5 Written questions
5 Matching questions
- 3 requirements for adequate blood flow
- Nursing interventions for shock
- Medical management of septic shock
- S/s of hypodynamic/cold phase of septic shock?
- mechanical support during cardiogenic shock
- a Adequate cardiac pump
Sufficient blood volume
- b intra-aortic ballon pump (IABP)
- c monitor HR, BP, LOC, urine output. Recognize early and manage to reduce chance of end-stage organ damage. Provide pt teaching regarding drug therapy.
- d Id and treat infection (usually Gram neg); eliminate potential sources of infection (remove and culture all lines and tubes, restart lines at different sites); Start broad spectrum abx-usually 3rd generation cephalosporin and an aminoglycoside, until C&S reports are received. Change abx according to organisms to a more specific/less toxic abx.; fluid replacement; aggressive nutritional support
- e Further increased HR; Further decreased BP; Increased pulse; decreased CO; cool, mottled skin; further increased respirations;
decreased urine output; Decreased temperature/subnormal, low WBC count with many immature cells.
5 Multiple choice questions
- vasodilation (lowers BP) and increased capillary permeability/leakage d/t cellular injury from bacterial toxins- lose fluid out of vasculature.
- a condition in which systemic blood pressure is inadequate to deliver oxygen and nutrients to support vital organs and cellular function- hypoxia
- Stabilization of spinal cord injury, positioning spinal anesthetic patient properly, giving glucose for hypoglycemia.
- MI, arrhythmias, valvular disease, cardiac surgery, cardiomyopathy.
- mental confusion, depression, apathy, oliguria, heart failure (low CO), tachycardia (report HR >100/min), thready pulse, thirst, restlessness, anxiety, lethargy, cool extremities, pale skin, frequently hypotension (report BP <90), fainting, syncope rapid, shallow breathing (body trying to get more O2), metabolic acidosis, coma.
5 True/False questions
Use of dobutamine (Dobutrex) in cardiogenic shock → to reverse low BP effect of nitroglycerin and morphine (MS) by elevating BP to perfuse vital organs. Causes peripheral vasoconstriction (alpha 1) and increases the force of contraction (beta 1 w/ IV fusion only). Potential to cause tachycardia.
cardiogenic shock → pump failure - 80-100% mortality rate
Medical management of hypovolemic shock → Treat underlying cause (may need surgery),
Fluid and blood replacement (colloids-albumin; crystalloids (NS and LR)
Redistribution of fluid - modified Trendelenburg
Medications - dopamin (Intropine) & dobutamine (Dobutrex) (only if adequate intravascular fluid)
Nursing considerations for septic shock → vital signs, electrolyte imbalance, I&O, correct acidosis
medical management of cardiogenic shock → O2, control chest pain, selective fluid support, medications (dopamine, dobutamine, isoproterenol, norepinephrine, IV nitro)