Chapter 29: Shock/Hypotension

Question 1

Dobutamine (what)

Answer 1

sympathomimetic agent. It was developed to provide less vascular activity than dopamine

it is less likely to cause tachycardia, dysrhythmias, and significant increases in myocardial oxygen consumption than dopamine

Question 2

Dobutamine (why)

Answer 2

most useful in cases of shock that require increased cardiac output without the need for blood pressure support

Question 3

Dobutamine (pt education)

Answer 3

Caution is warranted when administering the drug in patients with moderate or severe hypotension

it may increase blood pressure with large doses

In patients with an acute myocardial infarction, dobutamine may increase infarction size because of the potential for increases in myocardial oxygen consumption when oxygen supply is compromised

useful for short-term management of patients experiencing cardiac decompensation who have not responded to medical therapy while awaiting a heart transplant or mechanical circulatory support

Question 4

Dobutamine (assessment)

Answer 4

assess for adverse effects such as tachycardia, dysrhythmias, and significant increases in myocardial oxygen consumption, increase blood pressure

Question 5

Types of Shock (obstructive)

Answer 5

may result when any kind of mass or fluid accumulation and/or blood clot outside of the heart interferes with the heart’s ability to adequately pump a sufficient quantity of blood

Question 6

Types of Shock (Distributive)

Answer 6

develops from impaired utilization of oxygen and thus production of energy by the cell. It is characterized by massive vasodilation, which results in relative hypovolemia

Question 7

Types of Shock (Anaphylactic)

Answer 7

due to massive vasodilation caused by the release of histamine in response to a severe allergic reaction

Question 8

Types of Shock (Neurogenic)

Answer 8

is a result of massive vasodilation of the peripheral blood vessels from high-level spinal cord injuries

Question 9

Meds for Shock (Hypovolemic)

Answer 9

Epinephrine, dobutamine, phenylephrine

Hypovolemic shock, the most common type of shock, is caused by insufficient circulating volume from actual blood loss or relative loss from fluid shifts within the body

In children, vomiting and diarrhea are the most typical causal conditions

Seek help for signs of shock (weak, rapid pulse; cool, clammy skin; faintness, postural dizziness, nausea)

Question 10

Meds for shock (Cardiogenic)

Answer 10

norepinephrine, dobutamine, phenylephrine

seen with myocardial infarction, atrial and ventricular arrhythmias

Dobutamine is most useful in cases of shock that require increased cardiac output without the need for blood
pressure support. Dobutamine has a short plasma half-life and therefore requires administration by continuous IV infusion

Question 11

Meds for shock (Septic)

Answer 11

Norepinephrine
Septic shock is due to massive vasodilation caused by the release of mediators of the inflammatory process in response to overwhelming infection. Avoid coming into contact with people who are sick. Take care to prevent
infection

Question 12

Meds for shock (anaphylactic)

Answer 12

Epinephrine
Learn to self-administer an injection of epinephrine if you have severe allergies. Always carry your injection kit with you. Seek immediate medical care after self-injection of epinephrine

Question 13

IV norepinephrine for shock

Answer 13

Administration of norepinephrine should occur through a large vein or on an infusion pump, with titration as ordered to
achieve the desired therapeutic response

IV administration of norepinephrine has an immediate onset of action with a vasopressor duration of 1 to 2 minutes.

Norepinephrine is used to treat shock that persists after adequate fluid volume replacement. The drug is recommended as the first-choice vasopressor for the management of sepsis and septic shock