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Shock, Sepsis, and Multiple Organ Dysfunction Syndrome (Iggy ch. 37 & Urden ch. 34)

Terms in this set (67)

- Inotropic agents are used to increase contractility and maintain adequate blood pressure and tissue perfusion. Dobutamine is the inotrope of choice.
- A vasopressor, preferably norepinephrine, may be necessary to maintain blood pressure when hypotension is severe.
NOTE: As both of these therapies increase myocardial oxygen demand, the lowest possible doses should be used.

- Diuretics may be used for preload reduction. Vasodilating agents are used for preload and afterload reduction only in specific situations in conjunction with an inotrope or when the patient is no longer in shock. Antidysrhythmic agents should be used to suppress or control dysrhythmias that can affect CO. Intubation and mechanical ventilation are usually necessary to support oxygenation.

- The intraaortic balloon pump (IABP) is used to decrease myocardial workload by improving myocardial supply and decreasing myocardial demand.

- Nursing interventions include limiting myocardial oxygen demand, enhancing myocardial oxygen supply, maintaining adequate tissue perfusion, providing comfort and emotional support, and preventing and maintaining surveillance for complications. Measures to limit myocardial oxygen demand include administering analgesics, sedatives, and agents to control afterload and dysrhythmias; positioning the patient for comfort; limiting activities; providing a calm and quiet environment and offering support to reduce anxiety; and teaching the patient about the condition. Measures to enhance myocardial oxygen supply include administering supplemental oxygen, monitoring the patient's respiratory status, administering prescribed medications, and managing device therapy.