Shock Party
ID the type of shock: 27-year-old fell to the ground after walking out of the hospital cafeteria. Somnolent and unresponsive to command, with noisy breathing and a barely palpable radial pulse. temperature is 37.2°C (98.9°F), HR is 132/min, BP is 58/34 mm Hg, RR is 28/min, and Spo2 is 92%, Focused Exam: flushed skin in respiratory distress/audible wheezing
What is anaphylactic/distributive shock
Environmental factors that contribute to this problem are: sleep deprivation, anxiety, sensory overload and immobilization.
What is delirium?
Dobutamine and dopamine are examples of what types of drugs?
What are inotropics?
What is the antidote for the treatment of an opioid overdose?
Naloxone (Narcan)
Name the ranges for the following (ABGs):
pH, PaCO2, PaO2, HCO3
pH- 7.35- 7.45
PaCO2- 35-45mmHg
PO2- 94- 100 mmHg
HCO3- 22-26 mEq/L
What stage of shock: motorcyclist with multiple contusions over left hemithorax and right abdomen, and left femur. Received 1.5 L NS en route. HR is 116, BP is 110/75 mm Hg, RR is 28, and Spo2 is 93% on NRB at 15 L. At least 1 L of blood loss.
What is compensatory stage?
What two therapies are most important during sepsis (immediate)?
What is apply oxygen and initiate fluids?
Name three medications that can be found on the crash cart?
Epi, atropine, sodium bicarbonate, calcium chloride, IV fluids, dextrose, lidocaine, Narcan, amiodarone, aspirin, nitroglycerine spray
Your client is newly diagnosed with atrial fibrillation. What medication should they be prescribed?
What is an anticoagulant (warfarin, apixaban, dabigatran, rivaroxaban)
This mean arterial pressure (MAP) goal is targeted in the ICU to maintain organ perfusion
What is > 65
If an injury occurs to the spinal cord at C6, what type of shock may result?
The intensivist placed a central line (IJ) at the bedside. A chest x-ray is ordered to confirm placement. Where should the tip of the line be per the x-ray?
Superior vena cava
Your client is on an epinephrine drip, and the provider has entered an order to discontinue it. Explain what you do as the nurse to carry out this order.
Ensure hemodynamic stability, titrate it down, DO NOT stop immediately.
What is vasopressor of choice in patient with septic shock?
Norepinephrine
Antimicrobial agents should ideally be administered within this time frame (hours) after recognition of sepsis
What is one hour
Changes in patient's mental status is an important finding at this stage?
What is the progressive stage of shock?
Demonstrate how you would perform the Modified Allen's test
Checking for ulnar circulation.
What is vasopressor of choice in patient with anaphylaxic shock?
What is epinephrine?
Name three parameters you should assess when administering a dopamine drip?
Urine output, blood pressure, MAP
Name the three types of distributive shock
Septic, Neurogenic, Anaphylactic
For all types of shock, this should be provided/started within 24-48 hours?
What is nutrition?
This system is the first system to be affected by SIRS and MODS
What is the respiratory system
A patient with a weight of 60 kg requires a dopamine infusion at a rate of 8 mcg/kg/min. The available dopamine solution has a concentration of 600 mcg/mL. Calculate the dopamine infusion rate in mL/hr.
48 mL/hr
You have a client who is in septic shock. They weigh 70 kg. How much (in mL) IV fluids should they receive in the first six hours?
What is 30 mls/kg = 2.1 L of crystalloid solution
When the antidiuretic hormone (ADH) is activated during hypovolemia shock, what occurs?
Decreased urinary output