Cardiogenic & Septic Shock - Exam 3 Flashcards
Clinical manifestations of Cardiogenic shock
- Chest pain
- Diaphoresis
- N/V
S/S of decreased Cardiac OP
- 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!
Medications used to treat cardiogenic shock
- Dobuatmine
- Dopamine
- Epinephrine
- Norepinephrine
- Nitroglycerin
- Nitroprusside
- Phenylephrine
- Vasopressin
- Diuretics
- Morphine Sulfate
- Fentanyl
If a patient is in Cardiogenic shock how will their ABG present?
metabolic acidosis
Medical interventions for cardiogenic shock
surgical
IABP
LVAD
ECMO
Heart transplant
Post op care following IABP placement
- 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
How to avoid catheter migration post IABP placement?
the head of bed is elevated no more than 30 degrees, and the affected leg is kept straight at all times
A patient in cardiogenic shock is being hemodynamically monitored. What can you expect to see?
- Decreased cardiac output.
- Increased CVP and PAOP
- Increased SVR
- Decreased venous oxygen saturation (SvO2 or ScvO2)
- Hypotension and tachycardia
Labs for septic shock and how they will present
- 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
Clinical manifestations of DIC
- Excessive bleeding
- Thrombocytopenia
- Excessive blood clots form throughout the body
- Cyanosis
- Ischemia in fingers, toes, and tip of nose
Lab tests for DIC and their expected outcomes
- CBC-plt low
- Coagulation studies:
o Fibrinogen-decreased
o Fibrin-increased
o D-dimer-increased
o PT-prolonged
o Aptt-prolonged
o Antithrombin-decreased
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?
- intracranial hemorrhage
- ischemia
- cerebral infarction
How often should a neuro assessment be done on a DIC patient?
2 hrs
Clinical manifestations of sepsis
- Fever or Hypothermia
- Tachycardia
- Tachypnea
- Peripheral vasodialation
- Mental status changes
- Increased cardiac output
1 hr sepsis bundle in order
- Measure lactate level – Recheck if initial lactate elevated (> 2 mmol/L)
- Obtain blood cultures before abx
- Administer broad-spectrum abx
- Begin rapid administration of crystalloid IV fluid resuscitation for hypotension or lactate greater than or equal to 4 mmol/L
- Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a MAP greater than or equal to 65 mm Hg
What is the first step in the 1-hr sepsis bundle?
Measure lactate level
If the lactate is greater than 2 mmol/L?
Recheck it
In a 1-hr sepsis bundle vasopressors are given for hypotension. What should the MAP be maintained at?
Greater than or equal to 65mmHG
Early manifestations of septic shock
- 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
Manifestations of late phase septic shock
- 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
Post IABP placement the catheter should be assessed for brown flecks or blood in tubing can indicate what?
balloon rupture
It is important to assess extremity perfusion post IABP placement why?
IABP Cath may cause decreased perfusion to the affected extremity
