Unit 16 Neurogenic, Anaphylactic, Septic Shock Flashcards
What is shock?
Imbalance between supply of oxygen and demand
What is the body’s response to shock during each stage?
Compensated stage: Increased HR and RR,
Uncompensated stage: Decreased BP
Irreversible stage: PT can develop MODS, decreased cardiac output, body accumulates waste products
What is Neurogenic shock?
What are some S and S’s?
What are some causes?
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
What is the treatment/nursing interventions for Neurogenic shock?
- PT positioning, head down feet up, modified trend.
- Treat underlying disorder (immobilize spine for spinal cord injuries)
- Atropine/epinephrine to increase HR if needed
What is Anaphylactic shock?
- Life threatening allergic reaction
- Can happen within 20 minutes
- Usually not does not happen the first time exposed to the substance
What are signs and symptoms of Anaphylactic shock?
- Skin urticaria “Hives” (skin symptoms first)
- Anxiety
- Respiratory distress: stridor, wheeze, tachypnea, apnea, cyanosis, bronchospasms
- Cardiac: tachycardia, hypotension, dizziness, chest pain
What are the treatments/interventions for Anaphylactic shock?
Removal of causative agent (ex: antibiotic, latex, etc.)
Medications to restore vascular tone
Emergency life support
IV access
ID bracelet
Regarding giving the first dose of antibiotics with RN’s and LPN’s what is true?
RN’s give the first dose
What is the pharmacological treatment for Anaphylactic shock?
What to they do?
- Epinephrine (vasoconstricts, bronchodilates)
- Diphenhydramine (blocks release of anti-histamine)
- Nebulized medication (reduces bronchospasms)
- IV fluids
How and when is an EpiPen used?
What are the normal dosages for adults and children?
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
What is Systemic Inflammatory Response Syndrome (SIRS)?
Severe nonspecific response to conditions such as trauma, burns, or other major events (ischemia, infarction) that causes the inflammatory process to begin.
What is the Systemic Inflammatory Response Syndrome (SIRS) criteria and how many do you need to have it be considered SIRS?
Temp > 38 or < 36
HR > 90
Hyperventilation (Increased RR, decreased CO2)
WBC > 12,000 or < 4,000
2 or more of these = SIRS
What is Septic shock?
What is the Sepsis to septic shock continuum?
- Widespread infection causing organ failure and dangerously low blood pressure.
- Medical emergency
- Most common type of distributive shock
Infection to Sepsis to Septic Shock
What are the stages of Septic shock?
Infection (in blood)
Pre-shock/SIRS (warm flushed skin)
Shock (Decreased BP, cool-pale skin)
Irreversible organ dysfunction
What are risk factors for developing Sepsis?
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)
What is the pharmacological therapy to treat Sepsis?
Culture than broad-spectrum antibiotics:
-cephalosporins, aminoglycosides
- O2
- IV fluids
What is nursing management for Sepsis?
Nutritional therapy
Monitor invasive line sites for infection
Hyperthermia
Monitor and report changes in status
What is Sepsis?
- Life-threatening organ dysfunction due to un-regulated response to infection.
- Exaggerated response to infection
What are the signs and symptoms of Sepsis?
- 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
What is the treatment for Sepsis if organ failure recognized within 3 hours?
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
Why are enteral feedings preferred?
Nutrition provided via the GI tract maintains gut integrity and prevents bacterial translocation
What is used after the 3 hour bundle for Sepsis?
Treatment continues within 6 hours of presentation with:
- Remeasure lactate in initial lactate was elevated
- Apply vasopressors (norepinephrine, etc)
- Give fluids if hypotensive
- ICU
What are the target value outcomes for a PT w/Sepsis?
CVP > = 8
MAP 65
SVO2 > = 65
Urine output 30-50 ml/hr
Lactate level < 4
What PT should not be delayed to the ICU?
PT w/ Septic shock
-hypotension
and
-serum lactate >= 4
What targets aren’t met in Sepsis, what should be considered?
More fluids
Other meds:
-Dopamine, phenylephrine, vasopressin
Other therapies:
- Ventilators
- Blood products
- Manage glucose
- Renal replacement therapy
What is Disseminated Intravascular Coagulation (DIC)?
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
Describe DIC.
Secondary disorder
Hematologic failure (organ dysfunction)
Coagulation system chaos
How do you identify DIC?
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)
What is the treatment DIC?
Blood products:
-Replace consumed factors (platelets, fresh frozen plasma)
Herpain: to inhibit coagulation cascade
