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;
51 Cards in this Set
- Front
- Back
|
_____________shock involves a loss of intravascular fluid volume that may be due to actual blood loss or relative loss from fluid shifts within the body.
|
Hypovolemic
|
|
|
____________ shock occurs when the myocardium has lost its ability to contract efficiently and maintain an adequate cardiac output.
|
Cardiogenic
|
|
|
____________ is a clinical condition of insufficient perfusion of cells and vital organs causing tissue hypoxia.
|
Shock
|
|
|
____________ shock involves a loss of intravascualr fluid volume that may be due to actual blood or relative loss from fluid shifts with in the body.
|
Hypovolemic
|
|
|
_______ shock occurs when the myocardium has lost its ability to contract efficiently and maintain an adequate cardiac output.
|
Cardiogenic
|
|
|
________ or vasogenic shock is characterized by massive vasodilation which results in a relative hypovolemia.
|
Distributive
|
|
|
Distributive shock is further divided into anaphylactic, ______, and septic shock
|
neurogenic
|
|
|
A naturally occurring catecholamine produced by the adrenal glands.
|
Epinephrine
|
|
|
Used mainly for hypotension associated with spinal anesthesia; acts indirectly by releasing norepinephrine from sympathetic nerve endings.
|
Metaraminol
|
|
|
Useful in hypovolemic and cardiogenic shock.
|
Dopamine
|
|
|
An adrenergic drug that stimulates alphaadrenergic receptors.
|
Phenylephrine (neo - syephrine)
|
|
|
A synthetic catecholamine developed to provide less vascular activity than dopamine.
|
Dobutamine
|
|
|
What are the signs and symptoms related to the clinical condition of shock?
|
Shock is a clinical condition of insufficient perfusion of cells and vital orgaqns causing tissue hypoxia. Clinical symptoms depend on the degree of impaired perfusion of vital organs (ex brain, heart, kidneys) common signs and symptoms are oliguria, heart failure, mental confusion, cool extremities and coma. Most but not all people in shock are hypotensive.
|
|
|
What is the impact of anaerobic metabolism on the human body?
|
Lactic acid production by anaerobic metabolism leads to generalized metabolic acidosis and eventually to organ failure and death if blood flow is not promptly restored.
|
|
|
What causes anaphylactic shock?
|
Happens when massive vasodilation caused by release of histamine in response to a severe allergic reaction.
|
|
|
What causes septic shock?
|
Due to massive vasodilation caused by release of mediators of the inflammatory process in response to overwhelming infection.
|
|
|
What causes Neurogenic shock?
|
Due to massive vasodilation caused by a suppression of the sympathetic nervous system.
|
|
|
__________ is a naturally occurring catecholamine produced by the adrenal glands. At low doses, it stimulates beta receptors which increases cardiac output by increasing the rate and force of myocardial contractility. It also causes bronchodilation. At larger doses it acts on alpha receptors to increase blood pressure. Example of use is for bee stings.
|
Epinephrine
|
|
|
Why is epinephrine the drug of choice for management of anaphylactic shock and why is it administered by SQ injection?
|
It is the drug of choice because of its rapid onset of action and anti-allergic effects. It prevents the release of histamine and other mediators that cause symptoms of anaphylaxis, there by reversing vasodialtion and bronchoconstriction. In early management of anaphylaxis it is given Sub Q to to produce therapeutic effects within 5 to 10 mins. with peak activity in approximately 20 mins.
|
|
|
Epinephrine is also used to treat cardiac arrest secondary to anaphylactic shock, how would the epinephrine be administered then?
|
By continuous IV infusion but bolus doses may be given in emergencies such as cardiac arrest.
|
|
|
When administering Epinephrine what adverse effects should the nurse be monitoring for?
|
Excessive cardiac stimulation, ventricular dysrhythmias, and reduced renal blood flow.
|
|
|
Mr. Smith is admitted to the CCU in your facility after a motor vehicle accident and subsequent hypovolemic shock. Despite fluid replacement therapy and stablization of the patients eletrolyte imbalance his cardiac output remains low. What are the treatments of choice? (select all that apply)
a. Dobutamine b. Dopamine c. Epiephrine d. Phenylephrine |
a, b, c
Rationale: The adrenergic catecholamines; dobutamine, dopamine, epinephrine, and norepinephrine are widely used in patients with low cardiac output that persists despite adequate fluid replacement and correction of electrolyte imbalance. Dobutamine is usually cardiotonic agent of choice in critically ill patients. |
|
|
In hypotension and shock drugs with alpha adrenergic activity (ex norepinephrine, phenylephrine) are used for which of the following purposes?
a. To increase peripheral vascular resistance b. To decrease peripheral vascular resistance c. To resolve hypertensive crisis d. To correct fluid volume deficit. |
a.
Rationale: In hypotension and shock drugs with alpha adrenergic activity are used to increase peripheral vascular resistance and raise BP. |
|
|
Mr. Vento presents to the ER in hypovolemic shock secondary to a traumatic amputation of his left hand. The physician orders alpha adrenergic medications to be administered. During the infusion of the medication it is important to monitor which of the following values?
a. Electrolytes b. Blood pressure c. Albumin level d. Temperature. |
b.
Rationale: For all drugs used to manage shock blood pressure should be monitored frequently during infusion. |
|
|
Mr. Goldman is treated for hypotension and shock in your ER. Which of the following is an overall goal in the treatment of hypotension and shock? (select all that apply)
a. To decrease vascular volume b. To maintain vascular volume c. To maximize oxygen delivery to the tissues d. To maintain serum albumin levels. |
b, c
Rationale: The overall goal in the treatment of hypotension and shock is to maximize oxygen delivery to the tissues by maintaining vascular volume and optimal hemoglobin levels. |
|
|
True or false?
Shock is a clinical condition of insufficient perfusion of cells and vital organs causing tissue hypoxia. |
True
|
|
|
Mr. Smith who was brought in after a construction accident is experiencing multiple organ hypoxia precipitated by hypovolemic shock. To adequately monitor his condition what assessment methods should you be using?
|
Continuous invasive hemodynamic monitoring using a mixed venous oxygen pulmonary arterial catheter and an arterial catheter is indicated to titrate drug dosage and monitor response to drug therapy.
|
|
|
True or false?
Patients taking adrenergic drugs should be monitored closely and drug dosage should be adjusted as symptoms warrant in patients with hepatic impairment. |
True
|
|
|
What is a risk in older patients with diagnosis such as atherosclerosis, peripheral vascular disease, and diabetes mellitus who are prescribed anticholinergics?
|
Fluid volume depletion
|
|
|
True or false?
Children who lose up to 1/4 of their circulation blood volume may exhibit minimal changes in arterial BP and relatively low heart rate. In general management is the same as adults with drug dosages adjusted for weight. |
True
|
|
|
Anaphylactic shock is often managed by ________ drugs as well as epinephrine.
|
nonadrenergic
|
|
|
True or false?
Cardiogenic shock may be complicated by pulmonary congestion for which Diuretics drugs are indicated and IV fluids are contraindicated except to maintain a patent IV line (25ml/hr max) |
True
|
|
|
Patient is diagnosed with hypovolemic shock and may require volume replacement to optimize the SVO2 and thus mixed venous oxygen consumption. As the nurse caring for the patient you are careful to avoid?
|
Hypothermia
|
|
|
For distributive shock characterized by severe vasodilation and a decreased peripheral vascular resistance, a ___________________ drug such as norepinephrine is the first drug of choice.
|
vasopressor
|
|
|
For cardiogenic shock and decreased cardiac output which is the drug of choice?
a. dobutamine b. dopamine c. epinephrine d. norepinephrine |
a.
|
|
|
With severe heart failure characterized by decreased cardiac output and high peripheral vascular resistance which of the following drugs may be given in addition to the cardiotonic drugs?
a. Nitroprusside b. Digoxin c. Lisinopril d. Lopressor |
a.
|
|
|
Milrinone a treatment for heart failure is also used to manage ___________ shock in combination with other inotropic agents or vasopressors.
|
cardiogenic
|
|
|
Dobutamine may _________ BP with large doses.
|
increase.
|
|
|
True or false?
Dobutamine has a short plasma life and therefore must be administered by continuous IV infusion. |
True
|
|
|
________________
is a synthetic catecholamine developed to provide less vascular activity than dopamine. It acts mainly on beta 1 receptors in the heart to increase the force of myocardial contraction with a minimal increase in heart rate. It also increases blood pressure with large doses. It is less likely to cause tachycardia, dysrhythmias, and increase myocardial oxygen consumption than dopamine. It is most useful in cases of shock that require increased cardiac output without the need for blood pressure support. It is recommended for short-term use only. It may be used with dopamine to augment the beta 1 activity that is sometimes overridden by alpha effects when dopamine is used alone at doses greater than 20 micrograms per kilogram per minute. |
Dobutamine
|
|
|
___________ It is used to manage cardiogenic shock in combination with other inotropic agents or vasopressors. It increases cardiac output and decreases systemic vascular resistance without significantly increasing heart rate or myocardial oxygen consumption. The increased cardiac output improves renal blood flow, which then leads to increased urine output, decreased circulating blood volume, and decreased cardiac workload.
|
Milrinone
|
|
|
____________ is a pharmaceutical preparation of the naturally occurring catecholamine It stimulates alpha-adrenergic receptors and thus increases blood pressure primarily by vasoconstriction. It also stimulates beta 1
receptors and therefore increases heart rate, force of myocardial contraction, and coronary artery blood flow. It is useful in cardiogenic and septic shock, but reduced renal blood flow limits its prolonged use. As with all drugs used to manage shock, blood pressure should be monitored frequently during infusion. |
Norepinephrine
(Levophed) |
|
|
______________ is an adrenergic drug that stimulates alpha-adrenergic receptors. As a result, it constricts arterioles and raises systolic and diastolic blood pressures. This drug resembles epinephrine but has fewer cardiac effects and a longer duration of action. Reduction of renal and mesenteric blood flow limits prolonged use.
|
Phenylephrine
(Neo-Synephrine) |
|
|
What is a normal SVO2
|
60-75
|
|
|
What is a normal SI?
|
25-45 ml/beat/m2
|
|
|
What is normal CL?
|
2.5 - 4.0L/min/m2
|
|
|
What is normal PAOP?
|
8 - 12 mm Hg
|
|
|
What is normal CVP?
|
2 - 6 mm Hg
|
|
|
True or false?
Reflex bradycardia may occur with norepinephrine, metaraminol, and phenylephrine. |
true
|
|
|
True or false?
Tachycardia is more likely to occur with dopamine,but may also occur with epinephrine. |
True
|
|
|
True or false?
Serious dysrhythmias may occur with any of the agents used in hypotension and shock. Causes may include high doses that result in excessive adrenergic stimulation of the heart,low doses that result in inadequate perfusion of the myocardium,or the production of lactic acid by ischemic tissue |
True
|
