ENPC 6th Ed Chap 7 Stabilization Flashcards
How can pulsus paradoxus be assessed by the nurse?
By palpating the pulse or observing a POX waveform. The waveform will dampen with inspiration or the felt pulse will weaken (102)
What is Pulsus Paradoxus?
A drop in blood pressure with inspiration due to increased intrathoracic pressure
What type of shock can a congenital heart disease cause?
Usually obstructive or distributive (102 BX)
How might distributive shock present differently than other forms of shock as far as signs and symptoms?
“Be alert for bradycardia and vasodilation with warm, dry skin with neurogenic shock”
“Be alert for FLASH capillary refill (<1 second) and bounding pulses with septic and anaphylactic shock” (103 BX)
Fluid volume boluses for septic shock?
20ml/kg up to 40-60ml/kg (107)
Which vasopressor is preferred in fluid refractory shock in children?
Epi and norepi over dopmamine (107 CP)
What are some indications for chest compressions in a child?
include signs
- No Pulse
- HR <60 AND signs of poor prefusion
such as:
1. AMS
2. delayed cap refill >2 sec
3. cool skin
4. mottling
5. pallor
6. diaphoresis
7. hypotension
(111 RF)
What signs might be present with respiratory failure?
Altered LOC
Skin color changes
WEAKENED respiratory effort (95)
What signs might be present with respiratory distress?
Increased WOB (95)
What hallmark sign denotes DECOMPENSATED shock?
Hypotension (96) without hypotension are you really “in shock”?
What blood pressure parameters might be seen with COMPENSATED shock? What systemic signs mightbe present?
- BP is maintained
- DBP is ELEVATED d/t vasoconstriction,
however the vasoconstriction shunts blood away form organs
cool skin, decreased UO, elevated lactate, tachy (cardia/pnea), weak peripheral pulses, cap refill 2-3 seconds, (97 table 7-1)
What are some signs of DECOMPENSATED shock?
AMS, hypotension, increased WOB, pallor, weak or absent pulses (97)
What are some signs of irreversible shock?
bradycardia, lethargy/stupor/unresponsive, mottled skin, weak or absent peripheral pulses. (99)
What signs might be presents with a narrowed pulse pressure?
Increased DBP d/t vasoconstriction, weak pulse, delayed cap refill (98 BX 7-1)
What signs might be present with a widened pulse pressure?
A decreased DBP due to vasodilation, flushed skin, bounding pulse (98 Bx 7-1)
How much volume loss is required to produce hypotension?
30% in a 10kg patient may be <300 ml (100)
How might the SBP reflect in early shock?
remain or normal or even increase (100)
Compared to adults, describe the infants cardiac output?
Twice as much (100)
Compared to adults describe pediatric oxygen consumption?
It is twice that of adults (100)
What is the circulating blood volume of an infant?
90ml/kg
What is the circulating blood volume of a child ?
80ml/kg
What is the circulating blood volume of an adult?
70ml/kg
What might a narrowed pulse pressure be a sign of?
Compensation in shock (100)
What might signs of abnormal vasoconstriction include?
weak peripheral pulses, prolonged cap refill
What might signs of abnormal vasodilation include?
flushed skin and bounding pulses
What sites are preferable for assessing capillary refill?
“preferable sites …are those located AT the level of the heart. In the smaller pediatric population, a finger or toe is often not the most appropriate site” (101)
Describe hypovolemic shock in terms of;
1. volume
2. preload
3. cardiac output
4. afterload
- volume – decreased due to loss (bleeding/vomiting/burns/DKA)
- preload–decreased
- cardiac output – decreased due to decreased preload
- afterload–may increase due to vasoconstriction compensation, once decompensated, may decrease (101)
Describe obstructive shock in terms of;
1. volume
2. preload
3. cardiac output
4. afterload
“pump or pipe problem” obstruction that compresses the heart or vasculature (tamponade/tension pneumo/PE/HCM
- volume–normal
- preload–may be decreased depending on location
- cardiac output– decreased
- afterload– may be decreased
(p. 102)
What is Becks Triad?
A trio of finding s with cardiac tamponade that include, hypotension, muffled heart sounds and jugular vein distention (102)
Three types of distributive shock?
Anaphylactic, neurogenic, septic (102)
