Critical care medications/ SEPSIS Flashcards
(96 cards)
1
Q
What is the sympathetic nervous system?
A
The flight or fight response, it mobilizes the body, and allows the body to function under stress
2
Q
What are alpha 1 receptors and where are they located
A
The stimulation of alpha 1 receptors results in vasoconstriction. It responds strongly to norepinephrine and weakly to epinephrine
Alpha 1 receptors are located in blood vessels.
3
Q
Where are beta 1 receptors located
A
The heart and kidney
4
Q
What does stimulation of beta 1 receptors result in
A
Increased HR, contractility, conduction velocity, renin release in the kidney
5
Q
Where are beta 2 receptors located
A
In the lungs. They are located in the smooth muscle of the bronchi and skeletal blood vessels
6
Q
What does stimulation of beta 2 receptors result in
A
Relaxation of the bronchi and vasodilation
7
Q
What are beta 2 receptors more sensitive to
A
They are more sensitive to epinephrine than norepinephrine
8
Q
What are dopaminergic receptors
A
Receptor that upon there activation result in dilation
9
Q
Where are dopaminergic receptors located
A
In the coronary arteries, renal, mesenteric, and the CNS
10
Q
What medication is a neurotransmitter
A
Epinephrine,norepinephrine ( Levophed)
11
Q
What is inotrope
A
A substance which affects myocardial contractility
12
Q
What is a positive inotrope
A
Increased force of contraction
13
Q
What is a negative inotrope
A
Decreased force of contraction
14
Q
What is a chronotrope
A
A substance which affects the HR
15
Q
What is a positive chronotrope
A
It equals increased HR
16
Q
What is a negative chronotrope
A
Decreased HR
17
Q
Preload
A
The volume/ pressure left in ventricle at the end of diastole
18
Q
Wha is after load
A
The pressure of resistance against which the heart must pump
19
Q
What is a agonist
A
A drug or substance that produces a predictable response ( stimulates action)
20
Q
What is a antagonist
A
An agent that exerts an opposite action to another ( blocks the action
21
Q
What is the trade name of epinephrine
A
Adrenaline
22
Q
What are the clinical effects of epinephrine
A
Increased SVR, BP, HR, coronary and cerebral blood flow, contractility, and oxygen demand.
23
Q
What is the mechanism of action for epinephrine
A
Alpha, beta 1,2
24
Q
What are the beneficial effect of epinephrine
A
It produces beneficial effects in patients during cardiac arrest by of its alpha- Adrenergic stimulating properties
25
What is the trade name of dobutamine
Dobutrex
26
What is the mechanism of action for dobutamine
Strong beta 1, mild beta 2, weak alpha
27
What are the clinical effects of dobutamine
Increased CO, decreased SVR, slight increase in HR
28
What is the trade name of norepinephrine
Levophed
29
What is the mechanism of action for norepinephrine
Intense alpha and beta 1
30
What are the clinical effects of norepinephrine
Increased SVR, BP, bradycardia, some decrease in CO
| decreased perfusion of kidney, brain, gut, and skeletal muscle
31
What are the clinical effects of phenylephrine
Increased SVR, BP, oxygen demand, slight increase in CO
| decreased renal perfusion
32
What is the trade name of phenylephrine
Neosynephrine
33
What is the mechanism of action for phenylephrine
Potent alpha
No beta
Potent vasoconstrictor
34
What is isoproterenol
It increases HR,CO, contractility, extreme increase in myocardial oxygen consumption= myocardial ischemia, vasodilation
35
What is the mechanism of actin for isoproterenol
Pure beta 1 and 2
| No alpha
36
What effects does milrinone have
It is an inotropic and vasodilator,
It increases cardiac contractility and CO
It decreases PCWP, AMD SVR
it does not significantly increase HR or myocardial oxygen demand
37
What is the clinical use for milirinone
Increased CI/ post op cardiac surgery
| Increased cardiac function prior to heart transplant
38
What are complications for milrinone
Increased ectopy
Hypotension
Dysrthymias
39
What is vasopressin
A anti diuretic hormone with pressure and antidiuretic properties
40
What are the effects of vasopressin
Promotes reabsorption of water in renal tubules.
| Vasoconstrictor effect on GI TRACT
41
What is the clinical use of vasopressin
It decreased urinary output in diuresis in diabetes insipidus
It controls GI hemmorhage from gastric and esophageal varies as an adjunct drug
42
What are complications to monitor for with vasopressin
Anaphylaxis
Cardiac arrest
MI
POUNDING SENSATION IN HEAD
43
What is nesiritide
A human BNP that inhibits ADH by increasing Na loss by kidney
Decreased fluid overload
Decreased PCWP, preload, AMD dyspnea
44
What are complications to monitor for the nesiritide
Hypotension
Dysrthymias
Renal failure
Cough
45
What drug is used for shock
Dopamine
46
What drug is used to treat HF
Dobutamine
47
What drug is used to treat ischemic LVF
Dobutamine
48
What drug is used to treat renal failure
Dopamine
49
What are complications to monitor for with dopamine
Tachyarrthymias
| Immunosuppression
50
What's the clinical use of dopamine
Shock
| Renal failure
51
What's the clinical use of dobutamine
Heart failure
| Ischemic LVF
52
What is the action of nitroglycerin
It is a vasodilator. It increases the coronary blood flow by dilating the coronary arteries. ( it is also shown to potentiate hypotensive effects of those who take erectile dysfunction medications.)
53
What are the desired effects of nitroglycerin
It reduces systolic, diastolic and MAP,
It produces antianginal, anti ischemic, and anti hypertensive effects. when effective nitroglycerin prevents angina pectoris, controls CHF related to MI and controls HTN in the cardiac patient.
54
What are the most common adverse effects of nitroglycerin
Headaches
| Hypotension
55
ADENOSINE is used for what
It is an anti arrthymic
It causes a block at the AV node
It is used for stable and unstable narrow complex tachycardia
56
What are considerations of ADENOSINE
HR ,BP, AND CARDIAC PATTERN SHOULD BE MONITORED
| PREPARE FOR A CODE SITUATION BY HAVING A CRASH CART, O2,SUCTION AND DEFIBRILLATOR ON HAND
57
What are side effects of ADENOSINE
Facial flushing, Diaphoresis, light headedness,chest pain,and a sense of doom, the symptoms usually last less than one minute
58
If the Dysrthymia returns, or does not convert with ADENOSINE, what should be used
A longer acting AV node blocking agent such as calcupium channel blockers or BETA BLOCKERS is the second line DRUG of choice
59
What is dexamethosone used for
It produces a reduction in cerebral edema and an improvement in neurological symptoms within 8-48 hrs after dosing.
60
What are side effects of dexamethosone
Euphoria, insomnia,increased appetite, wt gain,HTN,muscle weaknesss in the legs HTPERGLYCEMIA
61
What is Phenytoin
It is an anti convulsant that works by blocking the repetitive action of the sodium channel
62
Side effects of phenytoin
Hirutism,acne, gingival hyperplasia
63
What are nursing considerations of phenytoin
Monitor ECG, and BP during administration and st least a half hour afterwards
64
What is epinephrine administered for
Epinephrine infusion may be used to treat symptomatic bradycardia that is UNRESPONSIVE to atropine
65
What are side effects of dopamine
Tachycardia
Arrthymias
Hypotension
66
What is dilitiazem
A CCB that treats narrow complex tachycardia of rhythm remains uncontrolled or or unconverted by adenosine. It also controls ventricular rate in pull with a fib, or a flutter.
67
What are side effects of dilitiazem
Hypotension
Bradycardia
AV heart block
Flushing, burning or itching at the injection site and CHF.
68
What is Amiodarone
It is a anti arrhythmic agent that has similar actions to CCB on slowing conduction. It treats a fib, ventricular tachycardia and
V fib.
69
What are are side effects of amiodarone
Hypotension
Bradycardia
QT interval prolongation
Torsades de pointes ( a type of ventricular tachycardia)
70
Silver sulfadiazene is used for what
Both partial and full thickness burns, it has a broad spectrum bactericidal action against many gram neg and positive bacteria. Applications is painless
IT DOES NOT PENETRATE ESCHAR
71
Side effect of silver sulfadiazene
Leukopenia
72
What is propofol
Is has a very short duration of action
It is indicated when sedation is required but rapid awakening to perform neurological assessment or extubation is necessary
73
What are nursing considerations of propofol
A large vein is recommended
Monitor for the development of hypotension
It has no analgesic properties
Monitor lipid levels, triglycerides
74
What is Lidocaine
An anti arrhythmic drug that blocks the sodium channels decreasing cardiac automaticity and depolarization. Used as a second line drug in treating VT
75
What process is impaired in ARDS
Alveolar perfusion and ventilation
76
Who should be monitored closely for ARDS
A pt with acute pancreatitis
77
What complications of propofol should be closely monitored
Hypotension and apnea
78
Why does hyperglycemia worsen the clients neurological outcome
Hyperglycemia increases ischemic acidosis
79
Most common complication of EVD
Meningitis
80
What is a fluid/med that should be given for shock
Crystalloids 0.9% NaCl
81
What should be given for hemmorhage
PRBC over whole blood bc it is less likely to cause coagulopathy or overload.
82
What shouldn't you give for a ICP patient
Don't give isotonic fluids
83
5 tubes for trauma patients
```
O2
IV
SUCTION
FOLEY CATHETER
NG TUBE
```
84
RTS
Revised trauma scale
| Helps assign a score to help determine the severity of the trauma
85
What is the lethal triad
Acute coagulopathy
Acidosis
Hypothermia
86
What are causes of SEPSIS
```
Pneumonia
Peritonitis
UTI
skin
Hospital acquired VAP, MRSA
```
87
What are signs and symptoms of SEPSIS
```
Chills
Hypotension
Decreased perfusion
Decreased urinary output
Significant edema or increased fluid balance hyperglycemia above 120
Fever
```
88
What is SIRS criteria
```
Temp greater than 100.4
HR greater than 90
RR greater than 20
PACO2 less than 32
WBC greater than 12,000 or less than 4,000
```
89
What is severe SEPSIS classified as
Dysfunction of 2 or more organ systems in response to hypoperfusion. It can develop suddenly or slowly
90
How is SEPSIS treated
To be completed within 6 hrs of dx!
1. Measure serum lactate ( if increased indicates decreased perfusion)
2. Obtain blood culture b4 abx tx
3. NOW administer broad spectrum abx within 3 HR of ER visit and within 2 HR of non ER admission
4. Give initial fluid challenge of 500-100 ml over 30-60 min/ evaluate response monitor for overload
5 insert CVP line for repeat fluid challenges until CVP is greater than 8 or, 12-15 on a ventilator
5.
91
If HCT is less than 30 what should you give
PRBC
92
What drug increases O2 delivery
Dobutamine
93
If the SEPSIS pt is experiencing refractory hypotension, what should the nurse do
Give vasopressors to maintain MAP above 80
The pt should have a arterial line
Give vasopressin if shock is refractory
Give norepinephrine or dopamine
94
How is a fever treated in a septic patient
Alternate between ibuprofen and acetaminophen for fever greater than 102
Watch LFTs
Use hypothermic blanket if temp greater than 103
Prevent shivering by sedation/ paralytics
95
What can be expected to be ordered in the septic patient
Give low dose steroids as ordered
| Maintain tight glucose control of 80-150
96
What is a complication of SEPSIS
SIRS
