Assessment
You're pt is coming back from surgery. You find your pt, restless and confused. You do a set a vitals and find the HR 110, Bp 125/76, RR 26. The skin is pale, cool, and clammy. His pulses are weak, with sluggish capillary refill. Urine output 40 ml in the last 2hrs. BS 197. What might be his problem?
What are early signs of hypovolemic shock?
Initial interventions for patient with suspected severe sepsis (Name 3)
draw (or facilitate) serum lactate levels,
obtain blood cultures (or other cultures),
administer antibiotics (after the cultures have been obtained)
Infusing vasopressors
measuring central venous pressure
Medication that Vasodilation through direct smooth muscle relaxation; indicated for preload and afterload reduction
What is nitroglycerin
Hemodynamics shows :decreased cardiac output, decreased CVP and PAOP, decreased SVR, decreased venous oxygen saturation (SvO2 or ScvO2), hypotension and tachycardia. Which shock am I?
What is anaphylactic shock?
Pt shows Restlessness, confusion, Increased heart rate, Tachypnea, Respiratory alkalosis, Oliguria, Hyperglycemia, Decreased bowel sounds, Weak pulses, Cool, moist skin. What stage of shock is this?
What is compensatory stage of shock?
You're pt comes into ER by EMS c/o chest pain x1 day. He is lethargic. You do a set a vitals and find the HR 50, Bp 76/46, RR 10. You assess poor pulses; pale, cool skin. Urine output 25 ml in the last 2hrs. What might be his problem?
What is late stage of cardiogenic shock?
Placement of long catheter threaded through the superior vena cava with the distal port resting in the superior vena cava immediately above the junction with the right atrium. It is used as an estimate of volume returning to the right heart or right heart preload, or the right ventricular end-diastolic volume. Which measurement is this?
What is Central Venous Pressure
Medication that primarily stimulation of αlpha1, resulting in vasoconstriction and increasing blood pressure; some stimulation of β1to increase contractility and HR, indicated for hypotension and low cardiac output
What is Norepinephrine?
Hemodynamics shows: decreased cardiac output, increased CVP and PAOP, increased SVR, decreased venous oxygen saturation (SvO2 or ScvO2), hypotension and tachycardia. Which shock am I?
what is cardiogenic shock?
Pt shows Lethargy or coma, Hypotension, Dysrhythmias, Anuria, Absent bowel sounds, Severe metabolic acidosis, Respiratory acidosis, Cold extremities, Weak or absent pulses. what stage of shock is this?
What is progressive stage of shock?
You're pt comes into ER c/o SOB. He is A/O x 2. You do a set a vitals and find the HR 133, Bp 80/46, RR 33. You assess that he has cool, pale, clammy skin; weak pulses; and angioedema; and auditory wheezing. What might be his problem?
What is late sign of anaphylactic shock?
Name 5 possible interventions in treating a pt with septicemia
Meticulous hand washing and aseptic technique with all procedures
• Administer oxygen as ordered.
• Anticipate and prepare for intubation.
• Obtain lactate level.
• Obtain two blood cultures from two different sites, obtain urine, sputum, and wound cultures.
• Administer antibiotics as ordered after cultures are obtained.
• Administer fluid replacement as ordered.
• Administer vasoactive drips such as norepinephrine as ordered.
• Provide mouth care every 4 hours and when needed.
• Supportive care: nutrition, turning, DVT prophylaxis, range of motion exercises, mobilize as tolerated.
Medication that causes arterial vasodilation through direct smooth muscle relaxation, decreasing afterload and blood pressure, indicated for preload and afterload reduction
What is Nitroprusside?
Hemodynamic shows: decreased cardiac output, decreased central venous pressure (CVP) and pulmonary artery occlusive pressure (PAOP), increased systemic vascular resistance (SVR), decreased venous oxygen saturation (SvO2 or ScvO2), hypotension and tachycardia. Which shock am I?
what is hypovolemic shock?
hematological disorder most commonly caused by sepsis. It occurs because of enhanced coagulation that results from the release of procoagulant factors as part of the inflammatory response associated with sepsis.
what is DIC?
You're pt comes into ER c/o palpitations. She is A/O x 2 and drowsy. You do a set a vitals and find the HR 122, Bp 77/46, RR 33, Temp 35C. You assess that she cool, pale skin; weak and thready pulses. What might be her problem?
What is late stage of septic shock?
Name 5 possible interventions in caring a pt with cardiogenic shock?
Apply a 100% nonrebreather oxygen mask.
• Prepare for intubation and mechanical ventilation.
• Administer medications as ordered:
• Vasoactive medications such as norepinephrine or dopamine
• Inotropic medications such as dobutamine
• Diuretics
• Morphine sulfate
• Administer fluids as prescribed.
• Restrict activity.
Medication that stimulates β1 receptors; increases cardiac contractility and heart rate (HR), indicated for low cardiac output
What is Dobutamine?
Hemodynamics shows: increased cardiac output, decreased CVP and PAOP Decreased SVR, increased venous oxygen saturation (SvO2 or ScvO2), normal or decreased blood pressure, tachycardia, and hyperthermia. Which shock am I?
What is Early Septic Shock?
A patient who has sustained multiple trauma has arrived to the emergency department. Place the assessments in order of priority.
airway patency
level of consciousness
presence of external bleeding
respiratory rate and breath sounds
airway patency
respiratory rate and breath sounds
presence of external bleeding
level of consciousness
You're pt comes into ER by EMS for a MVA. He is A/O x 1-2. You do a set a vitals and find the HR 110, Bp 86/46, RR 12. You assess that he has warm, dry skin and a flushed appearance. Urine output 60 ml in the last 2hrs. What might be his problem?
What is early signs of neurogenic shock?
The nurse is prioritizing her interventions to:
Remove trigger immediately.
Administer IM epinephrine as ordered.
Apply oxygen via a 100% nonrebreather mask or prepare for intubation.
Insert an IV line and administer IV fluid as ordered.
Administer medication therapy such as:
• Antihistamines
• Corticosteroids
• Inhaled bronchodilators
What is the patient's problem?
What is distributive shock/ anaphylactic shock?
Medication that causes arterial vasoconstriction through smooth muscle contraction, increasing blood pressure, indication for hypotension
What is vasopressin?
Hemodynamics shows: decreased cardiac output, variable CVP and PAOP, variable SVR, decreased venous oxygen saturation (SvO2 or ScvO2), hypotension, tachycardia, and hypothermia. Which shock am I?
What is late septic shock?
When caring for a patient who is experiencing septic shock and infrequent bowel sounds. What should the nurse do to maintain adequate nutrition?
A continuous infusion of total parenteral nutrition
should be initiated within 24 hours of the start of septic shock.