Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
53 Cards in this Set
- Front
- Back
|
What is the result of SNS activation in response to shock?
|
- inc HR, CO, vasocons - blood is shunted to vitals -> cool clammy skin, hypoactive bowel sounds, low urine outpout - inc glucuose due to epinephrine (gluconeogenesis)
|
|
|
A nurse is monitoring a pt. What findings might indicate that pt has shock? (early signs of shock)
|
Compensatory shock - although BP is maintained, there are still signs of shock:
- SNS - inc HR and vasoconstriction maint BP - Blood shunted towards vitals - cool clammy skin, hypoactive bowel sounds, dec urine output - anaerobic resp --> lactic acidosis --> compens respiratory alkalosis (inc respiration) --> confusion - hematological changes - inc sodium (fluid retention), inc glucose - narrowing pulse pressure |
|
|
what is normal pulse pressure?
|
30-40 mmhg
|
|
|
How is pulse pressure affected in shock? why?
|
decreased pulse pressure <-- dec stroke volume <-- dec preload <-- shock
|
|
|
what is best early indication for shock?
|
narrowing of pulse pressure. is apparent before BP decreases.
|
|
|
At what MAP do cells start to die?
|
65mmHg
|
|
|
When is best time to treat shock?
|
- best within 6 hours of identifying shock
- the earliter the better - best time before BP drops (before progressive stage) |
|
|
A nurse monitors a drop in systolic BP. When should it be reported to dr.?
|
<90mmHg or decrease in 40mmHg from baseline. This is clijnical hypotension, and indicates a progressive state in shock.
|
|
|
GFR fails when MAP falls below what number?
|
70mmHg
|
|
|
How might skin be affected in a pt. with shock?
|
inflammation during shock stim clotting cascade - may lead to microthrombi deposition and DIC
|
|
|
How does shock states affect blood?
|
clinical manifestation: petechiae and ecchymoses
inflammatory response leads to actiavtion of clotting cascade, possibly DIC |
|
|
What is shock? types of shock?
|
= condition in which blood is not perfusing tissues, resulting in a lack of O2 and nutrients
- sufficient perfusion depends on three things: 1. heart 2. blood volume 3. vessels, so shock can be - cardiogenic - hypovolemic - circulatory (septic, anaphylactic, neurogenic) |
|
|
How are ABG's affected by shock states?
|
low O2 perfusion --> anaerobic respiration --> inc lactic acid --> metabolic acidosis (inc HCO3) --> compensatory resp alkalosis
|
|
|
How is lactic acid affected by shock states?
|
low O2 --> anaerobic resp --> inc lactic acid
|
|
|
Explain the metabolic stress response.
|
In response injury, there are two phases of stress response. Ebb, and flow, which describes the initial decrease and subsequent increase of metabolic activity.
Ebb - immediate post trauma, body depresses enzymatic activity, and O2 consumption, main goal of conserving: -to stop bleeding and dec activity- dec UO, CO, shock, dec body temp - glucagon, catecholamines inc for gluconeogenesis Flow - spike in glucagon, catecholamines, cortisol to inc glucose for repair of body |
|
|
What are the stages of shock?
|
Compensatory
Progressive Irreversible |
|
|
effects of lactic acidosis?
|
- confusion, agitation
- compensatory respiratory alkalosis |
|
|
neuro effects of alkalosis?
|
- confusion
|
|
|
What are symptoms in the progressive stage of shock?
|
= mechanisms that regulate BP can no longer compensate - dec BP and MAP
- all organs suffer from dec hypoperfu - brain --> confusion, agitation, lethargy - heart - dysrhythmias, chest pain, MI - lungs - dec pulm blood flow --> further hypoxemia - renal - when MAP falls below 70 - acute renal failure, inc BUN creat - hematologic - inflammatory sytokins activate clotting. risk for DIC, ecchymoses, petechiae (bleeding) |
|
|
Nursing precaution for adminsitering colloids.
|
rare occurence of anaphylaxis
|
|
|
Nursing precaution for administering large amounts of crystalloids.
|
* - monitor for adventitious lung sounds
* - monitor for signs and symp of interstial edema (due to ACS - fluid leaking and inc pressure in abdominal compartment syndrome) |
|
|
Nursing precaution for vasoactive meds.
|
Never stop vasoactive meds abruptly. dosages and weaning should be tapered. May perpetuate shock.
|
|
|
What do all shock pts receive?
|
fluids, meds, nutrition
|
|
|
what is benefit of lactated ringer's solution?
|
lactate ion helps buffer metabolic acidosis
|
|
|
What can nurses do to promote venous return and preload in hypovolemic patients?
|
MODIFIED Trendelenburg position - elevated 30 degrees
|
|
|
Precaution for nurses when giving fluid bolus.
|
If given fluid bolus too quickly, patient with cardiogenic shock may develop pulmonary edema.
|
|
|
inotropic
|
effects contractility of heart (inc or decrease)
|
|
|
How is cardiogenic shock treated?
|
- preserve myocardial tissue through oxygenation
- increase cardiac contractility (inotropes - dobutamine & dopamine) - decrease afterload (nitroglycerine) |
|
|
How can a nurse prevent cardiogenic shock?
|
- administer oxygen
- conserve patient's energy - promptly relieve angina |
|
|
SIRS vs sepsis
|
Sepsis - systemic response to infection
SIRS - systemic inflammatory response syndrome - systemic response without an idenitified source |
|
|
Signs of Neurogenic Shock
|
- parasympathetic response is activated instead of sympathetic response (SNS usually activ in shock states)
- as a result, there is warm dry skin, and bradycardia with hypovolemia |
|
|
What are causes of neurogenic shock?
|
- spinal anesthsia
- spinal cord injury - hypoglycemia |
|
|
Pooled blood
|
- risk of thrombus formation
|
|
|
signs of thrombus formation
|
- lower extremity pain
- redness, tenderness, warmth |
|
|
How can a nurse prevent neurogenic shock?
|
- epidural - elevate HOB 30 degres to prevent medication from traveling up spinal cord
- immobilize pt to prevent further damage to spinal cord |
|
|
What is MODS? rate of survival?
|
= mutliorgan dysfunction syndrome
- when 2 or more organs fail - require medical intervention to survive - 75% mortality rate |
|
|
What kinds of drugs are used in treating shock?
|
- vasodilators
- inotropics - vasopressors |
|
|
Examples of inotropics
|
- dobutamine
- dopamine - epinephrine - milrinone |
|
|
examples of vasodilators -
|
- nitroglycerin
- nitroprusside |
|
|
examples of vasopressors
|
- norepinephrine
- dopamine - phenylephrine - vasopressin |
|
|
Frank starling law
|
- stroke volume increases with inc preload
- increase in end diastolic pressure causes cardiac muscle to contract more forcefully |
|
|
ST depression
|
myocardial ischemia
|
|
|
ST elevation
|
myocardial infarction
|
|
|
What is ACS?
|
= acute coronary syndrome
- unstable angina or MI |
|
|
Typical symptoms of angina
|
- pressure, squeezing, fullness substernal chest area
- may radiate across chest to medial aspect of one or both arms (usually left) - may also radiate to jaw, shoulders, upper back, epigastrium - radiation to arms and hands is described as numbness and tingling |
|
|
Symptoms of ACS
|
- symptoms are same as angina, except moderate to severe pain
- SOB, diaphoresis, palpitations, fatigue, N/V |
|
|
Early detection of ACS
|
- prodromal symptoms up to a month prrior
- fatigue, SOB, chest discomfort, sleep disturbances, anxiety |
|
|
treatment of angina
|
rest, NTG, oxygen (12 lead EKG)
|
|
|
treatment of ACS
|
- morphine
- PCI or thrombolytics for reperfusion of coronary artery |
|
|
What should be done to someone with acute MI at hospital?
|
- Oxygen
- NTG - EKG - Morphine - Aspirin - Beta Blocker - ACEI - angiotensin converting enzyme ihbitor within 24 hrs - dec afterload? - PCI within 90 min of arrival - thrombolytic therapy within 30 min of arrival |
|
|
What are nursing interventions for PCI or Cardiac CAth
|
- fast 8-12 hrs before surgery
- pt educ duration and type of procedu - reassured that iv meds will be given for comfort - informed about sensation during procedure - have pt express fear and anxiety |
|
|
Fasting before PCI or CC?
|
8 - 12 hr
|
|
|
Bed rest for post CC?
|
2-6 hr
|
