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Shock/MODS/SIRS
| Question | Answer |
|---|---|
| condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function; affects all body systems | shock |
| type of shock? shock state resulting from decreased intravascular volume due to fluid loss | hypovolemic |
| type of shock? shock state resulting from impairment or failure of myocardium | cardiogenic |
| type of shock? circulatory shock state resulting from overwhelming infection causing relative hypovolemia | septic |
| type of shock? circulatory shock state resulting from severe allergic reaction producing overwhelming systemic vasodilation, relative hypovolemia | anaphylactic |
| stage of shock? normal BP, elevated HR and RR, cool/clammy skin, decreased urine output, confusion/mental status change, hypoactive bowel sounds, resp. alkalosis | compensatory |
| stage of shock? decreased BP and MAP, elevated HR, mottling, crackles, ulcers, edema, confusion, stupor, semi-coma, hypoxia, decreased kidney function, oliguria/anuria, metabolic acidosis, lactic acidosis, decreased liver function | progressive (aka decompensation) |
| stage of shock? plan of death, profound acidosis | irreversible (aka refractory) |
| what labs will be elevated with decreased kidney function? | BUN, creatinine |
| decreased liver function can lead to? | decreased clotting factors (which can lead to DIC) |
| type of shock? causes: hemorrhage, dehydration, V/D excess, NG suction, burns, dialysis, trauma | hypovolemic shock |
| type of shock? S/Sx: decreased BP, elevated HR and RR, decreased urine output, change in mental status/LOC, cool/clammy skin, electrolyte imbalance | hypovolemic shock |
| type of shock? Tx: packed RBCs, LR or NS, FFP, albumin, decrease or stop NG suction, Foley cath, EKG/cont. heart monitor, VS q 15-mins, check urine output (at least 30mL/hr), Levophed, antiemetics, antidiarrheals | hypovolemic shock |
| type of shock? causes: **MI**, CAD, CHF, endocarditis, DVT, PE | cardiogenic shock |
| type of shock? S/Sx: angina, crackles, dusky/pale skin, decreased cap refill, dysrhythmias, fatigue, SOB, decreased BP, decreased or elevated HR, low urinary output, cyanosis | cardiogenic shock |
| type of shock? Tx: vasoconstrictors (dopamine, dobutamine), nitro, O2, EKG/heart monitoring, ATB (endocarditis), morphine, Foley cath, strict I&O, VS q 15-mins, anticoagulants | cardiogenic shock |
| type of shock? causes: infection (UTI, pneumonia, endocarditis, wound infection, CLABSI, CAUTI) | septic shock |
| type of shock? S/Sx: elevated temp, altered mental status, decreased BP, elevated HR and RR, decreased urine output | septic shock |
| type of shock? Tx: blood culture x 2 then broad-spectrum ATB, NS, Levophed (central line), A-line (arterial BP, draw labs), VS q 15-mins, hourly urine output, Foley, BG levels, DRSG change (wound vac or wet-to-dry), Tx fever (antipyretics, ice packs) | septic shock |
| type of shock? causes: foods (peanuts, seafood), environmental (insect stings), meds (iodine, PCN, lisinopril) | anaphylactic shock |
| type of shock? S/Sx: SOB, angioedema, throat closure, wheezing, hives, rash, facial edema | anaphylactic shock |
| type of shock? Tx: epinephrine (pen, gtt), benadryl, steroids (solu-medrol), bronchodilators, intubation | anaphylactic shock |
| heparin vs lovenox...which one gets out of system faster? | heparin (lovenox can take up to 24-hrs to get out of system) |
| position to get blood/fluids back to the lungs, heart, brain? | modified Trendelenburg |
| lisinopril allergic reaction? | angioedema |
| steroid that is specific to lungs? | solu-medrol |
| Which stage of shock is characterized by a normal blood pressure? A. Initial B. Compensatory C. Progressive D. Irreversible | B. Compensatory |
| T or F? The most common colloid solution used to treat hypovolemic shock is 5% albumin. | True |
| T or F? The primary goal in treating cardiogenic shock is to limit further myocardial damage. | False. Rationale: The primary goal in treating cardiogenic shock is to treat the oxygenation needs of the heart muscle. |
| When caring for a patient in hypovolemic shock who is receiving large volumes of IV isotonic fluids, the nurse should monitor for symptoms of: A. Hyperthermia B. Pain C. Pulmonary edema D. Tachycardia | C. Pulmonary edema Rationale: The nurse should monitor for circulatory overload & pulmonary edema when large volumes of fluids are given IV. Hypothermia--when fluid not warmed. Pain--cardiogenic shock. Tachycardia--hypovolemic shock. |
| MODS usually begins where? | in lungs |
| presence of altered function of two or more organs in acutely ill patient such that interventions are necessary to support continued organ function | MODS |
| MODS renal Sx | -decreased urine output -increased BUN/CR |
| MODS respiratory Sx | hypoxia, hyoxemia adventitious breath sounds hypercarbia (aka hypercapnia) |
| MODS cardiovascular Sx | decreased B/P hypoperfusion |
| MODS metabolic Sx | -metabolic acidosis -lactic acidemia (lactate >2---something wrong!) |
| MODS hepatic Sx | increased liver enzymes and LFTs (jaundice) |
| MODS neurological Sx | change in mental status/LOC |
| MODS hematological Sx | -decreased clotting factor (can lead to DIC) -thrombocytopenia (give FFP) |
| a syndrome resulting from a severe clinical insult that initiates an overwhelming inflammatory response by the body | systemic inflammatory response syndrome (SIRS) |
| treatment for lactic acidemia | IV fluids (flush out the lactic acid) |
| SIRS S/Sx | -temp <36C (96.8F) or >38C (100.4F) -HR >90 -RR >20 or PaCO2 <32 -WBC count <4000 or >12000, or >10% immature WBC (bands) |
| a systemic response to infection; manifested by two or more of the SIRS criteria as a consequence of documented or presumed infection | sepsis |
| the presence of S/Sx sepsis associated with organ dysfunction, hypotension, and/or hypoperfusion; clinical S/Sx include those of sepsis as well as: lactic acidosis, oliguria, altered LOC, thrombocytopenia & coagulation disorders, altered hepatic function | severe sepsis |
| normal urine output? | 0.5mL/kg/hr |
| used to assess preload in the right side of the heart; the value assists in monitoring the pt’s response to fluid replacement, especially when it is used with additional assessment parameters (e.g., urine output, HR, BP response to fluid challenge) | CVP (central venous pressure) line |
| vasopressor med action? inotropic med action? | vasopressor--raise BP inotropic--raise cardiac output |
| initial and first vasopressor of choice? | Levophed (norepinephrine) |
| ATB administration should occur within what time frame? | within 3-hrs of admission to ER or within 1-hr of inpatient admission |
| ideal glucose level for shock? | <180 |
| inflammation of the pia mater, the arachnoid, and the cerebrospinal fluid–filled subarachnoid space | meningitis |
| meningitis types? mode of transmission? | bacterial and viral; droplet, airborne |
| S/Sx: HA (chiss---for Sandra and Rachel : ) ), + Kernig's sign, + Brudzinski's sign, nuchal rigidity, photophobia, fever (risk for seizures), change in LOC, behavioral changes | meningitis |
| Tx: lumbar puncture, ATBs (for bacterial), acyclovir (for viral), steroids (dexamethasone), Tx for HA and fever, anti-seizure meds (Keppra, Dilantin, Depakote, Phenobarbital) | meningitis |
| med that is both an antipyretic and analgesic that passes the blood-brain barrier? | Tylenol |
| When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. When this is bilateral, meningeal irritation is suspected. | + Kernig's sign |
| When the patient’s neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity. | + Brudzinski's sign |
| a decrease in the partial pressure of oxygen in the blood | hypoxemia |
| reduced level of tissue oxygenation | hypoxia |
| MAP formula? | (SBP + (DBP x 2)) / 3 |
| You are caring for a client in the compensation stage of shock. You know that one of the body's mechanisms of compensation in this stage of shock is the renin-angiotensin-aldosterone system. What does this system do? | restores blood pressure |
| How should vasoactive medications be administered? | using a central venous line |
| a BUN-to-serum creatinine concentration ratio greater than ___ is indicative of volume depletion | 20:1 |
| normal BUN level? | around 7-20 |
| type of IV fluid? solution is used to pull water back in to circulation, as it has more particles than the body’s water | hypertonic solution |
| type of IV fluid? total osmolality close to that of the ECF and do not cause red blood cells to shrink or swell | isotonic solution |
| type of IV fluid? the cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis; this will cause CELL SWELLING which can cause the cell to burst or lyses | hypotonic solution |
| -inotropic meds -action: improve contractility, increase stroke volume, increase cardiac output -disadvantages: increase oxygen demand of the heart | Milrinone (Primacor) Epinephrine (Adrenalin) Dobutamine (Dobutrex) Dopamine (Intropin) |
| -vasodilator meds -action: reduce preload and afterload, reduce oxygen demand of heart -disadvantages: cause hypotension | nitroglycerin (Tridil) nitroprusside (Nipride) |
| -vasopressor meds -action: increase blood pressure by vasoconstriction -disadvantages: Increase afterload, thereby increasing cardiac workload; compromise perfusion to skin, kidneys, lungs, gastrointestinal tract | Vasopressin (Pitressin) Phenylephrine (Neo-Synephrine) Epinephrine (Adrenalin) Norepinephrine (Levophed) Dopamine (Intropin) |
| lactate ion converts to _____ by the liver; assists with treating acidosis | bicarbonate |
| The health care provider prescribes a vasoactive agent for a patient in cardiogenic shock. The nurse knows that the drug is prescribed to increase blood pressure by vasoconstriction. What is most likely the drug that is ordered? | Levophed |
| med given for bacterial meningitis? med for viral meningitis? steroid that is given for both? | ATBs (for bacterial), acyclovir (for viral), dexamethasone |
| what do you give for thrombocytopenia? | fresh frozen plasma (FFP) |
| In the treatment of shock, which of the following vasoactive drugs result in reduced preload and afterload, reducing oxygen demand of the heart? -Nitroprusside -Dopamine -Epinephrine -Methoxamine | Nitroprusside (a disadvantage of nitroprusside is that it causes hypotension) |
| The nurse is monitoring a patient in the compensatory stage of shock. What lab values does the nurse understand will elevate in response to the release of aldosterone and catecholamines? | sodium and glucose levels |
| A client presents to the ED in shock. At what point in shock does the nurse know that metabolic acidosis is going to occur? -Compensation -Irreversible -Early -Decompensation | decompensation (occurs as compensatory mechanisms fail; the client’s condition spirals into cellular hypoxia, coagulation defects, and CV changes; as energy supply falls below the demand, pyruvic and lactic acids increase, causing metabolic acidosis) |
Created by:
nurse savage
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