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Nursing Test 1 Sem 2
| Question | Answer |
|---|---|
| definition of shock | The state where widespread reduction of tissue perfusion leads to reversible, and then if prolonged, irreversible cellular injury |
| how does shock happen | Results from altered blood flow or impaired delivery of oxygen to the tissues |
| 6 common encountered conditions that result in shock | 1. trauma 2. anesthetic problems 3. anaphylaxis 4. colic 5. GI obstruction 6. Severe bacterial infection |
| what is the calculation for cardiac output | stroke volume x heart rate |
| when oxygen is insufficient the body switched from ________ metabolism to __________ metabolism | aerobic to anaerobic |
| since the by products from anaerobic metabolism are harmful to the body what can it lead too? | metabolic acidosis |
| what happens when metabolic acidosis is severe | cell death occus |
| which species is gastric torsion (GDV) most common in | deep chested dogs |
| how does gastric torsion happen | dog has an intense exercise immediately after a meal. they swallow air while eating and exercising and occasionally the stomach will flit resulting in the trapping of gas and fluid in the stomach |
| when there is a decreased blood pressure where does the blood pool | blood pools in the organs and does not return to the heart |
| _________ is required for the Krebs Cycle | oxygen |
| Glycolysis doesn't use __________ | oxygen |
| When using glycolysis what also can be produced | lactic acid |
| 4 types of shock and an example | 1. Cardiogenic: failure of the heart to pump (CHF) 2. Hypovolemic: decreased intravascular volume (hemorrhage) 3. Distributive: loss of peripheral resistance and flow maldistribution (anaphylaxis) 4: Obstructive: impaired diastolic filling (GDV) |
| when does cardiogenic shock occur | Occurs when the heart fails to pump efficiently which can happen from lack of blood circulation causing low BP |
| signs of cardiogenic shock | 1. increased heart rate 2. weak pulse 3. decreased BP |
| 4 reasons why hypovolemic shock can occur | 1. lack of body fluid or blood 2. acute hemorrhage 3. burns 4. severe dehydration |
| what percent of blood loss quickly leads to severe hypotension, circulatory collapse and irreversible shock | 40% |
| how does the body compensate for hypovolemic shock | spleen contracts to release stored RBCs and blood vessels constrict to minimize blood required to circulate in body |
| what happens during distributive shock | Normal blood volume, but vessels become dilated and ‘flabby’, causing blood pooling within and results in poor venous return to the heart |
| how does the body compensate for distributive shock | vasoconstriction, attempts to reduces the amount of blood needed to circulate in body |
| what is obstructive shock caused by | a physical obstruction in the circulatory system, originating outside the heart |
| what is the body's alarm system to let it know when shock is imminent | Decrease in BP |
| what are the 4 majorCompensatory mechanisms for shock | 1. Sympathetic Nervous System 2. Shunting of blood from unnecessary to necessary organs 3. Renal Shut Down 4. Splenic Contraction |
| in the sympathetic nervous system compensatory mechanism what gland releases what.... | adrenal gland releases epinephrine |
| what does the natural release of epinephrine do during shock | increases your heart rate and force of contractions, constricts blood vessels, resulting in Increased BP |
| why does shunting of the blood help during shock | preserves blood to the heart and brain at all costs |
| what is the order in which blood vessels constrict to conserve blood to the heart and brain during shock | 1 st : skin, fat, muscles (seen as blanched, cold extremities) 2 nd: liver and GI tract 3 rd: kidney |
| what does it mean when there is renal shut down during shock | Lack of urine production can indicate severity of shock |
| if an animal fails to produce urine after _________ hours of starting fluid therapy, can indicate irreversible damage to kidney tubules | 1-2 hours |
| what causes splenic contraction during shock | release of epinephrine from the sympathetic nervous system |
| what does splenic contraction cause the release of | stored RBCS |
| what are the 2 things that tell us the shock is irreversible | a) blood volume is inadequate to perfuse brain and heart b) when cells are too damaged by hypoxia & acidosis |
| what do hypoxia and acidosis also trigger the release of? | “bad chemicals” like histamine, serotonin, leukotrienes, etc. causing more cell damage |
| what does DIC stand for | Disseminated Intravascular Coagulation or Death is Coming |
| what happens in DIC | Massive vasodilation occurs along with excessive activation of the clotting mechanism. Fibrin clots form throughout the body’s smallest vessels |
| 6 signs of shock | 1. prolonged CRT 2. decreased urine production 3. weak pulse 4. pale MM 5. cold extremities and MM 6. rapid respirations |
| what is the ultimate goal with treating shock | optimize tissue oxygen delivery |
| for shock most patients die within _______ hours if they are not treated | 12 hours |
| what is the very first step to treating shock | ABC (airway, breathing, circulation) |
| what is the second step to treating shock | support circulation with crystalloid fluids |
| 2 crystalloid fluids we can give during shock | plasmalyte and LRS |
| should we give shock patients fluids at the maximum IV rate | yes |
| when should we avoid giving hypertonic saline | if dehydrated or hypernatremic |
| what are the traditional shock rates | 90 mL/kg/hr in the canine 45 mL/kg/hr in the feline |
| when do we use colloids in shock patients | when they are not responding to crystalloids |
| what is the 3rd treatment of shock | support with colloids |
| what is the 4th treatment of shock | treat blood loss |
| what should the patients PCV level at to consider transfusion | < 20% in canine < 15% in feline |
| what is the 5th step of treating shock | Good nursing care |
| what do dobutamine and dopamine do for shock | cardiac stimulant, increase myocardial contractility |
| what does sodium bicarbonate do for shock | helps counteract metabolic acidosis |
| when would we use bactericidal antibiotics when an animal is in shock | if speticemia is a cause |
| what does doxapram do for shock | stimulates respirations |
| what does epinephrine do for shock | used as a last resort to treat cardiac arrest, or anaphylaxis |
| what does lidocaine do for shock | treat any arrhythmias |
| what does furosemide do for shock | a diuretic that can help improve renal blood flow and stimulate urine production |
| what do analgesics do for shock | should be administered to control pain as it has many negative impacts on the body |
| why aren't corticosteroids used for shock anymore | may mask clinical signs and delay healing |
| 9 parameters to watch out for during shock | 1. urine output (1-2mls/kg/hr) 2. BP (>90mmHG systolic) 3. CRT and MM 4. Pulse 5. Heart Rate 6. Respiratory Rate 7. Temperature 8. Diagnostics 9. Fluid Therapy |
| 7 conditions often seen with shock | • Pneumothorax • Pulmonary contusions • Diaphragmatic hernias • Cardiac arrhythmias • Fractures • Ruptured bladder • External wounds |
| 5 causes for changes in consciousness | -Vitamin deficiencies -Electrolyte imbalances (hyper/hypo) -Hypoxia -Hypotension -Trauma |
| How do we assess level of consciousness | 1st observe 2nd observe response to non-contact stimuli 3rd assess response to light touch |
| what controls the rate, pattern and effort of breathing | brain and respiratory muscles |
| how is a TPR most accurately performed | in the order of RPT |
| what is the normal rpm | 8-30rpm |
| signs of breathings changes in order from least severe to most | Increased R.R. Change in respiratory pattern Postural positions of relief Open mouth / labouredbreathing Hypoxemia –cyanosis Death |
| what does moist lung sounds mean | fluid in lung tissue |
| what does dry lung sounds mean | fibrosis of the lungs |
| what do absent lung sounds mean | air or fluid in pleural space is dampening airway noises |
| what does heart rhythm depend on | route of electrical impulse from SA node through nerve fibres of heart |
| what can cause tachycardia | shock, stress, excitement, fever, and hyperthyroidism |
| what can cause bradycardia | hypothermia, metabolic disorders, parasympathetic (vagal) stimulation |
| what is one of the scales we can use to assess feline pain | Feline Grimace Scale |
| what does MM colour reflect | blood Hb concentration, tissue O2 levels, & peripheral blood flow |
| what might cause brown MM | acetaminophen toxicity |
| what can a CRT >2 sec mean | poor peripheral perfusion |
| what can a CRT <1sec mean | sign of anxiety, early compensatory shock, fever, pain |
| what is pulse character | rhythm & force |
| what is pulse strength | the difference between the systolic and diastolic pressure |
| what does hyperkinetic mean | bounding pulse, great difference between diastolic and systolic pressure |
| what does hypokinetic mean | weak pulse |
| if a patient has hyperthermia when should we stop cooling them | when they reach 39 degrees celcius |
| dont warm patient faster then _____ degree per ________ | one, hour |
| what does hyperthermia cause | increased metabolic rate, peripheral vasodilation |
| what does hypothermia cause | decreased metabolic rate, peripheral vasoconstriction |
| what is the urine output for oliguria | < 0.27 mL/kg/hr |
| what is the urine output for anuria | < 0.08 mL/kg/hr |
| when will a urine output decrease | with severe / prolonged hypotension and hypoxia |
| when will a urine output increase | if tubular cells unable to reabsorb Na |
| how to calculate mean arterial pressure | diastolic + 1/3 pulse pressure (pulse pressure is the difference b/t systolic and diastolic values) |
| what is a normal CVP | 0-10cm H20 |
| what happens if a CVP is <0-5cm | H20 is insufficient you must admin fluids |
| what happens if a CVP is >10-14cm | volume overload or R-side heart failure, check system and inform vet |
| 7 general emergency guidelines | 1. be prepared 2. do no harm 3. follow pre authorized procedures 4. don't expect too much of yourself at first 5. avoid diagnosis/surgery/prognosis without DVM present 6. keep calm 7. always stop and think before doing anything |
| 7 first steps when seeing a patient | 1. Identify yourself (name & VT) 2. Assess the owner 3. Thorough history and examination 4. Classify emergency 5. Contact Veterinarian 6. Watch what you tell owner 7. Separate before treatment if needed |
| what does the primary emergency survey include | A. Respiration B. HR & Pulse C. External Bleeding D. MM / CRT E. Pupils F. External Wounds G. Limbs H. Abdominal Palpation I. Auscultate Chest & Take Temperature |
| what is the secondary emergency survey normally called | A CRASH PLAN |
| what does "A CRASH PLAN" stand for | A= airway/breathing/bleeding C= circulation/cardiovascular R= respiration A= abdomen S= spine H= head P= pelvis/perineum/penis L=limb A=arteries/veins N=nerves/neurological |
| what are the 4 classes of triage | Class I:Critical within seconds to minutes Class II: Urgent within minutes to an hour Class III: Pressing within a few hours Class IV: Non-Pressing within 24 hours |
| examples of Class I triage | Cardiac/respiratory arrest, anaphylaxis, GDV, status epilepticus, heat stroke, uncontrolled hemorrhage |
| examples of Class II triage | Shock, intermittent seizures, IVDD, dystocia, toxicity, penetrating abdominal wounds, ocular proptosis |
| examples of Class III triage | Lacerations, burns, fractures, profuse V/D, FLUTD with obstruction |
| examples of Class IV triage | Lameness, anorexia of an adult animal |
| 6 treatments for dyspnea | 1. O2 and cage rest 2. close chest wounds 3. thoracocentesis 4. furosemide 5. chest tube 6. x-rays once stable |
| what is considered a continues seizure | lasting longer than 10 mins |
| 5 causes of seizures | • Epilepsy • Head trauma • Toxicity • Hypoglycemia • Hypocalcemia |
| what can we give patients with anaphylaxis | Benadryl (antihistamines) |
| what do we want to monitor for in patients with anaphylaxis | late phase reaction |
| how to treat heat stroke | Large bore IV catheter & cool IV fluids Cool animal without causing vasoconstriction (no icing!) |
| how to treat gastric torsion (GDV) | 1. Place a stomach tube 2. Gastric lavage 3. Trocarization PRN 4. IV catheter & fluids 5. Surgery PRN 6. Monitor the heart for PVC’s |
| what is an intussusception | part of the bowel telescopes on itself |
| what are 4 other gastrointestinal emergencies | 1. intussusception 2. string gut 3. foreign body 4. obstructive tumours |
| can you rinse off a dry chemical burn right away | no you must brush off the debris first |
| what are some causes of FLUTD | Struvite, calcium oxalate, or idiopathic blockage of urethra |
| how to treat FLUTD | Place IV catheter, sedate, and relieve that bladder! Relieve via cysto. Place urinary catheter and flush bladder and change animals diet |
| how long must an FLUTD animal be hospitalized | for 24-72 hrs before removing u-cath, then another 24 before sending home |
| what are 4 signs of dystocia | No fetus within 3 hours of membrane rupture or onset of active labour • > 1 hr between fetuses • Depressed or weak dam • Profuse vaginal hemorrhage • Large amount of greenish black vaginal discharge |
| what do RVTS do during dystocia for neonatal care | 1. resuscitate puppies 2. stimulate resps with towel 3. remove secretions with bulb syringe 4. provide O2 mask 5. drugs PRN 6. clam/tie/cut umbilical cord 7. keep puppies warm and return to dam |
| when does diabetic ketoacidosis occur | when patient has undiagnosed or poorly managed diabetes mellitus |
| what happens during diabetic ketoacidosis | Insufficient insulin to use carbohydrates as an energy source, so... • Body uses fat and protein for energy instead • Fatty acids released when fat breakdown occurs |
| 5 clinical signs of diabetic ketoacidosis | 1. Ketotic/fruity breath 2. oliguria 3. depression 4. vomiting 5. dehydration |
| what are the 3 kinds of burns | 1. Physical 2. Chemical 3. Electrical |
| how to care for physical burns | Apply cold water / saline via flushing or wet dressings for 30 min within 1 st 2 hours |
| how to care for chemical burns | Rinse copiously with cool water or saline |
| how to care for electrical burns | usually confined to oral cavity IV fluids, supportive care, ECG monitor |
| what to look for on a poisoning exam | Check oral cavity (burns, ulcers, breath) • Look for oils, powders, odour on coat or paws • Evidence of V/D, excessive salivation? • Seizures, depression, coma? |
| how to treat poisonings | Induce vomiting if within 4 hrs of ingestion of non-corrosive material |
| when should we not induce vomiting with a poisoning | if unconscious, seizuring, or substance was an acid, alkali, or petroleum product |
| 7 common toxins found in animals | 1. OTC flea and tick medication 2. Plants 3. Antifreeze 4. Coumarin Derivatives (blood thinners) 5. Caustics and petroleum products 6. illicit drugs 7. Human and Animal Rx OTC meds |
| what can we give to decrease brain swelling from a head trauma | corticosrteroids (dexamethasone) |
| when should lacerations be considered urgent | • Eyelids or eyes involved • Penetrate chest wall or abdomen • Enter a joint |
| emergency drugs to know | • Atropine • Calcium • Dexamethasone • Diazepam • Dopamine/Dobutamine • Doxapram • Epinephrine • Furosemide • Lidocaine • Naloxone • Sodium bicarbonate |
| what breeds is tracheal collapse most common in | miniature and toy breeds |
| what is tracheal collapse | partial airway obstruction from collapse of tracheal rings and pet presents with a loud honking non-productive honk |
| what can cause a tracheal collapse | when dog is excited, overheated, or when excess pressure is exerted on neck |
| what are 5 treatment options for tracheal collapse | 1. chest harness 2. bronchodilators 3. cough suppressants 4. surgery (stent placement) 5. weight loss |
| what are the two types of heart failure | 1. Myocardial dysfunction 2. Circulatory failure |
| 3 kinds of myocardial dysfunction | Cardiomyopathy Myocarditis Taurine deficiency (cats) |
| 4 kinds of circulatory failure | 1. hypovolemia 2. anemia 3. valvular dysfunction 4. congenital shunts or defects |
| what is CHF | fluid accumulates in the body resulting in edema |
| what are signs of Left Sided Heart Failure | 1. coughing 2. exercise intolerance 3. pulmonary edema |
| what are signs of Right Sided Heart Failure | 1. generalized edema 2. ascites |
| 5 ways to diagnose heart failure | 1. clinical signs 2. history 3. ECG 4. Auscultation 5. Echocardiogram |
| what are the 5 most common congenital heart problems | 1.Patent Ductus Arteriosus (PDA) 2.Aortic or Pulmonic Stenosis 3.Ventricular Septal Defect 4.Tetralogy of Fallot 5.Persistent Right Aortic Arch |
| how do puppies normally present with CHF | -weak -smaller -heart murmur -cyanosis |
| in fetus why is the pulmonary artery connected to the descending aorta | allow fetal blood to bypass pulmonary circulation At birth, take first breath of air and uses lungs, High O 2 levels trigger closure |
| when does the connection in fetuses between the pulmonary artery and descending aorta close | 2-3 days after birth |
| what happens if the pulmonary artery and descending aorta dont close off from one another | Result in Patent Ductus Arteriosus -“Left-to-Right shunting” of blood due to pressure (blood flows from aorta to pulmonary artery and into lungs) |
| what happens if the pressure is too high in the heart | “Right-to-Left” shunt will occur (a.k.a reverse PDA) Unoxygenated blood will bypass the lungs and enter the aorta and systemic circulation R L |
| what are 2 clinical signs of reverse PDA | +/- differential cyanosis +/- hind limb weakness |
| what are the 2 ways to diagnose PDA | -ECG -Echocardiogram |
| how do you treat PDA | -stabilize CHF first -Surgical ligation of the ductus arteriosus |
| how to treat reverse PDA | -no Sx -palliative care -exercise restriction -phlebotomy to maintain PCV at normal levels |
| why does differential cyanosis happen during reverse PDA | Due to location of the shunt, head and forelimbs still get normally oxygenated blood, but caudal body gets mixture |
| why is surgery contradicted with reverse PDA | Origin of initial pulmonary hypertension unknown, but surgical closure contraindicated as the PDA acts as a pressure relief valve, preventing excess pressure from building up |
| what is stenosis | narrowing of blood vessels |
| why does stenosis happen | due to fibrous tissue, muscle atrophy, or valvular abnormality |
| what is aortic stenosis | narrowing of aortic outflow |
| what happens during aortic stenosis | increased pressure & therefore L ventricle dilation & hypertrophy to maintain cardiac output |
| what does hypertrophy cause | increased O2 demand & decreased diastolic filling |
| what is pulmonic stenosis | Abnormal valve leads to R ventricle hypertrophy (from inc. pressure), then atrial dilation, +/- tricuspid valve regurgitation |
| how do we treat pulmonic and aortic stenosis | Palliative: exercise restriction and betablockers |
| what is a ventricular septal defect | hole between the ventricles |
| what does a ventricular septal defect cause | L-sided CHF and pulmonary hypertension |
| how to diagnose a ventricular septal defect | -ECG -Rads -Ultrasound |
| how to treat a ventricular septal defect | -may close on its own -medications -open heart surgery -pulmonary artery bandning |
| what is tetralogy of fallot | Polygenic genetically transmitted malformation of heart |
| what breeds is tetralogy of fallot normally seen in | Keeshonds and English Bulldog |
| what are the 4 defects of the tetralogy of fallot | 1. pulmonic stenosis 2. ventricular septal defect 3. overriding aorta 4. hypertrophy of right ventricle |
| 6 clinical signs of tetralogy of fallot | 1. lethargy 2. cyanosis 3. stunted growth 4. syncope 5. seizures 6. exercise intolerance |
| what happens during persistent right aortic arch | the esophagus is trapped in the arch and megaesophagus results |
| what is megaesophagus | esophagus dilates proximal to stricture, resulting in frequent regurgitation of food |
| 4 signs of persistent right aortic arch | -thin or emaciated patient -ravenous appetite -regurgitation of food -aspiration pneomonia |
| what is the treatment for persistent right aortic arch | surgical correction (younger the better) |
| when the valves thicken during CHF what happens | valves thicken allowing blood to leak through during contractions and inefficient blood flow cause heart to enlarge |
| treatment goals of CHF | 1. improve blood flow 2. remove pulmonary edema 3. control (because there is no cure) |
| common treatments for CHF | 1. diuretics 2. oxygen 3. bronchodilators 3. other meds 4. low sodium diet |
| CMVI | chronic mitral valve insufficiency |
| what is CMVI | deformity to mitral valve which causes a leak |
| CMVI results in approx ______-% of CHF in small dog breeds | 95% |
| what is Tricuspid valve insufficiency | -R-sided CHF and may require abdominocentesis |
| what are the 2 aquired valvular diseases resulting in CHF | 1. CVMI 2. Tricuspid valve insufficiency |
| what is cardiomyopathy | disease involving deterioration of function of the heart muscle |
| what is primary cardiomyopathy | direct result of heart muscle dysfunction (most common) |
| what is secondary cardiomyopathy | results from infection, metabolic disorder. endocrine disorder, or neoplasia |
| what is DCM | Dilated Cardiomyopathy |
| what is the problem in DCM | -large, flabby, inefficient heart -blood enters chambers of heart but is not pumped effectively around the body |
| what are the most common large dog breeds effected with DCM | -dobermans -boxers -great danes -german shepherds -labs |
| 3 signs on DCM | -cough -syncope -murmur |
| 3 main types of cardiomyopathy in cats | 1. hypertrophic cardiomyopathy 2. dilated cardiomyopathy 3. restrictive cardiomyopathy |
| what is the most common cardiomyopathy in cats | Hypertrophic cardiomyopathy |
| what is hypertrophic cardiomyopathy in cats | thickened ventricular wall and small heart chamber |
| what is feline aortic thromboembolism (saddle thrombus) | -clot in the heart valve dislodges, enters aorta, lodges in the iliac artery obstructing blood flow to one or both legs |
| what percent of hypertrophic cardiomyopathy cats develop a thrombi in the left heart | 10-20% |
| what are 4 clinical signs of feline aortic thromboembolism | 1. in distress and pain 2. hindlimb paralysis 3. femoral pulses poor or absent 4. decreased rectal temp and cold caudal extremities |
| how can we treat feline aortic thromboembolism | aim to dissolve clot and restore perfusion with heparin or other drugs |
| what is FCM associated with | taurine deficiency |
| in what year was taurine added to diets to decrease dilated cardiomyopathy cases | 1980's |
| what is restrictive cardiomyopathy | least common form and its when ventricles become stiff, reduced filling and reduced diastolic volume of one or both ventricles |
| what are the most common clinical signs in restrictive cardiomyopathy | respiratory distress |
| what is the 3 differences in treating cardiomyopathy in cats VS dogs | -some vets prescribe low dose aspirin to reduce risk of thrombi formation -cats are more easily stressed -poor prognosis |
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jscott41
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