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SHOCK (perfusion)
| Question | Answer |
|---|---|
| Define Shock | -widespread abnormal cellular metabolism when oxygen and tissue cannot maintain cellular function - ALL body organs are affected |
| Define multiple organ dysfunction syndrome (MODS) | - progressive organ dysfunction in two or more body systems requiring medical intervention |
| Define Sepsis | -Life-threatening organ dysfunction caused by systemic inflammation and coagulation in response to infection |
| Define Septic Shock | -Subset of sepsis in which circulatory, cellular, and metabolic alterations are associated with a higher mortality rate than sepsis alone |
| Define Sympathetic tone | - state of partial vasoconstriction caused by nerves that continuously stimulate vascular smooth muscle |
| Define Systemic Inflammatory response syndrome | - widespread inflammation that can occur with septic shock |
| Define anaphylaxis | - extreme type of allergic reaction |
| define hypovolemic shock | - loss of vascular volume resulting in decreased perfusion - ex: hemorrhage, severe burns, severe dehydration |
| define Cardiogenic shock | - heart muscle is impaired resulting in decreased perfusion -ex: Major MI, cardiac arrythmia, pulmonary embolism |
| Define Distributive shock | -systemic vasodilation and blood pooling in capillary beds and intestinal tissues resulting in decreased perfusion - Septic, neurogenic, anaphylactic |
| Neurogenic (distributive) shock | - caused by CNS injury |
| Sepsis (distributive) shock | - causes vasodilation, endothelial damage, capillary leak |
| Define initial stage (stage 1) | - mild decreased perfusion: MAP DROPS 5-10mmhg -smalls cellular level changes -normal vitals, difficult to detect indicators of shock at this stage |
| Define Compensatory stage (stage 2) | -compensatory mechanisms activated - MAP DROPS 10-15mmhg -RAAS and urine output decreases -mild acidosis -restlessness, irritability, ^HR, ^RR, narrow pulse pressure, decreased O2, cool extremities, mild hyperkalemia -thirst/anxiety subjective to pt |
| Define Progressive stage (stage 3) | -vital organs develop hypoxia -impending doom -rapid, weak pulse; low bp; pallor; cool moist mottled skin; anuria; decreased O2 -acidosis -increased lactic acid and potassium levels -correct in 1hr or shock progresses to refractory stage |
| Define refractory stage | - too little oxygen reaches tissues; cell death and tissue damage result - multiple organ dysfunction syndrome (mods) occurs - rapid loss of consciousness, nonpalpable pulse, cold, dusky extremities; slow shallow respirations, unmeasurable O2 |
| What occurs during MODS? | - high mortality rate - rapid loss of consciousness -nonpalpable pulse - cool extremities - unmeasurable O2 (review code status, call code blue) |
| SIRS CRITERIA | - 2 out of 4 must be present -temp: fever >38 or hypothermia <36 -tachycardia >90bpm - tachypnea >20breaths/min -leukocytes(WBC): >12,000 or <4,000 |
| Sepsis Health promotion | -identify those at risk -use aseptic technique -remove foley caths when no longer needed -remove other invasive lines when no longer needed - wean from ventilators as soon as possible - early detection |
| Sepsis: Who's at risk? | -malnutrition -immunocompromised/HIV/AIDS -large, open wound -recent surgery -cancer, diabetes, chronic kidney disease -alcoholism -hepatitis -advances age (65+) |
| Sepsis Diagnostic tests | -CBC (wbc, platelets) -serum lactate - arterial blood gases (ph level) -CMP ( electolytes /k+, blood urea nitrogen, creatinine, urine specific gravity, and osmolality. -blood cultures -hemodynamic monitoring -X-ray, CT, MRI -endoscopic exam -ECG |
| Sepsis Pharmacological Therapy (1/2) | Antimicrobials for bacterial/fungal infection -broad-spectrum antibiotics *condition may worsen initially due to increasing numbers of toxins released in bloodstream from pathogen destruction -vasopressors -inotropic drugs (milrinone, dobutamine) |
| Sepsis Pharmacological Therapy (2/2) | Oxygen Therapy: -establish/maintain patent airway -ensure adequate oxygenation -endotracheal intubation/ventilation may be needed Fluid Replacement: -Most effective treatment for septic shock -IV fluids or blood -two large bore lines or one central |
| Vasopressors | - strengthens cardiac contraction and increases cardiac output -uses: shock -ex: Dopamine, Norepinephrine (continuous IV) -titratable to keep hemodynamic status in normal ranges *works on heart |
| VASOPRESSIN | -causes vasoconstriction, increases vascular resistance and BP -uses: shock -ex: vasopressin (continuous IV) -titratable to keep hemodynamic status within normal limits. Requires central line to prevent extravasation *works on peripheral vasculature |
| inotropic drugs | - increases contraction and cardiac output -uses: shock ex: milrinone, dobutamine (continuous IV) - titratable to keep hemodynamic status in normal range |
| DEFINE DIC (disseminated Intravascular coagulation) | -accelerated activation of clotting cascade and depletion of clotting factors leading to micro clots and excessive bleeding -TREAT: Heparin and supportive care |
| What Causes DIC (disseminated Intravascular coagulation) | -secondary to precipitating event: -infection -trauma (burn/crush) -obstetric condition -hematological/oncological disorders -shock or sepsis, acute respiratory distress syndrome |
| Assessment of DIC | -overt bleeding or oozing -occult bleeding -signs of platelet deficiency (petechiae, ecchymosis) -decreased perfusion to organs (changes in mental status, infarction of tissue in digits or nose) |
| Nurse management and Medical treatment of DIC | -prevent/correct underlying cause - assess/monitor perfusion status and lab analysis - administer blood and components: platelets, fresh frozen plasma, cryoprecipitate, packed RBCs -stop abnormal coagulation: ADMINISTER HEPARIN |
| Transfusions: nursing considerations (prior to admin) | - type and crossmatch for donor compatibility -normal saline -special tubing and filter -order, consent, patient education -check ID with another RN - vitals and baseline assessment |
| Transfusions: nursing considerations (during admin) | -stay with patient for 15-30 mins -monitor for changes in vitals |
| transfusions: nursing considerations (after admin ) | -vitals and document -dispose in biohazard bag |
| Transfusion reaction: TRALI ( transfusion related acute lung injury) | -s/s: dyspnea, hypoxemia, bilateral chest infiltrates (think ARDS) treat: STOP infusion, airway control, supportive care *most common cause of death associated with transfusions |
| Transfusion reaction: Febrile reaction | s/s: 1 degree rise in temp, may have chills, malaise -treat: acetaminophen -most common |
| Transfusion reaction: Hemolytic reaction | -S/S: fever, chills, reaction site pain, N/V, shock , dark urine -Treat: STOP transfusion, lots of IV fluids + diuretics - worst reaction: ABO incompatibility |
| Transfusion reaction: Allergic Reaction | -S/S: urticaria, pruritis, hives, anaphylaxis is rare -treat: if symptomatic use antihistamines, do not need to stop transfusion |
| Transfusion reaction: TACO (transfusion associated circulatory overload) | -S/S: dyspnea, edema -treat: give blood slowly over 3-4hrs, Diuretics with transfusion -often occurs with elderly and chronically anemic |
Created by:
Katelynsw27