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NUR 213 > Cardiogenic & Septic Shock - Exam 3 > Flashcards

Cardiogenic & Septic Shock - Exam 3 Flashcards

1
Q

Clinical manifestations of Cardiogenic shock

A
  • Chest pain
  • Diaphoresis
  • N/V
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2
Q

S/S of decreased Cardiac OP

A
  • Hypotension
  • Tachycardia with weak pulses
  • Tachypnea
  • Cool skin temp
  • Cyanotic, mottled skin
  • Decreased or absent UOP
  • Decreased LOC
  • Decreased or absent bowel sounds

Important because decreased COP can indicate Cardiogenic shock!

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3
Q

Medications used to treat cardiogenic shock

A
  • Dobuatmine
  • Dopamine
  • Epinephrine
  • Norepinephrine
  • Nitroglycerin
  • Nitroprusside
  • Phenylephrine
  • Vasopressin
  • Diuretics
  • Morphine Sulfate
  • Fentanyl
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4
Q

If a patient is in Cardiogenic shock how will their ABG present?

A

metabolic acidosis

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5
Q

Medical interventions for cardiogenic shock

surgical

A

IABP
LVAD
ECMO
Heart transplant

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6
Q

Post op care following IABP placement

A
  • Ensure the IABP catheter is secured
  • Head of bed is elevated no more than 30 degrees
  • Affected leg is kept straight at all times
  • Assess catheter tubing for brown flecks or blood
  • Assess lower-extremity perfusion such as color, temperature, and pulses
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7
Q

It is important to assess extremity perfusion post IABP placement why?

A

IABP Cath may cause decreased perfusion to the affected extremity

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7
Q

Post IABP placement the catheter should be assessed for brown flecks or blood in tubing can indicate what?

A

balloon rupture

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7
Q

How to avoid catheter migration post IABP placement?

A

the head of bed is elevated no more than 30 degrees, and the affected leg is kept straight at all times

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8
Q

A patient in cardiogenic shock is being hemodynamically monitored. What can you expect to see?

A
  • Decreased cardiac output.
  • Increased CVP and PAOP
  • Increased SVR
  • Decreased venous oxygen saturation (SvO2 or ScvO2)
  • Hypotension and tachycardia
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9
Q

Labs for septic shock and how they will present

A
  • H & H – levels will be increased
  • ABGs – Metabilic acidosis
  • Serum electrolytes: Glucose decrease, Sodium decrease, Potassium increase
  • BUN & Creatinine-will increase
  • Blood cultures + for gram positive or negative
  • WBC-increased
  • Serum enzymes
  • Lactic acid/Lactate elevated
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10
Q

Clinical manifestations of DIC

A
  • Excessive bleeding
  • Thrombocytopenia
  • Excessive blood clots form throughout the body
  • Cyanosis
  • Ischemia in fingers, toes, and tip of nose
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11
Q

Lab tests for DIC and their expected outcomes

A
  • CBC-plt low
  • Coagulation studies:
    o Fibrinogen-decreased
    o Fibrin-increased
    o D-dimer-increased
    o PT-prolonged
    o Aptt-prolonged
    o Antithrombin-decreased
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12
Q

A patient with DIC presents with restlessness, agitation, visual disturbances, headaches and sensory or motor dysfunction can indicate a change in consciousness levels. What can this be a sign of?

A
  • intracranial hemorrhage
  • ischemia
  • cerebral infarction
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13
Q

How often should a neuro assessment be done on a DIC patient?

A

2 hrs

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14
Q

Clinical manifestations of sepsis

A
  • Fever or Hypothermia
  • Tachycardia
  • Tachypnea
  • Peripheral vasodialation
  • Mental status changes
  • Increased cardiac output
15
Q

1 hr sepsis bundle in order

A
  1. Measure lactate level – Recheck if initial lactate elevated (> 2 mmol/L)
  2. Obtain blood cultures before abx
  3. Administer broad-spectrum abx
  4. Begin rapid administration of crystalloid IV fluid resuscitation for hypotension or lactate greater than or equal to 4 mmol/L
  5. Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a MAP greater than or equal to 65 mm Hg
16
Q

What is the first step in the 1-hr sepsis bundle?

A

Measure lactate level

17
Q

If the lactate is greater than 2 mmol/L?

A

Recheck it

18
Q

In a 1-hr sepsis bundle vasopressors are given for hypotension. What should the MAP be maintained at?

A

Greater than or equal to 65mmHG

19
Q

Early manifestations of septic shock

A
  • BP – normal or hypotension
  • Pulse – increased, thready
  • Respirations – rapid & deep
  • Skin – warm, flushed
  • Mental status – alert, oriented, anxious
  • Urine output – normal
  • Cardiac output- increased
  • Other – increased body temperature, chills, weakness, NVD, decreased CVP
20
Q

Manifestations of late phase septic shock

A
  • BP – hypotension
  • Pulse – tachycardia, arrhythmias
  • Respirations – rapid, shallow, dyspneic
  • Skin – cool, pale, edematous
  • Mental status – lethargic to comatose
  • Urine output – oliguria to anuria
  • Cardiac output- decreased
  • Other – normal to hypothermic, decreased CVP

NUR 213 (29 decks)

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