SHOCK FUNDAMENTALS
A type of shock when circulating fluid volume falls and the pump can't maintain perfusion. Ongoing signs include tachycardia, cool clammy skin, and a narrow pulse pressure.
What is hypovolemic shock?
pH 7.30, PaCO2 30, HCO3 16: This primary disorder with respiratory compensation is present and often raises which serum iron (electrolyte).
What is Metabolic acidosis with respiratory compensation and associated hyperkalemia?
Palpable thrill and audible bruit over the forearm access site indicate this is functioning appropriately.
What is a patent arteriovenous (AV) fistula?
A lactate >2 mmol/L suggests poor tissue perfusion; values >4 mmol/L raise concern for severe sepsis and often prompt this immediate intervention.
What is rapid IV fluid resuscitation and sepsis bundle actions (cultures, antibiotics)?
Appropriate interventions for a patient developing anaphylaxis.
What are stop the offending agent, give epinephrine IM immediately, administer IV diphenhydramine (or Benadryl), and apply high flow oxygen/prepare airway (and start IV fluids)?
Before starting vasopressors in suspected septic shock, this step fills the vascular “tank” and improves the chance vasopressors will work safely.
What is administration of isotonic fluids?
A patient is blowing off CO2 low PaCO 2 after a panic attack; This pH change typically shifts potassium how?
What is respiratory alkalosis that shifts potassium into cells (lowering serum K+)?
***This rapid removal of fluid and toxins processed by a machine can cause dysrhythmias and electrolyte shifts; withhold certain chronic meds and give them when?***
What is after dialysis (withhold meds before an administer after the session)?
When a septic patient remains hypotensive despite 2L of crystalloids and a MAP < 65, this vasoactive infusion is commonly used, but watch for reduced renal perfusion.
What is norepinephrine?
In cardiogenic shock after a large MI, this infusion can help reduce myocardial workload.
What is a nitroglycerin infusion (vasodilator); Monitor blood pressure closely because nitrates can precipitate hypotension?
Compensatory surge in shock (catecholamines, RAAS, ADH) helps for a short time but can worsen this at the cellular level when oxygen needs exceed delivery.
What is cellular hypoxia and dysfunction (anaerobic metabolism, lactic acidosis)?
When correcting severe hyponatremia with IV sodium, correction is limited to ______ mEq/L per 24 hours due to this neurological concern.
What is 4 to 8 mEq/L to prevent osmotic demyelination syndrome.
Sudden kidney failure due to obstruction of urine flow after the kidneys (e.g. bilateral ureteral stones) is called this.
What is a post renal AKI?
The one hour sepsis bundle includes these initial interventions.
What is administering a rapid IV fluid bolus, obtaining lactate, blood cultures, and broad spectrum antibiotics?
This single lab value is the most specific indicator of impaired kidney filtration.
What is serum creatinine?
In anaphylactic collapse with airway swelling and hypotension, this intramuscular drug given to the mid thigh is the single most important immediate medication.
What is epinephrine?
A serum lactate of 4.2 mmol/L in a septic patient most commonly produces this acid base disturbance.
What is metabolic acidosis?
A patient has missed dialysis and presents with a K 6.9 and bradycardia with a wide QRS, the first immediate step to protect the heart is this.
What is administer IV calcium gluconate?
If lactate stays elevated after adequate fluids, the nurse should do this next to help restore perfusion.
What is notify the provider and prepare for vasopressors (e.g. Norepinephrine)?
List 3 common prerenal causes of acute kidney injury and the shared immediate nursing priority.
What are dehydration, vomiting, diuretics; Massive bleeding; Low cardiac output states, sepsis- essentially any type of shock that will reduce blood flow to the kidneys?
A patient with shock is hypotensive with a MAP < 65 mmHg; A vasopressor (i.e. norepinephrine) is likely next but only after confirming this first.
What is adequate fluid resuscitation (or confirming that fluid boluses have been given)?
When extracellular K is elevated, nurses must be ready with these temporizing measures while arranging definitive therapy.
What is administration of calcium gluconate (to stabilize the heart), dextrose & insulin, sodium bicarbonate, and/or emergent dialysis?
Using the abdominal lining to filter blood at home relies on this membrane and is known by this therapy name.
What is peritoneal dialysis using the peritoneum?
A patient on a dopamine infusion shows urine output rising from 20 to 40 mph and indicates this.
What is improved cardiac output and renal perfusion responsive to therapy?
This condition is characterized by hypotension, muffled heart sounds, and JVD called this triad and treated with this intervention.
What is cardiac tamponade, symptoms of Beck's triad, and treated with pericardiocentesis?