Exam 1 chapter 54 Flashcards

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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
Q

Effects of shock on the brain.

A

decrease O2 and nutrient supply: decreased brain function; confusion, unconsciousness.

26
Q

Effect of shock on the lungs

A

decrease blood volume=decreased O2.

decrease gas exchange at the capillary level.

27
Q

Effects of shock on the liver

A

Glycogen stores are depleted by an excess of circulating epinephrin - metabolic acids that are normally detoxified in the liver cause ACIDOSIS.

28
Q

inability of the heart to pump blood forward?

A

systolic dysfunction

29
Q

Inability of the heart to fill during diastole?

A

diastolic dysfunction

Eg. pericardial tamponade

30
Q

External loss of whole blood?

A

Absolute hypovolemia shock

Eg. hemorrhage, GI bleeding, surgery

loss of other body fluids (vomiting, diarrhea, excessive diuresis, diabetes insipidus, diabetes mellitus (DM)

31
Q

Relative hypovolemia

A
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
Q

Effects of shock on the kidneys

A

A drop in cardiac output causes a decrease in blood flow through the kidneys.
decrease urinary output
renal failure
BP systolic below 90

33
Q

what are the two types of low blood flow shock?

A

cardiogenic shock

hypovolemic shock

34
Q

name the three types of maldistribution of blood flow shock

A

septic
anaphylactic
neurogenic

No change in blood volume
blood not in the right place

35
Q

Early manifestations of cardiogenic shock

A
Tachycardia 
hypotension
narrowed pulse pressure
increase myocardial O2 consumption 
systolic dysfunction
diastolic dysfunction
compromised cardiac output (CO)
36
Q

During physical examination what are some of the findings of a patient in a cardiogenic shock?

A
Tachypnea
pulmonary congestion
pallor, cool, clammy skin
decreased capillary refill time (>3sec)
anxiety
confusion
agitation 
decreased renal perfusion and urinary output
37
Q

result when fluid volume moves out of the vascular space into extravascular space (third spacing)

A

Relative hypovolemia

38
Q

Some clinical manifestations of hypovolemic shock

A
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
Q

Compensatory stage of shock

A

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
Q

Name the three types of distributive (Vasogenic) shock

A

inadequate vascular tone.
Neurogenic
Anaphylactic
Septic

41
Q

Anaphylactic Shock

A

life-threatening hypersensitivity reaction
massive vasodilation
capillary permeability
release of mediators (histamine or bradykinin)

42
Q

clinical manifestations of anaphylactic shock

A
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
Q

Angioedema

A

The rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues.

occurs in anaphylactic shock
Tx: Epinephrine

44
Q

Medical management of Anaphylactic shock

A

Epinephrine (vasoconstrictive action and reducing bronchospasm)
Diphenhydramine (to reverse the effects of histamine, reducing cap permeability).
Albuterol (Proventil) reverse histamine induced bronchospasm.

45
Q

Patients who have a penicillin allergy may also develop and allergy to similar medications such as?

A

Cefazolin sodium (Ancef)

46
Q

Clinical manifestations of septic shock

A

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
Q

Initial stage of shock

A

not always clinically apparent
recognize who is at greater risk (actively bleeding, internal bleeding)
monitor for SNS stimulation

48
Q

Compensatory stage of shock

A

SNS activated
vasoconstriction
increase diastolic and systolic pressure

49
Q

decreasing pulse pressure is a positive sign of?

A

vasoconstriction

underlying hypovolemia

50
Q

what happens to the pulse pressure when diastolic pressure increases?

A

pulse pressure decrease

51
Q

Progressive stage of shock

A

end organ failure

medications that mimic the SNS should be given

52
Q

Refractory stage of shock

A
irreversible
profound hypotension and hypoxemia
tachycardia worsens
decreased coronary blood flow
renal shutdown
circulatory failure
cerebral ischemia (brain tissue death)
multiple organ failure
53
Q

Epinephrine (Adrenalin)

A

Mimics SNS
peripheral vasoconstriction (jeopardizes tissue perfusion)
increase work of heart, HR and CO.

54
Q

Side effects of Epinephrine (Adrenalin)

A
monitor HR >110 BPM
monitor dyspnea (pulmonary edema)
chest pain
dysrhythmias, increase myocardial O2 use
renal failure (ischemia)
55
Q

Norepinephrine (Levophed) use

A
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
Q

Side effects of Norepinephrine (Levophed)

A

dysrhythmias

hypertension

57
Q

side effects of Antihistamine (Benadryl)

A

drowsiness
blurred vision
dry mouth (anticholinergic)

Tx: DO NO TAKE WITH MAO
monitor BP

58
Q

Antihistamine (Benadryl) uses

A

anaphylactic shock
blocks massive release of histamine
to prevent and treat nausea, vomiting and dizziness

59
Q

Patients at risk for septic shock

A
immunosuppression
extremes of age (young, old)
malnourishment
chronic illness
invasive procedures
60
Q

patients at risk for neurogenic shock

A

spinal cord injury
spinal anesthesia
depressant action of medications
glucose deficiency

61
Q

Risk factors for anaphylactic shock

A
penicillin sensitivity
transfusion reaction
bee sting allergy
latex sensitivity
severe allergy to some foods or medications
62
Q

Risk factors for hypovolemic shock

A
trauma, surgery
vomiting, diarrhea
diuresis 
diabetes insipidus
NPO status
hemorrhage
burns
ascites
peritonitis 
dehydration