Exam 1 chapter 54

Question 1

what are some postoperative complications?

Answer 1

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

Question 2

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

Answer 2

heart

kidneys

Question 3

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

Answer 3

renal hypoperfusion and or hypovolemia

Question 4

clinical findings in pre-shock

Answer 4

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

Question 5

clinical findings in shock

Answer 5

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

Question 6

clinical findings in End-organ dysfunction

Answer 6

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

Question 7

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

Answer 7

Shock

Question 8

Management of shock in all types and phases.

Answer 8

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

Question 9

what happens when alpha adrenergic receptors are stimulated?

Answer 9

blood vessels constrict in cardiorespiratory
GI systems
skin
kidneys

Question 10

Medications commonly used to treat cardiogenic shock

Answer 10

dobutamine
dopamine
nitroglycerin

Question 11

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

Answer 11

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

Question 12

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

Answer 12

morphine sulfate
morphine dilates the blood vessels.

Monitor for decreased BP

Question 13

what are the primary pathophysiology outcome in shock?

Answer 13

Hypoperfusion
tissue hypoxia
acidosis
end organ dysfunction

Question 14

Medications to be given when shock is due to septic.

Answer 14

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

Question 15

medications to vasoconstrict and improve myocardial contractility

Answer 15

dopamine
norepinephrine 
phenylephrine
dobutamine
milrione

Question 16

medication to maintain adequate urine output in a shock patient.

Answer 16

Lasix

Question 17

medication to restore blood pressure in shock patients

Answer 17

adrenergics

sympathomimetics -Dopamine (Intropin)

Question 18

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

Answer 18

Headache

Question 19

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

Answer 19

Drowsiness
confusion
insomnia
headache 
vertigo
photosensitivity

Question 20

How should the RN administer Dobutamine hydrocholoride (Dubutrex)?

Answer 20

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

Question 21

what type of solution should be infused with Norepinephrine?

Answer 21

dextrose solution

Question 22

some side effects of Dopamine (Intropin)

Answer 22

Increased ocular pressure
Ectopic beats
nausea
Tachycardia
 chest pain
dysrhythmias 

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

Question 23

Side effects of Epinephrine (Adrenalin)

Answer 23

Nervousness
Restlessness
Dizziness
local necrosis of skin

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

Question 24

effects of shock on the heart?

Answer 24

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

Question 25

Effects of shock on the brain.

Answer 25

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

Question 26

Effect of shock on the lungs

Answer 26

decrease blood volume=decreased O2. | decrease gas exchange at the capillary level.

Question 27

Effects of shock on the liver

Answer 27

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

Question 28

inability of the heart to pump blood forward?

Answer 28

systolic dysfunction

Question 29

Inability of the heart to fill during diastole?

Answer 29

diastolic dysfunction Eg. pericardial tamponade

Question 30

External loss of whole blood?

Answer 30

Absolute hypovolemia shock Eg. hemorrhage, GI bleeding, surgery loss of other body fluids (vomiting, diarrhea, excessive diuresis, diabetes insipidus, diabetes mellitus (DM)

Question 31

Relative hypovolemia

Answer 31

``` 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). ```

Question 32

Effects of shock on the kidneys

Answer 32

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

Question 33

what are the two types of low blood flow shock?

Answer 33

cardiogenic shock | hypovolemic shock

Question 34

name the three types of maldistribution of blood flow shock

Answer 34

septic anaphylactic neurogenic No change in blood volume blood not in the right place

Question 35

Early manifestations of cardiogenic shock

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

Relative hypovolemia

Question 38

Some clinical manifestations of hypovolemic shock

Answer 38

``` 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

Question 39

Compensatory stage of shock

Answer 39

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.

Question 40

Name the three types of distributive (Vasogenic) shock

Answer 40

inadequate vascular tone. Neurogenic Anaphylactic Septic

Question 41

Anaphylactic Shock

Answer 41

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

Question 42

clinical manifestations of anaphylactic shock

Answer 42

``` 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 ```

Question 43

Angioedema

Answer 43

The rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues. occurs in anaphylactic shock Tx: Epinephrine

Question 44

Medical management of Anaphylactic shock

Answer 44

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

Question 45

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

Answer 45

Cefazolin sodium (Ancef)

Question 46

Clinical manifestations of septic shock

Answer 46

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

Question 47

Initial stage of shock

Answer 47

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

Question 48

Compensatory stage of shock

Answer 48

SNS activated vasoconstriction increase diastolic and systolic pressure

Question 49

decreasing pulse pressure is a positive sign of?

Answer 49

vasoconstriction | underlying hypovolemia

Question 50

what happens to the pulse pressure when diastolic pressure increases?

Answer 50

pulse pressure decrease

Question 51

Progressive stage of shock

Answer 51

end organ failure | medications that mimic the SNS should be given

Question 52

Refractory stage of shock

Answer 52

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

Question 53

Epinephrine (Adrenalin)

Answer 53

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

Question 54

Side effects of Epinephrine (Adrenalin)

Answer 54

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

Question 55

Norepinephrine (Levophed) use

Answer 55

``` 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 ```

Question 56

Side effects of Norepinephrine (Levophed)

Answer 56

dysrhythmias | hypertension

Question 57

side effects of Antihistamine (Benadryl)

Answer 57

drowsiness blurred vision dry mouth (anticholinergic) Tx: DO NO TAKE WITH MAO monitor BP

Question 58

Antihistamine (Benadryl) uses

Answer 58

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

Question 59

Patients at risk for septic shock

Answer 59

``` immunosuppression extremes of age (young, old) malnourishment chronic illness invasive procedures ```

Question 60

patients at risk for neurogenic shock

Answer 60

spinal cord injury spinal anesthesia depressant action of medications glucose deficiency

Question 61

Risk factors for anaphylactic shock

Answer 61

``` penicillin sensitivity transfusion reaction bee sting allergy latex sensitivity severe allergy to some foods or medications ```

Question 62

Risk factors for hypovolemic shock

Answer 62

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