drug therapy shock & hypotension

Question 1

chronotropic effect

Answer 1

causing a change in heart rate

Question 2

dromotropic effect

Answer 2

causing a change in speed of electrical conduction in the heart(velocity)

Question 3

inotropic effect

Answer 3

causing a change in myocardial contraction(force)

Question 4

pressor

Answer 4

effect that increase blood pressure

Question 5

what are homeostatic mechanisms

Answer 5

autonomic reflexes, capillary fluid shifts, variations in neurohormones

Question 6

normotensive

Answer 6

having a normal blood pressure

Question 7

causes of hypotension

Answer 7

failure of heart to pump effectively, blood or fluid loss, extreme stress that depletes NE (dehydration, N/V, diarrhea)

Question 8

hypotension impacts

Answer 8

decreased O2 delivery to tissues, accumulation of waste products, shock, cell death

Question 9

negative hemodynamic effects of hypotension

Answer 9

shock

Question 10

what is shock

Answer 10

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

Question 11

acute hypotension is a clinical indicator of

Answer 11

shock; the management will be ideally related to the underlying cause of shock

Question 12

hypotension =

Answer 12

circulatory failure, decrease tissue perfusion

Question 13

4 types of shocks

Answer 13

hypovolemic, cariogenic, obstructive, distributive

Question 14

what is hypovolemic shock

Answer 14

deficient circulating volume; result of a hemorrhage, trauma, burns, diabetes insidious/ ketoacidosis; children often develop this shock from vomiting and diarrhea

Question 15

what is cardiogenic shock

Answer 15

pumping problem with the heart; MI, cardiac dysrhythmias or a valve or ventricle septum rupture

Question 16

what is obstructive shock

Answer 16

obstruction of outflow; mass, accumulation of fluid, or blood clot, prevents heart from adequately pump

Question 17

what is distributive shock

Answer 17

massive vasodilation

Question 18

distributive shock has 3 subsets of shock, what are they

Answer 18

anaphylactic, neurogenic, septic

Question 19

what is anaphylactic shock

Answer 19

major vasodilation caused by histamine release in severe allergic reactions

Question 20

hat is neurogenic shock

Answer 20

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

Question 21

what is septic shock.

Answer 21

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

Question 22

what are the three stages of shock

Answer 22

compensated, uncompensated, irreversible

Question 23

what is the compensated stage of shock

Answer 23

first stage “preshock”, body attempt to restore hemostasis, increase HR/ vasoconstriction (activation of SNS)

Question 24

what is the uncompensated stage of shock

Answer 24

“decompensated”, r/t compensated shock = not diagnosised or left untreated, compensatory mechanism worsen organ dysfunction, CO/BP is low = hypo perfusion = endothelial damage = decrease capillary blood flow, CO/HR/BP continue to decrease

Question 25

s/sx of uncompensated shock

Answer 25

cool/ clammy skin, restlessness, diaphoretic, decrease/concentrated urine output; if rapid medical attention - may be a treatable condition

Question 26

what is irreversible shock

Answer 26

"end stage", permanent and irreversible damage, irreversible tissue and end organ damage (multiple organ failure), renal failure (anuric), anerobic metabolism = lactic acidosis = decreased CO/ severe hypotension

Question 27

medications used for hypotension/ shock

Answer 27

adrenergic agonists/ vasopressors

Question 28

example of adrenergic agonists/ vasopressor

Answer 28

norepinephrine; alpha adrenergic agonist/ emergency drug in the treatment of acute cardiovascular and respiratory collapse/ severe hypotension/ shocks

Question 29

therapeutic action of adrenergic agonists/ vasopressor

Answer 29

cause potent peripheral arterial vasoconstriction, which will cause an increase in blood pressure and at times will also increase the HR, it will also increase force of contraction and CO

Question 30

pharmacokinetics of adrenergic agonists/ vasopressor

Answer 30

immediate onset/ metabolized via monoamine oxidase (MAO) and catechol-O-methylthransferase, excreted in urine

Question 31

adverse effects of adrenergic agonists/ vasopressor

Answer 31

decreased renal perfusion, decrease liver perfusion, cardiac dysrhythmias, limb ischemia (r/t vasoconstriction), extravasation

Question 32

nursing considerations when using adrenergic agonists/ vasopressor

Answer 32

monitor urine output, monitor ALT/AST, tissue and circulation checks, monitor IV sites

Question 33

contraindications of adrenergic agonists/ vasopressor

Answer 33

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

Question 34

other adrenergic agonists/ vasopressor medications

Answer 34

phenylephrine, epinephrine, dopamine (critical care medications)

Question 35

what does epinephrine do for hypotension

Answer 35

stimulates alpha and beta adrenergic receptors (potent vasoconstrictor), emergency medication, increased HR/ contractility and vasoconstrictor

Question 36

what does dopamine do for hypotension

Answer 36

potent alpha adrenergic agonist, low dose= dilates renal and coronary arteries, high dose = increase HR/ vasoconstrictor

Question 37

what does dobutamine do for hypotension

Answer 37

stimulates beta 1 receptors, low dose= increase contractility = increase CO, does not cause tachycardia (incompatible with bicarb/ run separately)

Question 38

nursing concerns with medications for hypotension

Answer 38

must be ACLS certified; fluids first (not with CHF pts), infusion pump(maybe 3, 4, 5), arterial line(in radial artery/ continuers BP reading), central line, titrate meds per protocol, DC slowly(discontinue), assess skin integrity and perfusion, close monitor of VS and UOP(urine output)

Question 39

extravasation is

Answer 39

the leakage of an intravenous or IV fluid with potential damaging medications into the extravascular tissue around the site of infusion

Question 40

what to do if extravasation occurs

Answer 40

stop infusion immediately, leave the needle/ catheter in place and slowly aspirate as much of the drug as possible (do not apply pressure to area), remove IV access while aspirating, elevate area for 48 hours to minimize swelling -> give phentolamine (alpha blocker)