Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/47

Click to flip

47 Cards in this Set

  • Front
  • Back
DURING RESPIRATORY ALKALOSIS, PH WILL BE__ AND PCO2 WILL BE __?
PH WILL BE HIGH
PCO2 WILL BE LOW
SEPTIC SHOCK
FORM OF DISTRIBUTIVE SHOCK
-COMPLICATION OF ANOTHER ILLNESS/INJURY
-USUALLY DUE TO INFECTION
-HIGH MORTALITY RATE !
-OFTEN DUE TO NOSOCOMIAL INFEC IMMUNOSUPP CLT
WHAT ARE THE 3 TYPES OF SHOCK
1.REDUCED INTRAVASCULAR VOLUME
2.IMPAIRED HEART PUMPING
3.WIDESPREAD ARTERIOLAR & VENOUS DILATION
WHEN ACID IS IN CELLS,RESPIRATORY SYS __ AND __
COMPENSATES AND BLOWS OFF CO2
FOR SEPSIS,NURSE NEEDS TO MAINTAIN__FOR PT,GIVE__,PUT PT ON__,AND GIVE__ SUPPORT
1.FLUID& ELECTROLYTES (SUPPORT CARDIAC OUTPUT,CORRECT ACIDOSIS0
2.CORTICOSTEROIDS/GLUCOCORTICOIDS OFTEN GIVEN
3.PUT PT ON VENTILATOR
4.NUTRITION-GIVE ENTERAL FEED,**PT MUST HAVE GOOD GI TRACT BEFORE GIVING
IF 4 BODY SYSTEMS AFFECTED =
MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)-100% MORTALITY
-OFTEN FROM NORMAL FLORA
GOALS OF NURSE FOR PT W/ SEPTIC SHOCK:
1.MAINTAIN ADEQUATE TISSUE PERFUSION & OXYGENATION
2.IDENTIFY & ELIMNATE CAUSE OF INFECTION
3.CULTURE ALL ASAP
THE STAGES OF SHOCK ARE_?
ON A CONTINUUM..YOU MUST GO FROM STAGE 1-TO STAGE 2-TO STAGE 3
WHAT ARE THE 2 BLOOD VALUES TO BE LOOKED AT DURING SHOCK?
1.SODIUM
2.GLUCOSE
SYNDROME
A COLLECTION OF SYMPTOMS
LATE SHOCK/IRREVERSIBLE (LATE REFRACTORY)
LEADS TO ORGAN FAILURE/DEATH
BP-WILL BE <70 OR NON PALPABLE
HEART-WILL FAIL
OVERWHELMING METABOLIC ACIDOSIS
-KIDNEY & LIVER FAIL
ALTERED BLEEDING-LEADS TO DIC
-BRAIN CEASES TO FCN (MULTIPLE SYS FAIL)
PROGRESSIVE STAGE (MIDDLE STAGE)
1.BODY UNABLE TO MAINTAIN COMPENSATION
2.BP DECREASES (CELLS HAVE BEEN DAMAGED
3.LACTIC ACID-METABOLIC ACIDOSIS.PH WILL BE LOW,BICARBONATE WILL BE LOW
4.3RD SPACE SHIFTING-EDEMA
AS NURSE:WHAT IS ASSESSED FOR COMPENSATORY STAGE OF SHOCK?
VS-GOOSEBUMPS,THIRST,BP (WNL)
LOC-INCREASED ALERTNESS,ANXIOUS,COMBATIVE,CONFUSED
U/O-WILL DECREASE
SKIN-WILL BE PALE,COOL
SODIUM-WILL INCREASE
GLUCOSE WILL INCREASE
WHAT ARE THE 3 STAGES OF SHOCK?
1.EARLY-COMPENSATORY STAGE
2.MIDDLE-PROGRESSIVE STAGE
3.LATE-IRREVERSIBLE STAGE OR REFRACTORY (DOESNT GET BETTER)..LEADS TO MUTIPLE ORGAN FAILURE
WHAT SYSTEMS ARE 1ST AFFECTED BY SHOCK ?
1.BRAIN
2.HEART
3.KIDNEY (30CC/L)
4.LIVER
5.SKIN-EARLY SIGN (PALE,WEAK CLAMY)LATE SIGN(CYANOSIS)
S/S OF HYPERDYNAMIC SHOCK
1.INCREASED CARIAC OUTPUT
2.BOUNDING PULSE
3.SKIN FLUSHED,WARM,DRY
SHOCK
ABNORMAL PHYSIOLOGICAL STATE IN WHICH THERE IS INSUFFICIENT BLD VOLUME RESULTING IN CIRCULATORY FAILURE & HAVE ANOXIA
WHAT ARE THE 2 TYPES OF SEPTIC SHOCK?
1.HYPERDYNAMIC "WARM"
2.HYPODYNAMIC "COLD"
WHAT DO ALL TYPES OF DISTRIBUTIVE SHOCK CAUSE?
A DECREASE IN VENOUSE RETURN:
-DECREASED BLD TO HEART
-DECREASED CARDIAC OUTPUT
-DECREASED TISSUE PERFUSION
-DECREASED STROKE VOLUMER
WHAT ARE THE 3 TYPES OF DISTRIBUTIVE SHOCK ?
1.NEUROGENIC-LOSS OF SYMPATHETIC T
ONE.OCCURS W/ SPINAL INJURY & SPINAL ANESTHETIC.
2.ANAPHYLAXIS-ALLERGIC SHOCK.AS NURSE:GIVE EPINEPHRINE..REMOVE ANTIGEN-GIVE ANTIHISTIMINE
3.SEPTIC SHOCK-RESULTS FROM OVERWHELMING INFECTION
AS NURSE:WHAT IS ASSESSED/SUSPECTED FOR LATE SHOCK?
1.PT TAKEN TO ICU & UNDERGOES HEMODYNAMIC MONITORING
-GOAL:MONTITOR TISSUE PERFUSION,RESTORE FLUID & ELECTROLYTES
-USE VASOMOTER MEDS,IMPROVE CARDIAC FCN,GIVEN IV
-NUTRITION SUPPORT-INC ENERGY
-PAIN RELIEF:GIVE PAIN MEDS & MONITOR SAFETY IF LOC DEC
-H2 BLOCKERS
-GIVE DRUGS THAT INHIBIT GASTRIC ACID & PREVENT TEMP EXTREMES
SEPSIS
BACTERIA CONTAMINATION
AS NURSE,ASSESS: FOR HYPERDYNAMIC SHOCK
VS-HR INCREASES,BOUNDING PULSE
SKIN-FLUSHED,WARM
LOC-AGITATED,RESTLESS
RESPIRATIONS-RAPID
**U/O-LOW (FIRST OVERT SIGN)*
SYSTEMIC
AN IMBALANCE BET OXYGEN SUPPLY & DEMAND
S/S OF SHOCK CAN BE _ OR _?
GRADUAL OR RAPID
DURING THE PROGRESSIVE STAGE,A BP<90 =
NARROW PULSE PRESSURE
SHOCK RESULTS WHEN...?
TOO LITTLE OXYGEN REACHES THE CELL
S/S OF HYPODYNAMIC SHOCK
1.DECREASED BP AND CO
2.SKIN-COOL,CLAMY,PALE
3.TEMP-CAN BE NORMAL OR LOW
4.HR-WILL BE ELEVATED BUT THREADY
5.RESPIRATIONS-ELEVATED
6.U/O-ABSENT
7.MULTIPLE ORGAN FAILURE
NURSING DIAGNOSES FOR SEPTIC SHOCK:
1.ALTERED TISSUE PERFUSION & OXYGENATION
2.DECREASED CARDIAC OUTPUT
3.ANXIETY
AS NURSE: WHAT IS DONE FOR SHOCK?
CHECK:
1.VS-CHECK PERIPHERAL PULSE
2.BP-NOT GOOD INDICATER CUZ DOESNT DECREASE UNTIL LATER IN SHOCK
3.PULSE INCREASE-LOOK FOR SUBTLE SIGNS
4.LOC-JUST ASK PT QUESTIONS
5.URINE OUTPUT
5.SKIN
AS NURSE:WHATS TO BE DONE FOR REDUCED INTRAVASCULAR VOLUME?
1.RESTORE FLUID AND CORRECT VOLUME
2.POSITION OF PT.-FEET ELEVATED AT 20 DEGREES
WHAT HAPPENS TO SODIUM DURING SHOCK?
DURING SHOCK, YOU BEGIN TO RETAIN WATER
-SODIUM LEVELS INCREASE DUE TO RELEASE OF ALDOSTERONE
FOR SEPSIS,WHEN SHOULD ANTIBIOTIC BEGIN?
W/IN 1 HR-GIVE BROAD SPECTRUM ANTIBIOTIC:CEPHALOSPORIN/AMINOGLYCOSIDE
WHAT IS ASSOCIATED W/ REDUCED INTRAVASCULAR VOLUME?
1.HYPOVOLEMIC SHOCK
2.EXTERNAL BLEEDING
3.3RD SPACE FLUID SHIFT
PREVENTION:AS NURSE..WHAT IS TO BE DONE FOR SEPSIS?
1.ASSESS VS,LISTEN TO LUNGS,SODIUM,GLUCOSE
2.ASEPTIC TECHNIQUE-HANDWASH
3.ENSURE PT HAS GOOD NUTRITION
4.MONITOR FOR LOCAL & SYSTEMIC SIGNS OF INFECTION
5.GIVE ANTIBIOTICS-CULTURE 1ST
6.QUESTION DELIRIUM/CONFUSION
INSOMNIA-ESP IN ELDERY
POOR TISSUE PERFUSION CAUSES:
1.LACK OF OXYGEN
2.GLUCOSE (ENERY=ATP)CANT POWER CELL
3.WASTES=ACIDS
4.ACIDS---ENZYME RELEASE,DESTROYS CELL MEMBRANE,DIGEST CELL CONTENTS
5.IRREVERSIBLE CELL CHANGES
DURING SHOCK,CELLS DECREASE BEFORE__?
S/S ARE NOTICED...AT THIS POINT,REVERSIBLE
WHAT HAPPENS DURING SHOCK ?
1.DECREASED BLD FLOW= LOW O2,LOW ELECTROLYTES,LOW NUTRIENTS
2.WASTES BUILD UP
3.CELLS DYSFUNCTION
4.IF THE CELL DIES,THE TISSUE DIES
WHATS ASSOCIATED W/ IMPAIRED HEART PUMPING?
1.CARDIOGENIC SHOCK
2.HEART ATTACK
WHATS ASSOCIATED WITH WIDESPREAD ARTERIOLAR & VENOUS DILATION ?
1.DISTRIBUTIVE SHOCK A.K.A. VASOGENIC SHOCK
WHAT HAPPENS TO GLUCOSE DURING SHOCK?
IT INCREASES DUE TO EPINEPHRINE AND GLYCOCORTICOID RELEASE "STRESS RESPONSE"
COMPLICATIONS OF SEPIS:
1.DIC-DISSEMINATED INTRAVASCULAR COAGULATION (NEW DRUG XIGRIS (DROTRECOGIN ALFA)
2.ARDS-ACUTE RESP DISTRESS SYN
3.MODS-MULTIPLE SYS ORGAN DYSFCN SYNDROME
...LONG TERM RECOVERY
EARLY INDICATORS OF SEPSIS ARE:
FEVER,CHILLS,HYPOTENSION
PULSE PRESSURE
THE DIFFERENCE BET SYSTOLIC AND DIASTOLIC
WHAT OCCURS DURING THE COMPENSATORY (EARLY/INITIAL-NON PROGRESSIVE)STAGE?
1.BODY TRIES TO COMPENSATE TO RETURN TO HOMEOSTASIS
2.CNS (NERVOUS SYS)FIGHT OR FLIGHT & ENDOCRINE SYS
S/S:INCREASED HR,NA,WATER,ADH (SAVES FLUID),BP,PUPILS DILATE,LOW U/O
STRESS EPINEPHRINE & GLUCOCORTICOIDS __ GLUCOSE?
INCREASE
S/S OF PROGRESSIVE STAGE:
HR INCREASES,MUSCLES BECOME WEAK,THREADY PULSE,DYSRYTHMIAS,HEART FAILS,PUPILS SLUGGISH
-RESPIRATIONS INCREASE
-PT GOES INTO PULMONARY EDEMA
-ARDS (ACUTE RESP DISTRESS SYN
-U/O DECREASES (DECREASED PERFUSION & HORMONES)
-LOC-DECREASED (LETHARGIC,DISORIENTED)
-LIVER(TOXINS BUILD UP)
-GI SYS (BLEEDING & STRESS ULCERS DEVELOP)
-BLEEDING ABNORMALITIES-LEAD TO DIC (DISSEMINATED INTRAVASCULAR COAGULATION)