drug therapy for hypotension and shock Flashcards by Katie James

describe chronotropic effect

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

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describe dromotropic effect

-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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describe inotropic effect

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

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describe normotensive

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

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describe pressor

effect that increases blood pressure

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what are some cardiac homeostatic mechanisms

-autonomic reflexes
-capillary fluid shifts
-variations in neurohormones

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what are some causes of hypotension

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

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names some impacts from hypotension

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

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what is shock

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

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what is the physiological process of shock

circulatory failure = hypotension = decreased tissue perfusion

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what is the clinical indicator of shock

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

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what is the key to positive outcomes of shock

early identification of risk factors and signs and symptoms

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name the four types of shock

-hypovolemic
-cardiogenic
-obstructive
-distributive

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describe hypovolemic shock

what is it? what does it result from?

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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describe cardiogenic shock

what is it? what does it result from?

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

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describe obstructive shock

what is it? what does it result from?

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

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describe distributive shock

massive vasodilation
-has three subsets

what are the three subsets of distributive shock

-anaphylactic
-neurogenic
-septic

describe anaphylatic shock

major vasodilation caused by histamine release in severe allergic reactions

describe neurogenic shock

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

describe septic shock

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

is shock progressive?

yep

what are the 3 stages of shock?

-compensated
-uncompensated
-irreversible

describe compensated stage of shock

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

describe uncompensated stage of shock

-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

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

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

describe the irreversible stage of shock

-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

name and describe an example of and adrenergic agonist/vasopressor

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

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

-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

describe the pharmacokinetics of adrenergic agonists/vasopressors

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

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

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

what are some contraindications of adrenergic agonists/vasopressors

-cardiac dysrhythmias -angina pectoris -hypertension -hyperthyroidism -cerebrovascular disease -narrow angle glaucoma -can worsen anxiety, insomnia, and some psychiatric disorders

name a few adrenergic agonists/vasopressors | other than norepi

-phenylephrine -epinephrine -dopamine

describe epinephrine

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

describe dopamine | what do the different doses do?

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

describe dobutamine

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

describe nursing concerns with giving emergency cardiac meds

-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

describe extravasation

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

what are the signs and symptoms of extravasation

-irritation -pain -inflammation -warmth -errythema

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

central lines

what should you do if extravasation occurs

-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

what med may be ordered if extravasation occurs

phentolamine