Critical care medications/ SEPSIS Flashcards
What is the sympathetic nervous system?
The flight or fight response, it mobilizes the body, and allows the body to function under stress
What are alpha 1 receptors and where are they located
The stimulation of alpha 1 receptors results in vasoconstriction. It responds strongly to norepinephrine and weakly to epinephrine
Alpha 1 receptors are located in blood vessels.
Where are beta 1 receptors located
The heart and kidney
What does stimulation of beta 1 receptors result in
Increased HR, contractility, conduction velocity, renin release in the kidney
Where are beta 2 receptors located
In the lungs. They are located in the smooth muscle of the bronchi and skeletal blood vessels
What does stimulation of beta 2 receptors result in
Relaxation of the bronchi and vasodilation
What are beta 2 receptors more sensitive to
They are more sensitive to epinephrine than norepinephrine
What are dopaminergic receptors
Receptor that upon there activation result in dilation
Where are dopaminergic receptors located
In the coronary arteries, renal, mesenteric, and the CNS
What medication is a neurotransmitter
Epinephrine,norepinephrine ( Levophed)
What is inotrope
A substance which affects myocardial contractility
What is a positive inotrope
Increased force of contraction
What is a negative inotrope
Decreased force of contraction
What is a chronotrope
A substance which affects the HR
What is a positive chronotrope
It equals increased HR
What is a negative chronotrope
Decreased HR
Preload
The volume/ pressure left in ventricle at the end of diastole
Wha is after load
The pressure of resistance against which the heart must pump
What is a agonist
A drug or substance that produces a predictable response ( stimulates action)
What is a antagonist
An agent that exerts an opposite action to another ( blocks the action
What is the trade name of epinephrine
Adrenaline
What are the clinical effects of epinephrine
Increased SVR, BP, HR, coronary and cerebral blood flow, contractility, and oxygen demand.
What is the mechanism of action for epinephrine
Alpha, beta 1,2
What are the beneficial effect of epinephrine
It produces beneficial effects in patients during cardiac arrest by of its alpha- Adrenergic stimulating properties
What is the trade name of dobutamine
Dobutrex
What is the mechanism of action for dobutamine
Strong beta 1, mild beta 2, weak alpha
What are the clinical effects of dobutamine
Increased CO, decreased SVR, slight increase in HR
What is the trade name of norepinephrine
Levophed
What is the mechanism of action for norepinephrine
Intense alpha and beta 1
What are the clinical effects of norepinephrine
Increased SVR, BP, bradycardia, some decrease in CO
decreased perfusion of kidney, brain, gut, and skeletal muscle
What are the clinical effects of phenylephrine
Increased SVR, BP, oxygen demand, slight increase in CO
decreased renal perfusion
What is the trade name of phenylephrine
Neosynephrine
What is the mechanism of action for phenylephrine
Potent alpha
No beta
Potent vasoconstrictor
What is isoproterenol
It increases HR,CO, contractility, extreme increase in myocardial oxygen consumption= myocardial ischemia, vasodilation
What is the mechanism of actin for isoproterenol
Pure beta 1 and 2
No alpha
What effects does milrinone have
It is an inotropic and vasodilator,
It increases cardiac contractility and CO
It decreases PCWP, AMD SVR
it does not significantly increase HR or myocardial oxygen demand
What is the clinical use for milirinone
Increased CI/ post op cardiac surgery
Increased cardiac function prior to heart transplant
What are complications for milrinone
Increased ectopy
Hypotension
Dysrthymias
What is vasopressin
A anti diuretic hormone with pressure and antidiuretic properties
What are the effects of vasopressin
Promotes reabsorption of water in renal tubules.
Vasoconstrictor effect on GI TRACT
What is the clinical use of vasopressin
It decreased urinary output in diuresis in diabetes insipidus
It controls GI hemmorhage from gastric and esophageal varies as an adjunct drug
What are complications to monitor for with vasopressin
Anaphylaxis
Cardiac arrest
MI
POUNDING SENSATION IN HEAD
What is nesiritide
A human BNP that inhibits ADH by increasing Na loss by kidney
Decreased fluid overload
Decreased PCWP, preload, AMD dyspnea
What are complications to monitor for the nesiritide
Hypotension
Dysrthymias
Renal failure
Cough
What drug is used for shock
Dopamine
What drug is used to treat HF
Dobutamine
What drug is used to treat ischemic LVF
Dobutamine
What drug is used to treat renal failure
Dopamine
What are complications to monitor for with dopamine
Tachyarrthymias
Immunosuppression
What’s the clinical use of dopamine
Shock
Renal failure
What’s the clinical use of dobutamine
Heart failure
Ischemic LVF
What is the action of nitroglycerin
It is a vasodilator. It increases the coronary blood flow by dilating the coronary arteries. ( it is also shown to potentiate hypotensive effects of those who take erectile dysfunction medications.)
What are the desired effects of nitroglycerin
It reduces systolic, diastolic and MAP,
It produces antianginal, anti ischemic, and anti hypertensive effects. when effective nitroglycerin prevents angina pectoris, controls CHF related to MI and controls HTN in the cardiac patient.
What are the most common adverse effects of nitroglycerin
Headaches
Hypotension
ADENOSINE is used for what
It is an anti arrthymic
It causes a block at the AV node
It is used for stable and unstable narrow complex tachycardia
What are considerations of ADENOSINE
HR ,BP, AND CARDIAC PATTERN SHOULD BE MONITORED
PREPARE FOR A CODE SITUATION BY HAVING A CRASH CART, O2,SUCTION AND DEFIBRILLATOR ON HAND
What are side effects of ADENOSINE
Facial flushing, Diaphoresis, light headedness,chest pain,and a sense of doom, the symptoms usually last less than one minute
If the Dysrthymia returns, or does not convert with ADENOSINE, what should be used
A longer acting AV node blocking agent such as calcupium channel blockers or BETA BLOCKERS is the second line DRUG of choice
What is dexamethosone used for
It produces a reduction in cerebral edema and an improvement in neurological symptoms within 8-48 hrs after dosing.
What are side effects of dexamethosone
Euphoria, insomnia,increased appetite, wt gain,HTN,muscle weaknesss in the legs HTPERGLYCEMIA
What is Phenytoin
It is an anti convulsant that works by blocking the repetitive action of the sodium channel
Side effects of phenytoin
Hirutism,acne, gingival hyperplasia
What are nursing considerations of phenytoin
Monitor ECG, and BP during administration and st least a half hour afterwards
What is epinephrine administered for
Epinephrine infusion may be used to treat symptomatic bradycardia that is UNRESPONSIVE to atropine
What are side effects of dopamine
Tachycardia
Arrthymias
Hypotension
What is dilitiazem
A CCB that treats narrow complex tachycardia of rhythm remains uncontrolled or or unconverted by adenosine. It also controls ventricular rate in pull with a fib, or a flutter.
What are side effects of dilitiazem
Hypotension
Bradycardia
AV heart block
Flushing, burning or itching at the injection site and CHF.
What is Amiodarone
It is a anti arrhythmic agent that has similar actions to CCB on slowing conduction. It treats a fib, ventricular tachycardia and
V fib.
What are are side effects of amiodarone
Hypotension
Bradycardia
QT interval prolongation
Torsades de pointes ( a type of ventricular tachycardia)
Silver sulfadiazene is used for what
Both partial and full thickness burns, it has a broad spectrum bactericidal action against many gram neg and positive bacteria. Applications is painless
IT DOES NOT PENETRATE ESCHAR
Side effect of silver sulfadiazene
Leukopenia
What is propofol
Is has a very short duration of action
It is indicated when sedation is required but rapid awakening to perform neurological assessment or extubation is necessary
What are nursing considerations of propofol
A large vein is recommended
Monitor for the development of hypotension
It has no analgesic properties
Monitor lipid levels, triglycerides
What is Lidocaine
An anti arrhythmic drug that blocks the sodium channels decreasing cardiac automaticity and depolarization. Used as a second line drug in treating VT
What process is impaired in ARDS
Alveolar perfusion and ventilation
Who should be monitored closely for ARDS
A pt with acute pancreatitis
What complications of propofol should be closely monitored
Hypotension and apnea
Why does hyperglycemia worsen the clients neurological outcome
Hyperglycemia increases ischemic acidosis
Most common complication of EVD
Meningitis
What is a fluid/med that should be given for shock
Crystalloids 0.9% NaCl
What should be given for hemmorhage
PRBC over whole blood bc it is less likely to cause coagulopathy or overload.
What shouldn’t you give for a ICP patient
Don’t give isotonic fluids
5 tubes for trauma patients
O2 IV SUCTION FOLEY CATHETER NG TUBE
RTS
Revised trauma scale
Helps assign a score to help determine the severity of the trauma
What is the lethal triad
Acute coagulopathy
Acidosis
Hypothermia
What are causes of SEPSIS
Pneumonia Peritonitis UTI skin Hospital acquired VAP, MRSA
What are signs and symptoms of SEPSIS
Chills Hypotension Decreased perfusion Decreased urinary output Significant edema or increased fluid balance hyperglycemia above 120 Fever
What is SIRS criteria
Temp greater than 100.4 HR greater than 90 RR greater than 20 PACO2 less than 32 WBC greater than 12,000 or less than 4,000
What is severe SEPSIS classified as
Dysfunction of 2 or more organ systems in response to hypoperfusion. It can develop suddenly or slowly
How is SEPSIS treated
To be completed within 6 hrs of dx!
1. Measure serum lactate ( if increased indicates decreased perfusion)
2. Obtain blood culture b4 abx tx
3. NOW administer broad spectrum abx within 3 HR of ER visit and within 2 HR of non ER admission
4. Give initial fluid challenge of 500-100 ml over 30-60 min/ evaluate response monitor for overload
5 insert CVP line for repeat fluid challenges until CVP is greater than 8 or, 12-15 on a ventilator
5.
If HCT is less than 30 what should you give
PRBC
What drug increases O2 delivery
Dobutamine
If the SEPSIS pt is experiencing refractory hypotension, what should the nurse do
Give vasopressors to maintain MAP above 80
The pt should have a arterial line
Give vasopressin if shock is refractory
Give norepinephrine or dopamine
How is a fever treated in a septic patient
Alternate between ibuprofen and acetaminophen for fever greater than 102
Watch LFTs
Use hypothermic blanket if temp greater than 103
Prevent shivering by sedation/ paralytics
What can be expected to be ordered in the septic patient
Give low dose steroids as ordered
Maintain tight glucose control of 80-150
What is a complication of SEPSIS
SIRS
