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Shock/MODS/SIRS

QuestionAnswer
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