Complex Care

Question 1

What is Septic Shock

Answer 1

Exaggerated immune response to a mircoorgnaism, casuing vasodilation. Main triggers are gram neg or postive bacteria

Question 2

General Symptoms of Shock

Answer 2

Think of what you see with poor perfusion. The body is reacting too this, it doesnt care what type of shock
- Tachycardia
- Pale, clammy skin
- Dyspnea with decreased 02 sats
- Oliguria
- ALOC

Question 3

Why do lactate levels rise in shock

Answer 3

Hypoxia, causes body to switch to anerobic metabolism of oxygen, raising lactic acid

Question 4

General Nursing Interventions for Shock

Answer 4

• IV Fluids
• Monitor I/O
• Monitor LOC
• Monitor Labs (electrolytes, BG, lactate,)
• Cardiac Monitoring
• lower head of bed, elevate lower extremities

Question 5

How does Pulmonary Congestion Happen in Cardiogenic Shock

Answer 5

Cardiogenic shock is typically a L sided heart injury, meaning blood cannot be adequately pumped out of the heart into the body, therefore it gets back up in the heart and eventually, all the way to the lungs

Question 6

Sympathetic vs parasympathetic NS

Answer 6

S = constrict
P = relax and dilate

Question 7

What is hypovolemic shock

Answer 7

Shock caused by fluid volume loss, causing decreased intravascular volume, then decreasing perfusion and venous return, then decreasing CO, causing vasoconstriciton and more vascular resistance

Question 8

What is Anaphylactic Shock

Answer 8

• Hypersensitivity reaction occuring to repeat exposure to an allergen.
• IgE mediated.
• Excessive relase of cytokines cause vasodilation, increased cap permeability/poor perfusion/ and laryngospasm and brochonspasm.
  Tx: epinephrine, maintain airway, elevate legs, bronchodilator, antihistamine, corticosteroids

Question 9

What is cardiogenic shock

Answer 9

The impairment of the hearts ability to contract, therfore decreasing cardiac output and impairing tissue perfusion.
Some causes include:
- MI
- Valve disease
- HF
- cardiomyopathy

Question 10

What is neurogenic shock

Answer 10

The disruption of the symapthic tone. (over parasympathetic). The intravasular fluid shifts to the periphery in response. Decreasing CO and perfusion.
Some causes include:
- Spinal injury
- Brian injury
- Spinal anaesthia
- Some medication (CNS depressant, opioids)

Question 11

Clinical Features of neurogenic shock

Answer 11

• Hypotension
• BRADYCARDIC
• WARM DRY SKIN (high blood flow to periphery, warm at first but then cools when stagnant = HYPOTHERMIA
• weakness or paralysis (d/t injury)

Question 12

What to do if water seal of chest tube breaks

Answer 12

1. clamp
2. cut away tube
3. submerg into sterile water
4. unclamp
5. monitor for pulmonary embolism
6. inform provider
   *chest tube should only be clamped for 15 seconds without an order

Question 13

Explain when and where a chest tube should or shoudnt bubble

Answer 13

Water seal chamber
- intermittent = good
- constant = bad
Suction chamber
- intermittent = bad
- constant = good