Exam 1 chapter 54 Flashcards

(62 cards)

1
Q

what are some postoperative complications?

A
fluid and electrolyte imbalances-deficit
nausea and vomiting
shock
ineffective breathing pattern
urinary retention
constipation
acute pain
risk for infection
risk for peripheral neurovvascular dysfunction
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2
Q

which two organs are the first to show signs of dysfunction during shock?

A

heart

kidneys

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3
Q

A urine output of less than 30 mL/hr is indicative of

A

renal hypoperfusion and or hypovolemia

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4
Q

clinical findings in pre-shock

A
Near normal BP
> 100bmp HR
>20 RR
cold, clammy skin
mildly decrease urinary output
confusion
respiratory alkalosis
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5
Q

clinical findings in shock

A
systolic <80 to 90
100 to 150 HR
RR-rapid, shallow, crackles
skin-mottled, petechiae
severely decreased urinary output
lethargy
metabolic acidosis
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6
Q

clinical findings in End-organ dysfunction

A
requires mechanical or pharmacologic support
HR-Erratic or asystole
RR-requires ventilation 
Skin-Jaudice
Anuric, requires dialysis
Unresponsive
Profound acidosis
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7
Q

Syndrome characterized by decrease tissue perfusion and impaired cellular metabolism. Imbalance in supply/demand for O2 and nutrients?

A

Shock

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8
Q

Management of shock in all types and phases.

A

fluid replacement to restore intravascular volume
vasoactive medications to restore vasomotor tone and improve cardiac function.
nutritional support.

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9
Q

what happens when alpha adrenergic receptors are stimulated?

A

blood vessels constrict in cardiorespiratory
GI systems
skin
kidneys

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10
Q

Medications commonly used to treat cardiogenic shock

A

dobutamine
dopamine
nitroglycerin

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11
Q

How is supplemental O2 administered in the early stages of shock?

A

nasal cannula
saturation exceeding 90%
Monitoring of ABG values
pulse oximetry values

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12
Q

if a patient is experiences chest pain, what IV analgesic should be administered for pain relief?

A

morphine sulfate
morphine dilates the blood vessels.

Monitor for decreased BP

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13
Q

what are the primary pathophysiology outcome in shock?

A

Hypoperfusion
tissue hypoxia
acidosis
end organ dysfunction

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14
Q

Medications to be given when shock is due to septic.

A

Antibiotics- if the organism is unknown, empiric broad-spectrum are started.
blood, urine, sputum and drainage of any kind should be sent for culture.

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15
Q

medications to vasoconstrict and improve myocardial contractility

A
dopamine
norepinephrine 
phenylephrine
dobutamine
milrione
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16
Q

medication to maintain adequate urine output in a shock patient.

A

Lasix

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17
Q

medication to restore blood pressure in shock patients

A

adrenergics

sympathomimetics -Dopamine (Intropin)

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18
Q

when administering Dopamine (Intropin), what is an early symptom of drug excess?

A

Headache

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19
Q

what are some side effects of Diphenhydramine HCl (Benadryl)?

A
Drowsiness
confusion
insomnia
headache 
vertigo
photosensitivity
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20
Q

How should the RN administer Dobutamine hydrocholoride (Dubutrex)?

A

Through central venous catheter or large peripheral vein with and infusion pump.
Don’t infuse through line with other meds.

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21
Q

what type of solution should be infused with Norepinephrine?

A

dextrose solution

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22
Q

some side effects of Dopamine (Intropin)

A
Increased ocular pressure
Ectopic beats
nausea
Tachycardia
 chest pain
dysrhythmias 

Tx: monitor BP, pulses, urinary output. Use infusion pump

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23
Q

Side effects of Epinephrine (Adrenalin)

A

Nervousness
Restlessness
Dizziness
local necrosis of skin

Tx: adequate hydration, carefully aspirate syringe before IM and SC doses.

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24
Q

effects of shock on the heart?

A

decreased coronary artery perfusion: decreased function of the heart muscle as a pump.
decreased SV, CO and BP.

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25
Effects of shock on the brain.
decrease O2 and nutrient supply: decreased brain function; confusion, unconsciousness.
26
Effect of shock on the lungs
decrease blood volume=decreased O2. | decrease gas exchange at the capillary level.
27
Effects of shock on the liver
Glycogen stores are depleted by an excess of circulating epinephrin - metabolic acids that are normally detoxified in the liver cause ACIDOSIS.
28
inability of the heart to pump blood forward?
systolic dysfunction
29
Inability of the heart to fill during diastole?
diastolic dysfunction Eg. pericardial tamponade
30
External loss of whole blood?
Absolute hypovolemia shock Eg. hemorrhage, GI bleeding, surgery loss of other body fluids (vomiting, diarrhea, excessive diuresis, diabetes insipidus, diabetes mellitus (DM)
31
Relative hypovolemia
``` pooling of blood or fluids (bowel obstruction). fluid shifts (burn injuries, ascites). internal bleeding (fracture of long bones, ruptured spleen, severe pancreatitis, hemothorax). massive vasodilation (sepsis). ```
32
Effects of shock on the kidneys
A drop in cardiac output causes a decrease in blood flow through the kidneys. decrease urinary output renal failure BP systolic below 90
33
what are the two types of low blood flow shock?
cardiogenic shock | hypovolemic shock
34
name the three types of maldistribution of blood flow shock
septic anaphylactic neurogenic No change in blood volume blood not in the right place
35
Early manifestations of cardiogenic shock
``` Tachycardia hypotension narrowed pulse pressure increase myocardial O2 consumption systolic dysfunction diastolic dysfunction compromised cardiac output (CO) ```
36
During physical examination what are some of the findings of a patient in a cardiogenic shock?
``` Tachypnea pulmonary congestion pallor, cool, clammy skin decreased capillary refill time (>3sec) anxiety confusion agitation decreased renal perfusion and urinary output ```
37
result when fluid volume moves out of the vascular space into extravascular space (third spacing)
Relative hypovolemia
38
Some clinical manifestations of hypovolemic shock
``` Anxiety, confusion, agitation Tachypnea decreased Preload, SV and CO decreased urinary output pallor, cool clammy skin ``` Tx: identify the cause of the problem volume replacement, adequate oxygenation
39
Compensatory stage of shock
cardiac output is further reduced, but due to compensatory vasoconstriction blood pressure tends to remain within a normal range. blood flow to skin and kidneys decrease. blood flow to CNS and myocardium tends to be maintained. decrease occurs in blood reservoirs. pt. may compensate for 15% total blood volume (750mL). further loss of 15-30% activates SNS (increase HR, CO, RR). if lose is >30% blood volume is replaced.
40
Name the three types of distributive (Vasogenic) shock
inadequate vascular tone. Neurogenic Anaphylactic Septic
41
Anaphylactic Shock
life-threatening hypersensitivity reaction massive vasodilation capillary permeability release of mediators (histamine or bradykinin)
42
clinical manifestations of anaphylactic shock
``` Anxiety, confusion, dizziness sense of impeding doom chest pain incontinence swelling of the lips and tongue, angioedema wheezing, stridor, SOB flushing, pruritus, urticaria respiratory distress and circulatory failure ```
43
Angioedema
The rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues. occurs in anaphylactic shock Tx: Epinephrine
44
Medical management of Anaphylactic shock
Epinephrine (vasoconstrictive action and reducing bronchospasm) Diphenhydramine (to reverse the effects of histamine, reducing cap permeability). Albuterol (Proventil) reverse histamine induced bronchospasm.
45
Patients who have a penicillin allergy may also develop and allergy to similar medications such as?
Cefazolin sodium (Ancef)
46
Clinical manifestations of septic shock
Tachypnea/hyperventilation temperature dysregulation (fever, warm flushed skin) decrease urine output altered neurologic status (confusion or agitation) GI dysfunction (nausea, vomiting, diarrhea, decrease bowel sounds) respiratory failure is common
47
Initial stage of shock
not always clinically apparent recognize who is at greater risk (actively bleeding, internal bleeding) monitor for SNS stimulation
48
Compensatory stage of shock
SNS activated vasoconstriction increase diastolic and systolic pressure
49
decreasing pulse pressure is a positive sign of?
vasoconstriction | underlying hypovolemia
50
what happens to the pulse pressure when diastolic pressure increases?
pulse pressure decrease
51
Progressive stage of shock
end organ failure | medications that mimic the SNS should be given
52
Refractory stage of shock
``` irreversible profound hypotension and hypoxemia tachycardia worsens decreased coronary blood flow renal shutdown circulatory failure cerebral ischemia (brain tissue death) multiple organ failure ```
53
Epinephrine (Adrenalin)
Mimics SNS peripheral vasoconstriction (jeopardizes tissue perfusion) increase work of heart, HR and CO.
54
Side effects of Epinephrine (Adrenalin)
``` monitor HR >110 BPM monitor dyspnea (pulmonary edema) chest pain dysrhythmias, increase myocardial O2 use renal failure (ischemia) ```
55
Norepinephrine (Levophed) use
``` hypotension (unresponsive to fluid) cardiogenic shock after MI septic shock (increase vascular tone) cardiac stimulation to increase BP mimics SNS peripheral vasoconstriction renal vasoconstriction increase systemic vascular resistance ```
56
Side effects of Norepinephrine (Levophed)
dysrhythmias | hypertension
57
side effects of Antihistamine (Benadryl)
drowsiness blurred vision dry mouth (anticholinergic) Tx: DO NO TAKE WITH MAO monitor BP
58
Antihistamine (Benadryl) uses
anaphylactic shock blocks massive release of histamine to prevent and treat nausea, vomiting and dizziness
59
Patients at risk for septic shock
``` immunosuppression extremes of age (young, old) malnourishment chronic illness invasive procedures ```
60
patients at risk for neurogenic shock
spinal cord injury spinal anesthesia depressant action of medications glucose deficiency
61
Risk factors for anaphylactic shock
``` penicillin sensitivity transfusion reaction bee sting allergy latex sensitivity severe allergy to some foods or medications ```
62
Risk factors for hypovolemic shock
``` trauma, surgery vomiting, diarrhea diuresis diabetes insipidus NPO status hemorrhage burns ascites peritonitis dehydration ```