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Pharm 1 > drug therapy for hypotension and shock > Flashcards

drug therapy for hypotension and shock Flashcards

1
Q

describe chronotropic effect

A

-causes a change in heart rate
-positive chronotropes will increase HR
-negative chronotropes will decrease HR

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2
Q

describe dromotropic effect

A

-causing a change in speed of electrical conduction in the heart
-positive dromotropic will increase speed of conduction
-negative dromotropic will decrease speed of conduction

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3
Q

describe inotropic effect

A

-causing a change in myocardial contraction
-positive inotrope will increase strength of contraction
-negative inotrope will decrese strength of contraction

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4
Q

describe normotensive

A

-having normal blood pressure
-may be 120/80 or just the pts baseline

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5
Q

describe pressor

A

effect that increases blood pressure

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6
Q

what are some cardiac homeostatic mechanisms

A

-autonomic reflexes
-capillary fluid shifts
-variations in neurohormones

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7
Q

what are some causes of hypotension

A

-failure of the heart to pump effectively
-blood or fluid loss
-extreme stress that depletes norepinephrine

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8
Q

names some impacts from hypotension

A

-decreased O2 delivery to tissues and organs
-accumulation of waste products
-shock
-cell death

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9
Q

what is shock

A

clinical condition initiated by compromised oxygen delivery, oxygen consumption, and/or oxygen utilization that leads to cellular and tissue hypoxia

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10
Q

what is the physiological process of shock

A

circulatory failure = hypotension = decreased tissue perfusion

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11
Q

what is the clinical indicator of shock

A

-acute hypotension
-the management will be ideally related to the underlying cause of shock

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12
Q

what is the key to positive outcomes of shock

A

early identification of risk factors and signs and symptoms

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13
Q

name the four types of shock

A

-hypovolemic
-cardiogenic
-obstructive
-distributive

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14
Q

describe hypovolemic shock

what is it? what does it result from?

A

deficient circulating volume
-most common
-result of a hemmorhage, trauma, burns, and in some cases diabtes insipidous or diabeteic ketoacidosis
-children can often develop hypovolemic shock from vomiting and diarrhea

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15
Q

describe cardiogenic shock

what is it? what does it result from?

A

“pumping” problem with the heart
- results from MI, cardiac dysrhythmias, or a valve or ventricle septal rupture

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16
Q

describe obstructive shock

what is it? what does it result from?

A

obstruction of outflow
-results from a mass, accumulation of fluid, or blood clot; prevents the heart from adequately pumping

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17
Q

describe distributive shock

A

massive vasodilation
-has three subsets

18
Q

what are the three subsets of distributive shock

A

-anaphylactic
-neurogenic
-septic

19
Q

describe anaphylatic shock

A

major vasodilation caused by histamine release in severe allergic reactions

20
Q

describe neurogenic shock

A

major vasodilation from high level spinal cord injuries because there is a loss of signals from the sympathetic nervous system

21
Q

describe septic shock

A

major vasodilation r/t release of inflammatory mediators as a result of an overwhelming infection

22
Q

is shock progressive?

A

yep

23
Q

what are the 3 stages of shock?

A

-compensated
-uncompensated
-irreversible

24
Q

describe compensated stage of shock

A

-first stage
-“preshock”
-bodys attempt to restore homeostasis
-increase in HR and vasoconstriction (activation of SNS)

25
Q

describe uncompensated stage of shock

A

-occurs if compensated shcok is not diagnosed or not treated
-compensatory mechanisms are unable to reverse and organ functions progressively worsen
-cardiac output and BP are low = hypoperfusion = endothelial damage = microvascular thrombosis = decreased capillary bloodflow
-CO, HR, and BP continue to decrease

with dx and rapid medical attention = may be treatable condition

26
Q

what ar the signs and symptoms of the uncompensated stage of shock

A

-cool/clammy skin
-restlessness
-decrease/concentrated urine output
-metabolic acidosos

27
Q

describe the irreversible stage of shock

A

-permanent and irreversible damage
-irreversible tissue and end organ damage (multiple organ failure)
-commonly renal failure is first = anuric
-anerobic metabolism = lactic acidosis = decreased cardiac output and severe hypotension

28
Q

name and describe an example of and adrenergic agonist/vasopressor

A

norepinephrine
-alpha adrenergic agonist
-emergency drugs in the treatment of acute cardiovascular and respiratory collapse, severe hypotension, and shocks

29
Q

what are some therapeutic actions and indications of adrenergic agonists/vasopressors

A

-cause potent peripheral arterial vasoconstriction, which will cause increase in BP and at time increase HR
-will also increase force of contraction and cardiac output

-can be used in allergic reactions with hypotension

30
Q

describe the pharmacokinetics of adrenergic agonists/vasopressors

A

-immediate onset
-metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT)
-excreted in the urine

31
Q

what are some nursing implications r/t adrenergic agonists/vasopressors

A

-monitor urine output and vital signs
-monitor ALT/AST
-tissue and circulation checks
-monitor IV sites

32
Q

what are some contraindications of adrenergic agonists/vasopressors

A

-cardiac dysrhythmias
-angina pectoris
-hypertension
-hyperthyroidism
-cerebrovascular disease
-narrow angle glaucoma

-can worsen anxiety, insomnia, and some psychiatric disorders

33
Q

name a few adrenergic agonists/vasopressors

other than norepi

A

-phenylephrine
-epinephrine
-dopamine

34
Q

describe epinephrine

A

-stimulates alpha and beta adrenergic receptors
-potent vasoconstrictor
-emergency med
-increases HR and contracility

35
Q

describe dopamine

what do the different doses do?

A

-potent alpha adrenergic agonist
-low dose: dilates renal and coronary arteries
-high dose: increase HR and vasoconstrict

36
Q

describe dobutamine

A

-stimulates beta 1 receptors
-low dose = increased contractility = increased cardiac output
-does not cause tachycardia
incompatable with bicarb*

37
Q

describe nursing concerns with giving emergency cardiac meds

A

-proper education and taining in emergency/IV drip medication administration/ ACLS certified
-fluid first (if appropriate)
-infusion pump
-arterial line
-central line
-titrate meds per protocol
-discontinue slowly
-assess skin integrity and perfusion
-close monitoring of VS and UOP

38
Q

describe extravasation

A

-leakage of IV infusion fluids (that are toxic to tissue) into the tissue
-can lead to tissue necrosis

39
Q

what are the signs and symptoms of extravasation

A

-irritation
-pain
-inflammation
-warmth
-errythema

40
Q

what is used instead of IVs (when possible) to prevent extravasation

A

central lines

41
Q

what should you do if extravasation occurs

A

-stop injection/infusion immediately
-leave the needle/catheter in place
-slowly aspirate as much of the drug as possible
-do not apply pressie to the area
-remove IV access while aspirating
-elevate area for 48 hours to minimize swelling
-initiate substance specific measures per physician order

42
Q

what med may be ordered if extravasation occurs

A

phentolamine

Pharm 1 (29 decks)

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