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nursing 272: final semester > Unit 1: Neurogenic Shock > Flashcards

Unit 1: Neurogenic Shock Flashcards

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1
Q

Neurogenic Shock

A
  • distributive shock
  • a disruption in sympathetic nervous system stimulation
  • vasodilation and hypovolemia; hypoperfusion
  • loss of vasomotor tone
  • vessel walls relaxing and dilating
  • bradycardia
  • hypotension
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2
Q

Sympathetic Nervous System Disruption

A

a disruption in SNS stimulation = a inability of vascular smooth muscle to constrict = decreased blood return to the heart and decreased cardiac output
-bradycardia, hypoperfusion

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3
Q

Causes of Neurogenic Shock

A
  • spinal cord injury (above T6 level)
  • stroke in the brain stem
  • high doses of barbiturates and anesthesia techniques (both general and regional)
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4
Q

Clinical Manifestations of Neurogenic Shcok

A
  • decreased vascular tone; vulnerable to hypoperfusion
  • warm and dry skin d/t vasodilation
  • hypovolemia b/c the size of the systemic vasculature has expanded w/o current increase in volume to fill that expanded space
  • bradycardia
  • hypotension
  • changes in LOC
  • metabolic acidosis
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5
Q

Medical Management of Neurogenic Shock

A
  • Correcting primary etiology
  • Correcting the Cardiovascular effects (hypotension, bradycardia)
  • Fluid resuscitation (boluses of crystalloids to increase stretch of the myocardial fibers in the atria = an increase in strength of ventricular contractions and increased cardiac output)
  • Vasoactive infusions (e.g. norepinephrine (Levophed), epinephrine (adrenaline), phenylephrine (Neo-Synephrine)
  • Atropine to block vagal (parasympathetic) stimulation
  • Transcutaneous or transvenous pacing capabilities to treat sustained symptomatic bradycardia
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6
Q

Vasoactive Tx for Loss of Vascular Tone

A
  • phenylephrine
  • norepinephrine
  • epinephrine
  • dopamine
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7
Q

Fluid resuscitation

A

to restore vascular volume and improved systemic perfusion

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8
Q

How to treat Episodic Bradycardia

A
  • parasympatholytic medications (Atropine)

- transcutaneous and then transvenous pacing ay be used to treat repeated episodes of bradycardia

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9
Q

Serum Lactate (lactic acid) Levels and ABGs

A

to monitor acidosis and judge effectiveness of resuscitation strategies

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10
Q

Ongoing Tx of decreased vascular tone

A

-oral sympathomimetics, causing constriction of the peripheral vasculature

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11
Q

Complications of Neurogenic Shock

A
  • Continued systemic hypoperfusion leading to multisystem organ failure
  • Hypoperfusion occurs as a result of massive systemic vasodilation causing a reduction in cardiac output and blood pressure
  • Bradycardia can occur, further compromising blood flow to vital tissues and organs b/c of disruption of sympathetic outflow; contributes to decreased cardiac output and BP
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12
Q

Nursing Management: Assessment and Analysis

A

w/ neurogenic shock, require cardiovascular monitoring in order to detect bradycardia, dysrhythmias, and hypotension that result from a disruption in sympathetic innervations

> Rapid Medical Interventions:

  • atropine
  • transcutaneous or transvenous pacing
  • fluid resuscitation
  • vasoactive medications
  • ongoing assessments: monitoring cardiac output, intravascular volume, and other hemodynamic parameters
  • mechanical ventilation depending on underlying cause
  • management of complications: DVT, PE, and skin breakdown
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13
Q

Rapid Medical Interventions

A
  • Atropine
  • Transcutaneous or Transvenous Pacing
  • Fluid resuscitation
  • Vasoactive medications
  • Ongoing Assessments: monitoring cardiac output, intravascular volume, and other hemodynamic parameters
  • Mechanical ventilation depending on underlying cause
  • Management of complications: DVT, PE, Skin breakdown
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14
Q

Nursing Diagnoses

A
  • Impaired tissue perfusion r/t hypotension, bradycardia, and peripheral vasodilation
  • Risk for fluid volume deficit d/t hypovolemia that occurs w/ loss of vasomotor tone and maldistribution of volume in vascular space
  • Anticipatory grieving r/t sudden loss of function and accompanying critical illness
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15
Q

Nursing Assessments for Neurogenic Shock

A
  • Vital signs q 1-2 hours for vasoactive infusions
  • Hemodynamic Parameters q 2 to 4 hours or after tx of bolus or fluid
  • Intake + Output q 1-2 hours
  • Physical Assessment at q 4 hours
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16
Q

Assessments: Vital Signs q 1-2 hours for vasoactive infusions

A

> norepinephrine (Levophed); phenylephrine (Neo-Synephrine)

  • allows identification of cardiovascular deterioration (hypotension, bradycardia)
  • may require further intervention: titration of vasoactive meds; use of pacemaker; atropine (increases HR)
17
Q

Assessments: Hemodynamic Parameters q 2 to 4 hours or after tx of bolus or fluid

A

> Central venous pressure (CVP), Pulmonary artery occlusion pressure (PAOP), cardiac output/ cardiac index (CO/CI), stroke volume (SV), systemic vascular resistance (SVR)

  • measure q 2 to 4 hours or after tx of bolus of IV infusions
  • to evaluate response of therapies
  • CVP or PAOP to determine adequate vascular volume or preload is established
  • CO or CI to determine overall condition of vascular system
  • SVR to quantify the degree of vasoconstriction or vasodilation in the vascular system (afterload)
18
Q

Assessments: Intake and Output q 1-2 hours

A

determines if fluid balance is in excess or if patient requires additional fluid

19
Q

Assessment: Physical Assessment at least q 4 hours

A

-helps in detecting multisystem complications that may arise

>ARDs, pneumonia, paralytic ileus, skin breakdown

20
Q

Nursing Actions

A
  • Raise HOB slowly (10-15 degrees/hour) in a systematic matter
  • Assist w/ insertion of an arterial line for continuous BP monitoring
  • Assist w/ insertion of a pulmonary artery catheter in situations where cardiovascular function is severe
  • IV fluids and IV sympathomimetic agents
  • Atropine
  • Prepare for Transcutaneous pacing if patient does not have transvenous pacing wires in place
  • Implement VTE prophylaxis
21
Q

Nursing Actions: Raise HOB slowly (10-15 degrees/hour) in a systematic matter

A
  • b/c of loss of systemic vascular tone, raising HOB may cause orthostatic hypotension b/c of an inability of the peripheral blood vessels to constrict upon position change
  • orthostatic hypotension may cause hemodynamic instability (lowered BP and cardiac output)
22
Q

Nursing Actions: Assist w/ insertion of an arterial line for continuous BP monitoring

A
  • enables continuous monitoring of BP and the ability to set alarm parameters so that hypotension is immediately identified
  • frequent blood sampling for ABGS and lab tests is facilitated by presence of arterial line
23
Q

Nursing Actions: Assist w/ insertion of a pulmonary artery catheter in situation where cardiovascular function is severe

A

-allows for frequent monitoring of preload (CVP and PAOP), afterload (SVR), and contractility

24
Q

Nursing Actions: IV fluids and IV Sympathomimetic agents (phenylephrine, norepinephrine)

A
  • fluid resuscitation to increase vascular volume; which is inadequate compared to the increased in the size of vascular space d/t vasodilation
  • sympathomimetics increase vasomotor tone; reflected as an increase in systemic vascular resistance (SVR)
  • raise cardiac output; restore adequate tissue perfusion
25
Q

Nursing Actions: Atropine

A
  • inhibit vagal nerve action (parasympathetic)

- increases HR

26
Q

Nursing Actions: Prepare for transcutaneous pacing if pt does not have transvenous pacing wires in place

A
  • temporary pacemaker to manage bradycardia in neurogenic shock b/c of sympathetic nervous system dysfunction
  • if dysfunction of sympathetic nervous system is irreversible, a permanent pacemaker may be required
27
Q

Nursing Actions: VTE prophylaxis

A
  • high risk for VTE; especially if etiology is spinal cord injury
  • sequential compression devices
  • pneumatic foot pumps
  • pharmacological methods
28
Q

Nursing Teaching

A
  • Explain specific cause of neurogenic shock and anticipated impact on immediate and future hospital care
  • explain reason for medical therapy
  • explain supportive therapies
29
Q

Evaluating Care Outcomes

A
  • monitoring of patients response to interventions is necessary to establish and maintain adequate tissue perfusion
  • tissue perfusion compromised b/c of systemic hypoperfusion
  • evaluation of BP, HR, RR, hemodynamic parameters (preload [CVP; PAOP]) provides info on therapy effectiveness
  • evaluation of mentation
  • vascular tone managed w/ sympathomimetics
  • bradycardia may be managed w/ pacemaker

nursing 272: final semester (79 decks)

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