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Nursing 4 Exam 3 > Unit 16 Neurogenic, Anaphylactic, Septic Shock > Flashcards

Unit 16 Neurogenic, Anaphylactic, Septic Shock Flashcards

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1
Q

What is shock?

A

Imbalance between supply of oxygen and demand

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2
Q

What is the body’s response to shock during each stage?

A

Compensated stage: Increased HR and RR,

Uncompensated stage: Decreased BP

Irreversible stage: PT can develop MODS, decreased cardiac output, body accumulates waste products

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3
Q

What is Neurogenic shock?
What are some S and S’s?
What are some causes?

A

Vasodilation occurs because of a loss of balance between parasympathetic and sympathetic stimulation.
-Relative/Internal hypovolemia

S and S’s:

  • Skin warm and flushed
  • Decreased BP
  • Decreased HR
  • Decreased perfusion

Causes:
-Spinal cord injury, spinal anesthesia

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4
Q

What is the treatment/nursing interventions for Neurogenic shock?

A
  • PT positioning, head down feet up, modified trend.
  • Treat underlying disorder (immobilize spine for spinal cord injuries)
  • Atropine/epinephrine to increase HR if needed
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5
Q

What is Anaphylactic shock?

A
  • Life threatening allergic reaction
  • Can happen within 20 minutes
  • Usually not does not happen the first time exposed to the substance
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6
Q

What are signs and symptoms of Anaphylactic shock?

A
  • Skin urticaria “Hives” (skin symptoms first)
  • Anxiety
  • Respiratory distress: stridor, wheeze, tachypnea, apnea, cyanosis, bronchospasms
  • Cardiac: tachycardia, hypotension, dizziness, chest pain
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7
Q

What are the treatments/interventions for Anaphylactic shock?

A

Removal of causative agent (ex: antibiotic, latex, etc.)

Medications to restore vascular tone

Emergency life support

IV access

ID bracelet

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8
Q

Regarding giving the first dose of antibiotics with RN’s and LPN’s what is true?

A

RN’s give the first dose

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9
Q

What is the pharmacological treatment for Anaphylactic shock?
What to they do?

A
  1. Epinephrine (vasoconstricts, bronchodilates)
  2. Diphenhydramine (blocks release of anti-histamine)
  3. Nebulized medication (reduces bronchospasms)
  4. IV fluids
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10
Q

How and when is an EpiPen used?

What are the normal dosages for adults and children?

A

IM injection 90 degree angle into thigh, hold 10 seconds, then massage for 10 seconds.

-For use at home, doctor’s office, emergency situations

Adult dosage: 0.3 mg
Child dosage: 0.15 mg

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11
Q

What is Systemic Inflammatory Response Syndrome (SIRS)?

A

Severe nonspecific response to conditions such as trauma, burns, or other major events (ischemia, infarction) that causes the inflammatory process to begin.

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12
Q

What is the Systemic Inflammatory Response Syndrome (SIRS) criteria and how many do you need to have it be considered SIRS?

A

Temp > 38 or < 36

HR > 90

Hyperventilation (Increased RR, decreased CO2)

WBC > 12,000 or < 4,000

2 or more of these = SIRS

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13
Q

What is Septic shock?

What is the Sepsis to septic shock continuum?

A
  • Widespread infection causing organ failure and dangerously low blood pressure.
  • Medical emergency
  • Most common type of distributive shock

Infection to Sepsis to Septic Shock

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14
Q

What are the stages of Septic shock?

A

Infection (in blood)

Pre-shock/SIRS (warm flushed skin)

Shock (Decreased BP, cool-pale skin)

Irreversible organ dysfunction

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15
Q

What are risk factors for developing Sepsis?

A

Immunosuppression (PT’s on corticosteroids, other conditions, etc)

Extreme age (very young or very old)

Malnourishment

Chronic illness (HIV, diabetes, CRF, Liver failure, etc)

Invasive procedure (central lines, surgical procedures)

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16
Q

What is the pharmacological therapy to treat Sepsis?

A

Culture than broad-spectrum antibiotics:
-cephalosporins, aminoglycosides

  • O2
  • IV fluids
17
Q

What is nursing management for Sepsis?

A

Nutritional therapy

Monitor invasive line sites for infection

Hyperthermia

Monitor and report changes in status

18
Q

What is Sepsis?

A
  • Life-threatening organ dysfunction due to un-regulated response to infection.
  • Exaggerated response to infection
19
Q

What are the signs and symptoms of Sepsis?

A
  • Known or suspected infection
  • SIRS criteria (at least two)**
  • Dysfunction of an organ: lactate level 4mMol/L or more, other labs
  • ALOW
  • Decreased urine output
  • Petechiae
20
Q

What is the treatment for Sepsis if organ failure recognized within 3 hours?

A

3 Hour Sepsis Bundle:
-Measure serum lactate level

  • Blood cultures prior to antibiotics
  • Administer broad spectrum antibiotcs
  • Administer 30 ml/kg crystalloid fluid for hypotension or lactate level > or = to 4mMol
21
Q

Why are enteral feedings preferred?

A

Nutrition provided via the GI tract maintains gut integrity and prevents bacterial translocation

22
Q

What is used after the 3 hour bundle for Sepsis?

A

Treatment continues within 6 hours of presentation with:

  • Remeasure lactate in initial lactate was elevated
  • Apply vasopressors (norepinephrine, etc)
  • Give fluids if hypotensive
  • ICU
23
Q

What are the target value outcomes for a PT w/Sepsis?

A

CVP > = 8

MAP 65

SVO2 > = 65

Urine output 30-50 ml/hr

Lactate level < 4

24
Q

What PT should not be delayed to the ICU?

A

PT w/ Septic shock

-hypotension
and
-serum lactate >= 4

25
Q

What targets aren’t met in Sepsis, what should be considered?

A

More fluids

Other meds:
-Dopamine, phenylephrine, vasopressin

Other therapies:

  • Ventilators
  • Blood products
  • Manage glucose
  • Renal replacement therapy
26
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Condition which small blood clots develop throughout bloodstream, blocking vessels and therefor perfusion.

Increased clotting depletes platelets and clotting factors needed to control bleeding, which causes excessive bleeding.

-Triggered by Sepsis, shock, cancers, snake bites

27
Q

Describe DIC.

A

Secondary disorder

Hematologic failure (organ dysfunction)

Coagulation system chaos

28
Q

How do you identify DIC?

A

Symptoms like:

  • Bleeding from membranes
  • Petechiae

Labs:

  • Platelets low (norm 150-500)
  • Fibrinogen low (norm 150-400)
  • PT/PTT and thrombin time high
  • D-dimer high (norm < 400)
29
Q

What is the treatment DIC?

A

Blood products:
-Replace consumed factors (platelets, fresh frozen plasma)

Herpain: to inhibit coagulation cascade

Nursing 4 Exam 3 (7 decks)

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