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Adult Nursing 2.0 Exam 2 > Shock part 2 > Flashcards

Shock part 2 Flashcards

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1
Q

Can you bringback deal cells/organs

A

Nope

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2
Q

What are the main forms of care we provide for shock?

A

Supplemental oxygen is given.
Replace fluids to restore volume.
Vasoactive medications
Nutritional support to address metabolic requirements (later on - its complicated since they are already in a hyper-metabolic state )

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3
Q

Main goals of shock management?

A

1) optimize o2 delivery
2) decrease the o2 being consumed

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4
Q

You think your patient isn’t perfusing well. What lab is a clue for hypo-perfusion?

Explain

A

Increased lactate levels greater than 2 mMol/L

Lactate is the byproduct of anaerobic metabolism. This occurs when the there’s a lack of oxygen and you need to use carbs.

Rt metabolic acidosis

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5
Q

You see that the lactate is high and this means hypo perfusion. What other labs/measurements can you check rt to shock?

A

Blood glucose - due to the hyper metabolic state

CRP related to inflammation

WBC related to sepsis

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6
Q

What IV fluids are used for shock?

A

crystalloids = restore interstitial fluid and volume to increase preload and CO

colloids = enhance blood oxygens carrying capacity

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7
Q

You have a patient with hyperlactatemia. What lab exam do you grab (aside from lactate)?

How can you regulate it?

A

Grab an ABG to look at co2 levels.

This is related to metabolic acidosis. May have to turn off the rate on the vent to let them blow the co2 off.

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8
Q

Your patient has been put on a vent. How will that effect your CVP/preload reading?

A

CVP will be lower due to the affect the vent has on CO.

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9
Q

For a patient with shock, what interventions/orders help with perfusion and delivery of oxygen?

A

Supplemental Oxygen

IV fluids

Inotropic drugs

Vasoactive drugs

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10
Q

What routes of supplemental oxygen do stroke patients receive?

A

They can be on everything from NC to the vent. The point is, we can give oxygen to them to help with the perfusion.

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11
Q

What categories IV fluids will we want to use to increase perfusion and oxygen delivery for shock patients?

A

Combination of crystalloids and colloids.

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12
Q

What do crystalloid IV fluids do?

A

Crystalloids IV fluids restore interstitial and intravascular volume by increasing

  • preload (CVP)
  • CO
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13
Q

What do colloid IV fluid do for shock patients?

A

Colloids are there to enhance the patient’s blood oxygen carrying capacity to get more o2 to their cells.

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14
Q

What Inotropic drugs do we use for shock? (3)

A

Dopamine

Dobutamine

Milrinone

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15
Q

You see your shock patient on 5mcg/kg/min of dopamine. What is the reason for this? And how can you evaluate its working?

A

5mcg is a renal dose (anything >5mcg is for renal). We use it for its inotropic properties for shock patients to increase perfusion of kidneys to increase UO and to help with contractility.

So, you can check the if there’s increased CO to see if it is working.

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16
Q

Your patient’s BP is dropping. What dose of dopamine will you use and why?

A

Do a cardiac dose so greater than 10 mcg to increase the BP by vasoconstriction.

Remember: dopamine is a two fold drug. You can either dilate vessels to help out kidneys or you can let it be a pressor. In this case, we needed pressor for BP.

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17
Q

What is the difference between dopamine and dobutamine?

A

Dobutamine helps with contractility and CO but it won’t affect your heart rate .

  • Good to use for patients who already have a “troubled or worn out” heart
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18
Q

Your shock patient is given dobumatine. What is a good marker to look for to evaluate the med?

A

SVR decreases!

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19
Q

Your patient with a hx of MI has a high SVR reading. What med do you anticipate giving?

A

Probably dobutamine. It should decrease SVR without making the heart have to overwork and risk MI again.

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20
Q

What type of drug is Milrinone?

What does it affect?

What marker is a good tool to evaluate it?

A

Phosphodiesterase inhibitor that effects contractility and increases the CO.

SVR should decrease here too

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21
Q

How do they choose between Milirnone or Dobutmine?

A

It really just depends. Sometimes its picked bc the doctor likes it.

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22
Q

List the vasoactive drugs ABC order

A

Epinephrine

Dopamine

Norepinephrine

Vasopressin

23
Q

Which vasoactive drug do patients with CABG come back on?

What meds will you need?

A

Epinephrine - which causes hyper metabolism.

They will need an insulin drips.

24
Q

What is the goal of using a vasoactive drug?

How do they work?

A

Drives BP and Cardiac output

They do this by mimicking the sympathetic nervous system to increase below flow to organs

25
Q

What is the first line agent to correct hypotension (related to shock)?

A

Norepinephrine (Levophed)

26
Q

What vasodilators** can we use to help with perfusion for shock? Why do they help?

A

Nitroprusside (Nipride)

Nitroglycerin

They reduce the afterload of the heart by dilating vessels

27
Q

What is the main reason we wouldn’t want to use Nitroglycerin to help with perfusion by decreasing afterload?

A

Wouldn’t want to use Nitroglycerins with an MI patient

28
Q

T/F

Vasodilators decrease SVR

A

True! They decrease afterload svr

29
Q

What do you need to monitor for when using Nipride?

A

Cyanide toxicity

30
Q

Cyanide toxicity symptoms related to Nipride

A

Almond breath

Acidosis, tachycardia, mental status changes, and even death.

31
Q

What is the treatment for cyanide toxicity due to nipride?

How can you avoid the toxicity?

A

Theosulfate

Avoid it by having a cumulative dose less than 0.5 mg/kg/hr

32
Q

What are vasodilators supposed to do again?

What do nitro and nipride do to SV?

A

They dilate vessels to decrease SVR in order to increase the output.

Stroke volume will increase and so will cardiac output

33
Q

What is a simple nursing intervention you can do if you see your patients BP is tanking?

A

Modified Trendelenburg - It gets blood back up to the heart for perfusion.

  • short term
34
Q

What is a contraindication of doing the modified Trendelenburg for shock/tanking BP?

A

A trauma patient most likely

35
Q

What methods can be used to reach the goal of decrease the consumption of O2?

A

Mechanical ventilation

Neuromuscular blocking drugs

Sedation

Pain & anxiety control

36
Q

Why do we use mechanical ventilation for shock?

A

It decreases workload for them and therefore decreases the amount of O2 they use up.

37
Q

What neuromuscular drugs/paralytics can we use to decrease o2 consumption?

A

Pavulon (pancronium)

Norcuran (veruronium)

38
Q

Why would we use a neuromuscular paralytic for shock patient on vent?

A

It keeps them from moving so they don’t use up all of their oxygen that’s left

39
Q

What sedative drug do we use a lot for shock patients on the vent and why?

A

Use a sedative like Propofol to sedate them to aid in helping them not use as much o2.

40
Q

You’re using Propofol as a sedative for your vented patient.

What is a big nursing consideration?

A

Propfolol is a sedative with a short half life. So, never let it run dry because your patient will be waking up and bucking the vent.

41
Q

We have a paralytic and sedative onboard for a vented patient. What other med do you anticipate?

A

Anticipate an analgesic for pain

Anxiolytic for anxiety

Antipyretic analgesic for fever - we don’t want them to shiver.

42
Q

Evidence based practice slide

A

Early intervention is best

Tight Glucose control is key with insulin drip

Low tidal volume ventilation settings

43
Q

When should initial resuscitation take place with septic shock?

A

First 6 hours for septic shock

  • those elderly patients that come in that have urosepsis … it’ll be too late.
44
Q

When managing treatment shock, what measurements do we want to watch?

A

CVP

MAP

Urine output

Central venous o2 sat

45
Q

When managing Septic shock…

What CVP do we want?

What MAP do we want?

A

CVP should be 8-12

Map should be greater than 65

46
Q

When managing Septic shock..

What should UO be?

What should central venous O2 sat be?

A

Urine output. needs to be greater than 0.5 ml/kg/hr

Central venous o2 sat needs to be greater than 70%

47
Q

How do we diagnose septic shock?

How many sites?

A

Ideally we would like a blood cultures taken before antibiotics but this doesn’t always happen.

48
Q

How many sites do get for diagnosing septic shock?

What types?

A

We want 2 or more blood cultures from 2 different sites.

With at least one percutaneous. One from each vascular access place that’s been in place for 48 hours

49
Q

You get all your septic shock patient orders in all at once. Do you hang the antibiotics or do you get the culture first?

A

You’d hang the broad spectrum antibiotic. This is bc cultures take forever to get back and this is a SHOCK patient. The window is just too tight.

50
Q

How soon do you hang antibiotics within the diagnosis? (this could be broad or specialized)

A

Hang antibiotics within 1 hour of the diagnosis

51
Q

What is a broad spectrum antibiotic?

A

Broad spectrum means it’s able to treat one or more bacterial/fungal infections.

52
Q

You hung your broad spectrum antibiotics before giving the culture. What should you as the nurse be on the look out for on the computer?

A

Look for the culture results so you can see if there’s going to be a more specialized antibiotic needed.

53
Q

T/F

You can only use one antibiotic at a time for a septic shock patient

A

False. You will often use combo antibiotic therapy.

54
Q

How long can we use antibiotic treatments and why?

A

Limit antibiotic treatment to 7-10 days due to C. diff.

Adult Nursing 2.0 Exam 2 (11 decks)

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