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MS II > Chapter 37: Hemodynamic Shock > Flashcards

Chapter 37: Hemodynamic Shock Flashcards

1
Q

Shock is a _______ progressing life-threatening process. Early detection with rapid response is necessary to improve client outcome.

A

rapidly

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2
Q

_____ is a state of inadequate tissue perfusion that impairs cellular function and can lead to organ failure.

A

Shock

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3
Q

Any condition that compromises _____ delivery to organs and tissues can lead to shock.

A

oxygen

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4
Q

Older adult clients can have reduced compensatory mechanisms and rapidly progress through the _____ of shock.

A

stages

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5
Q

________ secretions might not improve cardiac contractility or cause vasoconstriction as in younger adults due to decreased baroreceptor response.

A

Catecholamine

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6
Q

Decreased ability to compensate can cause sustained low ______ and blood pressure.

A

cardiac output

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7
Q

The type of shock is ______ by its underlying cause.

A

identitifed

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8
Q

______ shock is the failure of the heart to pump effectively due to a cardiac factor.

A

Cardiogenic

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9
Q

_______ shock occurs when a decrease in intravascular volume of at least 15% to 30%.

A

Hypovolemic

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10
Q

_________ shock is impairment of the heart to pump effectively as a result of a noncardiac factor.

A

Obstructive

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11
Q

______ shock is widespread vasodilation and increased capillary permeability. This includes neurogenic, septic, and anaphylactic shock.

A

Distributive

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12
Q

During the _____ stage of shock occurs with no visible changes in client parameters; only changes on the cellular level.

A

initial

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13
Q

All types of shock progress through the _____ stages and produce similar effects on body systems.

A

same

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14
Q

The _________ stage of shock measures to increase cardiac output to restore tissue perfusion and oxygenation.

A

compensatory (non-progressive)

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15
Q

The __________ stage of shock is when the compensatory mechanisms begin to fail.

A

progressive

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16
Q

The _______ stage of shock is irreversible shock and results in total body failure.

A

refractory

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17
Q

The stages of shock

A

Initial
Compensatory (non-progressive)
Progressive
Refractory

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18
Q

With ________ shock educate the client about ways to reduce the risk of a myocardial infarction (MI), such as exercise, diet, stress, reduction, and smoking cessation.

A

cardiogenic

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19
Q

With ______ shock advise the client to drink plenty of fluids when exercising or when in hot weather.

A

Hypovolemic shock

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20
Q

With ________ adivise the client to obtain early medical attention with illness or trauma and with any evidence of dehydration or bleeding.

A

Hypovolemic shock

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21
Q

With _______ shock educate the client about the manifestations of dehydration, including thirst, decreased urine output, and dizziness.

A

Hypovolemic shock

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22
Q

With _________ educate the client about wearing seat belts and helmets, and the use of caution with dangerous equipment, machinery, and burning.

A

obstructive
neurogenic
hypovolemic

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23
Q

With _____ shock adivse the client to obtain early medical attention with evidence of an infection, such as localized redness, swelling, drainage, fever, or urinary frequency and burning.

A

septic shock

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24
Q

With _____ shock advise the client to complete the entire course of antibiotics as directed.

A

septic shock

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25
Q

With _____ shock advise the client to wear a medical id wristband, avoid allergens and to have an _______ available at all times.

A

Anaphylactic shock

epinephrine pen

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26
Q

Teach the client and family how to use the ______ and to be alert to early manifestations of an allergic reaction with _______ shock.

A

epinephrine pens

anaphylactic

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27
Q

Older adult clients are at increased risk for MI and cardiomyopathy with ________.

A

cardiogenic shock

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28
Q

_________ due to a direct cardiac cause, such as MI, heart failure, cardiomyopathy, dyrhythmia, and valvular rupture or stenosis are risk factors for cardiogenic shock.

A

Cardiac pump failure

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29
Q

Excessive fluid loss from diuresis, vomiting, or diarrhea; or blood loss secondary to surgery, trauma, gynecologic/obstetric causes, burns, and diabetic ketoacidosis are risk factors for ______ shock.

A

hypovolemic

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30
Q

Older adult clients are more prone to dehydration due to decreased fluid and protein intake and the use of medications, such as diuretics. Minimal amounts of fluid loss (vomiting, diarrhea) can cause the older adult client to become dehydrated are risk factors for _______.

A

hypovolemic shock

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31
Q

Cardiac pump failure due to an indirect _______, such as a blockage of the great vessels, pulmonary artery, stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax and aortic dissection are all risk factors for ______.

A

cardiac factor

obstructive shock

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32
Q

There are three types of _____ shock: nurogenic, septic, anaphylactic.

A

distributive shock

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33
Q

______ shock occurs when there is a loss of sympathetic tone causing massive vasoldilation. Head trauma, spinal cord injury, and epidural anesthesia are among the causes.

A

neurogenic

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34
Q

_____ shock is when endotoxins and other mediators cause massive vasodilation. Most common cause is a gram-negative bacteria.

A

septic

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35
Q

______ is more frequent in older adult clients due to increased use of catheters in long-term care facilities and late detection of UTI (decreased sensation of burning, urgency).

A

Urosepsis

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36
Q

______ shock is when allergen exposure results in an antigen=antibody reaction causing massive vasodilation. Common causes include antibiotics, foods (e.g. peanuts), latex, and bee stings.

A

anaphylatic

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37
Q

Manifestations of hemodynamic shock can include

A 
chest pain
lethargy
somnolence
restlessness
anxiousness
dyspnea
diaphoresis
thirst
muscle weakness
nausea
constipation
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38
Q

A physical finding of hemodynamic shock is hypoxia, tachypnea progressing to greater than _______, and hypocarbia.

A

40/min

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39
Q

A physical finding of hemodynamic shock is when the skin can be pale, ______ or _____ in color, cool, diaphoretic, warm, flushed with fever (distributive shock), and exhibit a rash (anaphylactic or septic shock).

A

mottled or dusky

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40
Q

A physical finding of ______ shock is is angioedema.

A

anaphylactic shock

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41
Q

A physical finding of _____ is wheezing.

A

shock

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42
Q

A physical finding of hemodynamic shock is decreased bp with narrowed ______.

A

pulse pressure

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43
Q

A physical finding of hemodynamic shock is _______ hypotension.

A

postural

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44
Q

Pulse that is weak, thready, or bounding is an expected finding of _______.

A

distrubitive shock

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45
Q

A physical finding of _____ shock is tachycardia.

A

hemodynamic

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46
Q

A physical finding of _____ shock is decreased central venous pressure.

A

hypovolemic shock

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47
Q

A physical finding of _____ shock is central venous pressure increased with increased systemic vascular resistance.

A

cardiogenic sock

48
Q

A physical finding of ______ shock is decreased urine output and seizures.

A

hypovolemic shock

49
Q

Lab tests for shock

A

ABGs
Serum lactic acid
Serum glucose and electrolytes

50
Q

The ______ can show decreased tissue oxygenation (decreased pH, decreased PaO2, increased PaCO2).

A

ABGs

51
Q

The serum ______ will increase due to anaerobic metabolism.

A

lactic acid

52
Q

Serum glucose and electrolytes can ______ during shock.

A

increase

53
Q

A lab test for ______ shock will test for cardiac enzymes such as _______ and troponin.

A

creatine phosphokinase

54
Q

For ________ shock, there will be decreased with hemorrhage and increased with dehydration.

A

hypovolemic

55
Q

For _____ shock you monitor ______ via blood, urine, and wound. You also want to do a coagulation tests as well such as PT, INR, aPTT.

A

Septic

cultures

56
Q

Diagnostic procedures for hemodynamic monitoring (2)

A

arterial line insertion

pulmonary artery catheter insertion

57
Q

Hemodynamic monitoring includes an ______ insertion monitors continuous blood pressure monitoring and blood specimens for ABGs and other tests.

A

arterial line

58
Q

Hemodynamic monitoring includes a _______ which is inserted to measure central venous pressure, pulmonary artery pressures, and cardiac output.

A

pulmonary artery catheter insertion

59
Q

Continuous hemodynamic monitoring is important to manage fluids and dosage of ________ medications.

A

inotropic

60
Q

With a pulmonary artery catheter insertion the nurse must monitor the ______ during catheter insertion.

A

ECG

61
Q

With a pulmonary artery catheter insertion the nurse must have _____ and equipment ready.

A

resuscitation medications

62
Q

With a pulmonary artery catheter insertion the nurse must monitor the hemodynamic _______ and readings.

A

waveforms

63
Q

With a pulmonary artery catheter insertion the nurse must confirm catheter placement using a ______.

A

chest x ray

64
Q

With cardiogenic and obstructive shock use a _____ to assess changes associated with MI and dysrhythmias.

A

ECG

65
Q

With cardiogenic and obstructive shock use an _______ for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, _______, and valve function.

A

echocardiogram

ejection fraction

66
Q

With cardiogenic and obstructive shock use a ______ for cardiomegaly, cardiac tamponade, pulmonary emboli, cardiomyopathy, aortic dissection, or aneurysm, and pericardial effusion.

A

CT

67
Q

With cardiogenic and obstructive shock use a _______ to identify coronary artery blockage.

A

cardiac catheritization

68
Q

With cardiogenic and obstructive shock use a _____ to diagnose cardiomegaly and pneumothrorax, and to evaluate lungs.

A

chest x-ray

69
Q

With hypovolemic shock investigate possible sources of bleeding which can be located in…

A

blood in the nasogastric drainage or stools
esophagogastroduodenoscopy
CT scan of the abdomen

70
Q

With hypovolemic shock you should continuously monitor airway and ______.

A

vital signs

71
Q

With hypovolemic shock you should provide hemodynamic support by administration of ____ and meds because a client who has suspected shock can be hemodynmaically unstable.

A

fluids

72
Q

With hypovolemic shock you should have resuscitation equipment available when ______ the client to and from procedures.

A

transporting

73
Q

When investigating hypovolemic shock explain all _____ to the client.

A

procedures

74
Q

With shock monitor (6)

A

oxygenation status (priority)
vital signs
cardiac rhythm with continous cardiac monitoring
urine output: hourly, report if less than 20 mL/hr
LOC
skin color, temp, moisture, capillary refill, turgor

75
Q

With shock explain procedures and findings to the client and family while providing _____.

A

reassurance.

76
Q

With shock place the client on _____ oxygen, such as a 100% nonrebreather face mask. If the client has COPD, insert a _____ L/min nasal cannula and increase the oxygen flow as needed.

A

high flow

2L/min nasal cannula

77
Q

When a patient is in shock be prepared to _____ the client. Have emergency resuscitation equipment ready.

A

intubate

78
Q

When a patient is in shock maintain a ______ IV access.

A

patent

79
Q

When a patient is in shock, to treat ______, place the client flat with his legs elevated to increase venous return.

A

hypotension

80
Q

When a patient is in shock if a change in status occurs, notify the _________ and provider of the findings.

A

rapid response team

81
Q

When a patient is in shock prepare for and maintain client care during _____ to the ICU, surgery, other specialty unit, or diagnostic area.

A

transfer

82
Q

When a patient is in shock prepare for perform hemodynamic monitoring. Monitor CVP, PAP, CO, and pulse pressure. ____ continuous IV drips to maintain hemodynamic parameters as prescribed.

A

Titrate

83
Q

Inotropic agents

A

milirinon lactate

dobutamine

84
Q

Iontropic agents strengthens cardiac _______ and increases cardiac output.

A

contraction

85
Q

Iontropic agents (milirinon lactate, dobutamine) should be administered by _______ with constant hemodynamic monitoring.

A

continuous IV infusion

86
Q

Iontropic agents (milirinone lactate, dobutamine) can be ______ to maintain hemodynamic parameters.

A

titrated

87
Q

Iontropic agents (milirinone lactate, dobutamine) can cause ______ in some clients.

A

vasodilation

88
Q

Iontropic agents (milirinone lactate, dobutamine) are often administered in combination with a _____.

A

vasopressor

89
Q

Vasopressors

A

Dopamine hydrochloride

norepinephrine

90
Q

Vasopressors (dopamine hydrochloride, norepinephrine) strengthens cardiac contraction and increases ______.

A

cardiac output

91
Q

Vasopressors (dopamine hydrochloride, norepinephrine) increases kidney perfusion at ______ doses.

A

low

92
Q

Vasopressors (dopamine hydrochloride, norepinephrine) decreases kidney perfusion at ______ doses.

A

high

93
Q

Administer vasopressors (dopamine, norepinephrine) should be administered via ______ with constant hemodynamic monitoring.

A

continuous IV infusion

94
Q

Can titrate ______ to maintain prescribed hemodynamic parameters.

A

vasopressors

95
Q

With vasopressors monitor _____ output.

A

urine

96
Q

Administer vasopressors through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.

A

central line

97
Q

Pituitary hormone _______ causes vasoconstriction, increases systemic vascular resistance, and increases BP.

A

vasopressin

98
Q

Vasopressin is administered via ______ and can be titrated to maintain prescirbed hemodynamic parameters.

A

continuous IV infusion

99
Q

With Vasopression monitor ______ output.

A

urine

100
Q

Administer vasopressin through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.

A

central line

101
Q

Sympathomimetics: Epinenphrine is a rapid acting ______.

A

bronchodilator

102
Q

Sypathomimetics: Epinenphrine increases _______ and CO.

A

heart rate

103
Q

With sympathomimetics: epinenphrine you need to monitor

A

bp, pulse, cardiac output

104
Q

With sympathomimetics: epinephrine can cause sloughing if it infiltrates ______.

A

tissue

105
Q

Opioid analgesics: morphine sulfate is used for ____ management.

A

pain

106
Q

With Opiod analgesic: morphine sulfate monitor (5)

A 
RR of clients who are non ventilated
BP
HR
SaO2
ABGs
107
Q

Use opioid analgesics cautiously in conjunction with ______ sedatives.

A

hypnotic

108
Q

Assess and document the client’s pain level and response to medication with ________.

A

opioid analgesics: morphine sulfate

109
Q

Opioid analgesics: morphine sulfate should be used cautiously due to the risk for increased _______ and hypotension.

A

vasodilation

110
Q

When using opioid analgesics: morphine sulfate have ______ and resuscitation equipment available for sever respiratory depression in a client who is non ventilated.

A

naloxone

111
Q

Proton-pump inhibitors: pantoprazole protects against _______ development.

A

stress ulcer

112
Q

Proton-pump inhibitors: pantoprazole should not be ____ with other medications.

A

mixed

113
Q

Anticoagulants (2)

A

low molecular weight heparin

enoxaprin sodium

114
Q

Anticoagulants are used for phophylaxis of _____.

A

DVT

115
Q

Anticogulants are usually administered ____.

A

subq

116
Q

_____ can develop from severe hypotension and perfusion of ischemic cells, causing further tissue injury.

A

MODS

MS II (10 decks)

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