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Pathophysiology
Medication Management
Nursing Interventions
Shock Specific
Potpourri
100
What are the two main classifications of shock and give two examples of each.
What is Low Blood Flow and Maldistribution of Blood Flow. LBF =cardiogenic and hypovolemic, MBF = neurogenic, anaphylactic, and septic
100
This medication is used in both septic and anaphylactic shock to interrupt bleeding and clotting disorders and decrease inflammation.
What is Drotrecogin alfa (Xigris).
100
Nursing interventions for shock involve
What are identifying at risk patients and frequent ongoing monitoring for subtle changes in the patient's physical and emotional status.
100
Before treating patients with septic shock what type of diagnostic testing must be performed.
What are cultures: blood, urine, wound, stool, sputum before antibiotics, first broad spectrum then organism specific after identification
100
This is common to all forms of shock
What is decreased tissue perfusion
200
Explain the role of compensatory mechanisms in relation to the stages of shock
What is the compensatory mechanisms of increased HR, RAAS, and RR will keep the vital signs close to normal. These eventually fail since they require additional O2 the body cannot supply r/t decreased tissue perfusion
200
A positive inotrope used in low dose to increase renal blood flow, in high dose to cause vasoconstriction. Name the shock it is useful in treating.
What is Dopamine and cardiogenic shock.
200
This is the most important intervention to implement BEFORE starting vasopressive therapy in a patient experiencing hypovolemic shock
What is ensure the patient has adequate fluid volume in the system. Patients with low blood volume will have further reduction in tissue perfusion if not adequately resuscitated with fluid.
200
Explain the difference between absolute hypovolemia and relative hypovolemia and give an example of each.
Absolute=external loss of whole blood or body fluids (trauma, GI bleeding, diarrhea) Relative=pooling of blood(bowel obstruction), fluid shifts (burns, ascites), massive vasodilation(sepsis)
200
Name two of the diagnostic criteria for SIRS
What is: fever > 38C or <36C, HR>90bpm, RR > 20 or PaCO2 <32, WBC >12,000 or <4,000 or >10% bands
300
Describe and explain the expected changes in BP and HR in a patient experiencing neurogenic shock.
Hypotension d/t massive vasodilation, bradycardia d/t unopposed parasympathetic stimulation
300
Vasopressors (phenylephrine) and atropine are used to treat this type of shock.
What is Neurogenic shock.
300
Name three treatments implemented for hypovolemic shock.
What are establish large bore IV access, administer IV fluids (NS, LR), administer blood products, application of pressure.
300
State the type and amount of fluid replacement required for septic shock.
What is 6-10L of isotonic crystalloids and 2-4L colloids
300
This therapy should be initiated within 24 hours of onset of shock d/t protein malnutrition associated with shock.
What is enteral feedings?
400
Name the underlying insults that can lead to SIRS.
What is ischemia, inflammation, trauma, infection or a combination of the above.
400
BP must be monitored continuously when these two shock medications are used
What are nitroglycerine and Nipride
400
What assessments can be made to evaluate the effectiveness of an IABP.
What are ECG changes indicating resolving ischemia, decreased PVCs and chest pain; increased CO indicated by increased UO, decreased HR, decreased crackles, decreased PAWP.
400
This is the goal of hemodynamic management in cardiogenic shock
What is decrease workload by dilating the coronary arteries, reduce preload, reduce afterload, reduce HR and contractility
400
Name the symptoms associated with cyanide toxicity and the medication that can cause them.
What is Nipride and tinnitus, hyperreflexia, confusion, seizures.
500
What is the relationship between MODS, SIRS and Shock?
What is shock often leads to SIRS which ends with MODS.
500
These side effects should be monitored when using hydrocortisone (Solucortef) for septic and anaphylactic shock
What are hypokalemia and hyperglycemia?
500
These two complications are common to both IABP and VAD.
What are infection and thromboembolism?
500
In which of the 3 stages of shock are all body systems affected and compensatory mechanisms overwhelmed.
What is the Refractory Stage?
500
Survival rates for shock are improved when the blood glucose level is maintained at this level
What is < 150mg/dl; when using IV insulin, glucose between 80-110mg/dl