shock Flashcards

Question

skin of shock

Answer 1

- pale, mottled, dusky, cool, diaphoretic (cardiogenic, hypovolemic) - Warm, flushed with fever (distributive) - Rash (anaphylactic and septic)

Answer 2

- Hypoxia (anaphylactic) - Tachypnea: RR greater than 40 - Wheezing - Decreased Blood Pressure with narrowed pulse pressure - Postural hypotension - Tachycardia - Pulse that is weak, thread, or bounding (distributive) - Decreased cardiac output - Decreased CVP (hypovolemic shock) - Increase CVP (cardiogenic shock) - Decreased urine output - Seizures

Answer 3

Hemodynamic Monitoring: - Arterial line insertion - Pulmonary artery catheter insertion (assess right side and can be used as a central line) - The nurse will monitor ECG during procedures - Have resuscitation meds and emergency equipment ready - Catheter placement must be confirmed by X-ray before use!

Answer 4

Assess for changes associated with MI and dysrhythmias

Answer 5

Used for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, ejection fraction, and valve function

Answer 6

Used for cardiac tamponade, PE, cardiomyopathy, aortic dissection, aneurysm, pericardial effusion

Answer 7

Identify coronary artery blockage

Answer 8

Diagnose cardiomegaly and pneumothorax, evaluate lungs

Answer 9

- Investigate possible sources of bleeding NG tube Abdomen Stools - Continuously monitor airway! fluid resucciate - Provide hemodynamic support with fluid and medications. normal saline resembles blood plasma - Have resuscitation equipment available when transporting client, and during procedures

Answer 10

What is the priority? 1) Oxygenation First!!!! - Vital signs: attach your patient to a monitor Assess rhythm - Urine output Check hourly, report less than 30 mls! 2) LOC 3) Skin assessment - Color - Temperature - Capillary refill - Turgor

Answer 11

Place the client on high-flow oxygen (100%) - Consider using a non-rebreather - If patient has COPD, what can you do? GIVE 2L NOT 100% - Be prepared for intubation - Maintain IV access - If hypotensive: Place client flat with legs elevated to increase venous return

Answer 12

Prepare and perform other hemodynamic monitoring - CVP (right ventricle monitoring) - PAWP (left ventricle monitor - Cardiac output: intropes Titrate continuous IV drips to maintain hemodynamic parameters as prescribed

Answer 13

Inotropic Agents: Strengthen cardiac contraction and increase cardiac output - Milrinone - Dobutamine increase bp increase hr side effect

Answer 14

- Given by IV continuous infusion with constant hemodynamic monitoring (arterial line) - Some patients get more vasodilated (make sure they can handle that) - Often given with a vasopressor (helps with vasoconstriction)

Answer 15

- Strengthen cardiac contraction and increase cardiac output Increases client’s BP - Increase kidney perfusion at low doses - Decrease kidney perfusion at high doses…why? (b/c bp goes up) Dopamine Norepinephrine

Answer 16

- Given by IV continuous infusion with constant hemodynamic monitoring - Can titrate to maintain prescribed hemodynamic parameters - Monitor urine output - Give through a central line to prevent extravasation - Rapid onset occurs in 5 min, short duration, lasts 10 min

Answer 17

Vasopressin causes vasoconstriction, increases systemic vascular resistance, increases blood pressure

Answer 18

- Put patient on a monitor - Monitor urine output closely…what should happen? (improvement in urine) - Give through a central line

Answer 19

Rapid acting bronchodialator Increases heart rate and cardiac output

Answer 20

- Vasodilator: Sodium nitroprusside - Used to treat cardiogenic shock - Reduces afterload and preload - Causes vasodilation - Decreases cardiac output: decrease bp - Assess patient’s BP

Answer 21

- Reduces WBC migration and decreases inflammation Things to consider: - May cause hypertension - Should be discontinued slowly - Give with antiulcer medication - Monitor weight and BP - Monitor glucose and electrolytes: can make hyperglycemic

Answer 22

- Because septic shock is most commonly caused by gram-negative bacteria - the Joint Commission’s national patient safety goals recommends the administration of IV antibiotics that are effective against gram negative bacteria within: - 30min to 1 hour of a septic shock diagnosis - Antibiotics sensitive to cultured organisms must be administered! - fever decifers that it is sepsis - vanco most commonly used

Answer 23

Used to treat septic shock Inhibits cell growth or reproduction of causative organism

Answer 24

- Monitor for hypersensitivity of the antibiotics - Administer slowly to prevent Red Mans (90min-2hr) - Obtain blood/body cultures before administering the first dose - Monitor IV site for infiltration - Consider kidney function…how? Why? NEPHROTOXIC - Do not give in same line as other medications: Usually incompatible

Answer 25

Fluid Fluid Fluid! - For every type of shock, the patient will get fluid replacement, except which one? CARDIOGENIC Includes Blood Products - Give 0.9% sodium chloride or Lactated Ringers - During hypovolemic shock, give volume first! What about cardiogenic shock? fluid sparing, 1 fluid blous than inotropes and vasopressors

Answer 26

vasopressor drugs if BP stays low after volume

Answer 27

- Can develop from severe hypotension and reperfusion of ischemic cells, causing further tissue injury. - Inadequate tissue perfusion can cause organ failure in lungs (ARDS), kidneys, heart (decreased coronary artery perfusion), and GI tract (necrosis)

Answer 28

- Assess organ function - Provide support measures that can increase tissue perfusion and improve organ function - Ventilatory support - Inotropic medication Implement measures to compensate for dysfunction - Administer clotting factors (for liver) - Put patient on dialysis (for kidney)