6. Mottling 7. Tachycardia 8. Tachypnea 9. Leukocytosis 10. Signs of coagulopathy What is Mottling? - Answer- Rash that looks red lighting across the body Why is there decreased urinary output in sepsis? - Answer- Because not enough blood is going to the kidneys What is Serum Lactate? - Answer- Result of test to see if PaO2 is low and see if the cause is Lactic acidosis. Normal range is 1.0-2.5mmol/L (Needs a blood sample) What does SIRS mean? - Answer- Systemic Inflammatory Response Syndrome Its SIRS if two of the four of these criteria is met? - Answer- 1. Temp >38C or <36C 2. HR >90 3. BR >20 or PaCO2 <32 4. WBC >12,000, <4,000 or >10% immature neutrophils How do you manage Sepsis - Answer- Anti-infective and treating the source of infection What are the 4 Supportive cares for Sepsis? - Answer- 1. Resp. Support: O2 and mechanical ventilation 2. Cardiovascular Support: Fluids, vasopressors, steroids. 3. Renal Support: Hemodialysis 4. Glucose Support: Hyperglycemia is common, need to match insulin and glucose. What is Bacterimia? - Answer- Presence of pathogen in blood without symptoms of infection What is Septicemia (Sepsis)? - Answer- presence of pathogen in the blood with symptoms. What does HAI stand for? - Answer- Healthcare Associated Infections What is a HAI? - Answer- Infections that patients get while receiving medical treatment in a healthcare facility. ( can be prevented) Most important way to stop HAI? - Answer- Prevention is critical 5 Common HAIS? - Answer- 1. UTIS (most common) 2. Pneumonias 3. Infected wounds 4. Ulcers 5. Upper Resp. Infections Most deadly nosocomial infection (HAI)? - Answer- Pneumonia 11 Reasons why hospitalized patients are likely to get a infection? - Answer- 1. Poor hand hygiene 2. Decreased resistance 3. Many incisions, foreign objects in body 4. Antibiotics eliminated the weak organisms but the strong ones lived 5. Older population 6. More Pathogens around 7. Exposure to a lot of people 8. Patients being inactive 9. Need to rely on someone else leading to poor hygiene 10. Contaminated equipment 11. Poor Nutrition How long do you have to initiate sepsis? - Answer- 6hr What is pulmonary edema? - Answer- Fluid enters interstitial space, alveoli, bronchioles, and bronchi How does pulmonary edema happen? - Answer- When rate of fluid filtration exceeds absorptive capacity of lymphatic system. What is cardiogenic pulmonary edema? - Answer- Type of pulmonary edema that is caused by increased pressures to the heart. 5 Causes of cardiogenic pulmonary edema? - Answer- CHD excessive fluids left ventricular failure Mitral or Aortic valve disease Renal failure (due to increased volume) Causes of Noncardiogenic pulmonary edema? - Answer- Disease process that results in acute hypoxia secondary to a rapid deterioration in respiratory status 9 Signs and symptoms of pulmonary edema? - Answer- 1. Tachypnea 2. Hypertension 3. Tachycardia 4. Cheyne-Stokes Respiration 5. Orthopnea 6. Cough and frothy, pink sputum 7. Cool, clammy extremities 8. Cyanosis 9. Crackles and wheezes especially in bases. 4 Things you find in CXR for Pulmonary Edema? - Answer- 1. Cardiomegaly 2. Bats wing or butterfly pattern 3. Kerley A and B lines 4. Bilateral fluffy infiltrates, densities, opacities 5 Treatments of pulmonary edema? - Answer- 1. O2 therapy 2. PEEP/CPAP 3. Preload Reducers 4. Afterload Reducers 5. Inotropic Drugs What are preload reducers and a example? - Answer- Reduced Pulm. venous return, decreased pulmonary capillary hydrostatic pressure and reduces fluid into pulmonary interstitial spaces and alveoli. (Nitroglycerin) What are afterload reducers and a example? - Answer- Decrease SVR, increase cardiac output, improve renal function to promote diuresis. (Captopril) What are inotropic drugs and example? - Answer- Vasodilation and increase CO (Dobutamine) T or F Pneumonia is the leading cause of death from infection in us and 10% of admissions to hospitals? - Answer- T What is Pneumonia? - Answer- Infection within lung parenchyma (Parenchyma is portion of lung involved is gas transfer) What is Pneumonitis? - Answer- Inflammation within lung parenchyma What is Consolidation? - Answer- Inflammatory exudate and/or cellular infiltration of the alveolar walls and interstitial spaces 5 things that cause pneumonia? - Answer- 1. Bacteria 2. Virus 3. Mycoplasma 4. Fungus 5. Protozoa 10 reasons for people that are at risk foe pneumonia? - Answer- 1. Altered epiglottis and glottic reflexes 2. Ineffective cough 3. Impaired mucociliary transport 4. Obstructed airways 5.Immunocompromised 6. Endotracheal intubation 7. Low fluid transport 8. Limited mobility 9. Poor nutrition 10. Patients on long-term steroids and antibiotics. 7 points of pathophysiology of pneumonia? - Answer- 1. Pathogen reaches distal airway and causes inflammation 2. Outpouring of inflammatory exudate 3. Infiltrates in interstitial tissue and alveoli 4. Consolidation 5. Possible necrosis 6. Necrosis may cause permanent loss of lung tissue 7. Decreased FRC and V/Q mismatch Characteristics of Pneumococcal pneumonia? - Answer- 1.Any infection caused by Streptococcus pneumonia 2.Most common community acquired pneumonia 3.Usually lobar 4.Rusty Colored sputum 5.Gram + 6.Transmitted by inhalation Characteristics of Staphylococcus pneumonia? - Answer- 1. Gram + 2. Not very common 3. Pleural effusion and lung abscess common 4. Nonspecific infiltrates on x-ray 5. Rare in healthy patients 6. Up to 50% mortality Characteristics of Hemophilus Influenza pneumonia? - Answer- 1. Common with patients with COPD 2. Gram- 3. Difficult to culture 4. Often necrotizing Characteristics of Klebsiella Pneumoniae pneumonia? - Answer- 1. Necrotizing 2. Often with lung abscess 3. Red currant jelly Sputum 4. Common in Alcoholics 5. Common with patients with pulm. disease and diabetics 6. Lobar consolidations 7. Up to 50% mortality 8. Gram - What is Pneumocystis Jiroveci Pneumonia? - Answer- Formally known as Carinii pnemonia, now thought to be a fungus. Important parts of PJP? - Answer- Opportunistic in AIDS patients, interstitial disease, mortality greater then 50%, Insidious onset with fever 9 things with Viral Pneumonias? - Answer- 1. Gradual onset 2. Low grade fever 3. Chills uncommon 4. Minimal sputum production 5. Sputum is thin and mucoid 6. Tachypnea is rare 7. Pleuritic chest pain is rare 8.WBC not elevated 9. X-ray shows more patchy interstitial densities 7 Characteristics of Influenza Pneumonia? - Answer- 1. Viral pneumonia 2. Self-limited 3. Affects cell-lining of respiratory tract 4. Flu-like symptoms 5. Minimal infiltrate's on x-ray 6. May progress to more severe to pneumonia 7. Usually NPC Is the flu a respiratory disease? - Answer- Yes 5 Characteristics of Varciella Pneumonia? - Answer- 1. Viral pneumonia 2. Chicken Pox 3. More likely cause pneumonia in adults 4. May be severe pneumonia 5. Establish by chest X-ray and skin rash 4 Characteristics of Adenovirus? - Answer- 1. Viral Pneumonia 2. Usually mild pneumonia 3. Usually in small epidemics