5 Written questions
5 Matching questions
- anaphylactic shock
- Medical management of septic shock
- Nursing interventions for shock
- oncotic pressure
- distributive shock
- a 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
- b vasodilation d/t ALLERGIC REACTION causing release of HISTAMINE.
- 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 also called 'colloid osmotic pressure', is the 'pulling force', pulling fluids from the surrounding tissue into the capillaries. It's the result of a difference in the concentration of solutes in the fluid inside the capillaries as opposed to outside them
- e MASSIVE VASODILATION resulting in relative hypovolemia (3 divisions: anaphylactic, neurogenic, septic)
5 Multiple choice questions
- Dilates vessels to enhance blood flow to the myocardium. Drug of choice for chest pain during MI.
- Loss of sympathetic tone (disruption of SNS)
Skin warm and dry, decreasd BP, Decreased HR, Decreased Temperature.
- previous exposure to allergen with resulting antibody formation - exposure again to substance - develops a systemic antigen-antibody reaction - mast cells are provoked to release potent vasoactive substances, ie histamine or bradykinin - widespread vasoD and cap perm - Decreased venous return to heart - Decreased stroke volume - Decreased CO - Decreased BP - Decreased tissue perfusion - Respiratory arrest - Cardiac arrest - Death
- O2, control chest pain, selective fluid support, medications (dopamine, dobutamine, isoproterenol, norepinephrine, IV nitro)
- Limited to shock associated with slow HR and myocardial depression. Not a first line drug, used when pt not responsive to other meds.
5 True/False questions
S/S of hyperdynamic/warm phase of septic shock? → Increased HR and pulse, Decreased BP; flushed skin; Increased respirations/hyperventilation; Restlessness and confusion; increased urine output; Increased temperature. Legs may feel cool and mottled.
Use of norephinephrine (Levophed) 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.
Nursing considerations for hypovolemic shock → vital signs, electrolyte imbalance, I&O, correct acidosis
S/s of hypodynamic/cold phase of septic shock? → 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.
Use of dobutamine (Dobutrex) in cardiogenic shock → Drug of choice for cardiogenic shock because does not cause vasoconstriction but increases strength of contractions, improves stroke volume and CO. Minimal increase in HR. has a half-life of 2 minutes, given as an IV infusion drip, dosed in mcg/kg/min. only give in the ICU