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
Medication class that may make delirium worse
What are benzodiazepines?
Dobutamine and dopamine are examples of what types of drugs?
What are inotropics?
Name FIVE side effects of amiodarone.
Arrhythmias, liver toxicity (nausea, vomiting, jaundice), blurred vision, neuropathy, sun sensitivity, fatigue, headache, dizziness, hypotension, pulmonary toxicity
Interpret the following ABGs. Include if compensated, uncompensated, or partially compensated:
pH: 7.28; PaCO₂: 40 mm Hg; HCO₃⁻: 16 mEq/L; PaO2: 88 mm Hg
What is uncompensated metabolic acidosis?
Name the three types of distributive shock.
What are septic, anaphylactic, and neurogenic?
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 196 pounds. How much (in mL) IV fluids should they receive in the first six hours?
What is 30 mls/kg = 2673 ml of crystalloid solution
When the antidiuretic hormone (ADH) is activated during hypovolemia shock, what occurs?
Decreased urinary output
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 nursing interventions are most important during sepsis in the immediate phase?
What is apply oxygen and initiate fluids?
Your patient in the ICU weighs 72 kg and has been prescribed a dopamine infusion at 5 mcg/kg/min. The pharmacy supplies dopamine at a concentration of 400 mg in 250 mL of D5W. At what rate (ml/hr) will you program the infusion? Round to the nearest TENTH.
What is 13.5 ml/hr?
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 T2, what type of shock may result?
What is neurogenic shock?
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
Name five signs/symptoms that occur in the compensatory stage of shock.
What are restlessness, increased HR, cool, pale skin, anxiety, impending sense of doom, rapid RR, normal, low normal BP.
Amount of blood in the ventricles at the end of diastole, just before the heart contracts. It reflects the degree of stretch on the heart muscle and is influenced by venous return and fluid volume.
What is Preload?
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 four components of the SIRs criteria WITH ranges.
•Fever (above 101 F) or low body temperature (less than 96.8 F)
•Tachycardia (>90 bpm)
•Tachypnea (RR > 22)
•WBC greater than 12 OR less than 4