[Exam 4] Chapter 14 - Shock and Multisystem Failure Flashcards
1
Q
Shock: What is this?
A
Life-threatening condition related to inadequate tissue perfusion.
2
Q
Shock: Inadequate blood flow results in what changes to occur in body?
A
Poor delivery of oxygen and nutrients
Cellular Hypoxia
Cell death that progresses to organ dysfunction and eventually death
3
Q
Shock: What do you need for adequate flow to tissues?
A
Effective Cardiac Pump (Heart can effectively pump blood to rest of organs)
Adequate Vasculature/Circulatory System
Sufficient Blood Volume
4
Q
Shock: What should we think about shock when we hear this?
A
That there is not enough tissue perfusion happening in these patients.
5
Q
Shock: How does the body respond to shock?
A
By activation of the inflammatory response. Will then have hyperperfusion of tissues, hypermetabolism due to increased need for energy since tissues aren’t being perfused.
6
Q
Shock - Patho, Cellular Changes: What happens when inflammatory response kicks in?
A
You have increased permeability which leads to leaky vessels. Electrolytes and fluids go in-and-out.
Mitochondria will be damaged and you will have cell death
7
Q
Shock - Patho, Cellular Changes: How will the cell look?
A
You can have cellular edema. Fluids are leaking out. Will also have mitochondrial damage due to swelling.
8
Q
Shock - Patho, Cellular Changes: What changes occur electrolyte wise?
A
You will have efflux of potassium leaving
Large influx of Sodium and H2O coming in. flooding membranes
9
Q
Shock - Patho, Cellular Changes: The cell will change from aerobic metabolism to what?
A
anaerobic metabolism.
10
Q
Shock - Patho, Cellular Changes: What usually occurs in aerobic metabolism?
A
That is how we normally function. Glucose/oxygen goes into cell and outputs CO2 and Water to produce a lot of energy
11
Q
Shock - Patho, Cellular Changes: How does anaerobic work?
A
This is only using glucose. Only glucose goes into cell and lactic acid gets kicked out. This releases only a small amount of energy and creates an oxygen debt to break down all that lactic acid.
12
Q
Shock - Patho, Cellular Changes: What is the important thing to realize for shock on cellular level?
A
When patient goes into shock, they have inadequate tissue perfusion so no oxygen.
Not enough oxygen to do aerobic metabolism so they’lll switch to anaerobic. Causes buildup of lactic acid.
13
Q
Shock - Patho, Cellular Changes: Activation of stress response causes what changes to occur with energy levels?
A
Increased glucose levels , decreased insulin and the body becomes more insulin resistance. Cannot utilize the glucose. Depletes glycogen reserves and body gets energy from protein.
14
Q
Shock - Patho, Cellular Changes: what changes occur with clotting cascade
A
You will start to see small clots which can lead to decreased cellular perfusion because of mini-clots building up here.
15
Q
Shock - Patho, Cellular Changes: Big cellular changes relate to what?
A
Increased permeability , activates of stress response, and clotting cascade
16
Q
Shock - Patho, Vascular Response: During this response , you have the release of what?
A
Cytokines.
17
Q
Shock - Patho, Vascular Response: The release of cytokines does what to body?
A
Stimulates vasodilation or vasoconstriction . This is why vasodilation occurs with patients.
18
Q
Shock - Patho, BP Regulation: When looking at this, what should we be looking at?
A
Mean Arterial Pressure (MAP) . Tissue perfusion and organ perfusion depend on this .
19
Q
Shock - Patho, BP Regulation: What is MAP?
A
Cardiac Output x Peripheral Resistance.
20
Q
Shock - Patho, BP Regulation: What level should this be at?
A
MAP should be over 65 to maintain adequate tissue perfusion.
21
Q
Shock - Patho, BP Regulation: How does RAAS play a role here?
A
If kidneys not getting perfused, RAAS will be kicked in. Will have Angiotensin I -> Anngiotensin II whick causes vasoconstriction
Also have ADH kicked in that causes kidneys to retain water to help increased blood volume and blood pressure in patients.
22
Q
Stages of Shock: What are the stages of shock?
A
Compensatory
Progressive
Irreversible
23
Q
Stages of Shock - Compensatory: What occurs here?
A
The body is trying to compensate for what is going on
24
Q
Stages of Shock - Compensatory: Blood pressure here?
A
Will usually remain within normal limits
25
Stages of Shock - Compensatory: What changes occur here?
Release of biochemical mediators, cytokines, and start to cause vasoconstriction increasing HR and increased contractility. Blood is shunted to vital organs like lungs, brains. Body is compensating.
26
Stages of Shock - Progressive: What stage is this?
The 2nd stage of shock
27
Stages of Shock - Progressive: What blood pressure changes occur?
MAP below normal limits.
Systolic < 90.
If hypertensive, will have a drop of 40 mm of mercury from baseline. If 160/90, will drop to 120/70
28
Stages of Shock - Progressive: What changes occur in rest of body?
Mental status changes in patient.
Overworked heart doesn't beat at optimal level
Will start to see increased capillary permeability from inflammatory response being initiated. Coagulation cascade also activated, leading to microemboli.
29
Stages of Shock - Progressive: How does this progress?
This just continues to progress and get worse.
30
Stages of Shock - Irreversible: How does this progress?
The patients are not going to recover from this stage of shock
Organs so damaged that they don't respond to treatment.
31
Stages of Shock - Patho: What initially happens to the body when there is an initial insult leading to shock state?
Decrease in tissue perfusion and oxygenation. Leading ot activation of homeostatic response
32
Stages of Shock - Patho: What homeostatic responses occur?
Increase sympathetic response (Increase HR, BP, Cardiac Contractility = Increased CO)
Increase in RAAS
Increased in RR to increase oxygen saturation
Increase in catecholamines and cortisol to provide increased glucose for metabolism
33
Types of Shock: What are the different types?
Cardiogenic
Circulatory
Hypovolemic
Neurogenic
34
Types of Shock: Cardiogenic shock is a result of what?
When something happens to the heart.
35
Types of Shock: Circulatory shock is a result of what
This is Broad statement for shock. This is sometimes interhcanged with distributive.
36
Types of Shock: Regardless of the type of shock, what is imperative to do?
Must have early identification and timely treatment
37
Types of Shock: Shock needs to be identified early why?
So that we can identify treatments. The longer it takes to identify shock, the longer it will take to identify positive outcomes.
38
Types of Shock: How can you identify and treat underlying cause?
If hypovolemic, give them some fluids. Sequence of events for shock will vary but management and care can be done for all types.
39
Types of Shock: If patient is septic, what can we give them?
Antibiotics
40
General Shock Mx: First off, you want to support what?
The respiratory system. Will be on either supplemental O2 through nasal cannula but may be mechanically ventilated as they progress to provide optimal oxygenation
41
General Shock Mx: Fluid replacement is given why?
To restore intravascular volume. Different types of fluids can be given
42
General Shock Mx: What are some fluids can be given for shock?
Normal Saline
Lactated Ringers
because patient is losing fluid to intersittial space because of capillary permeability.
43
General Shock Mx: Fluids are adminsitered why?
Will be given early in shock. Administered to improve cardiac and tissue oxygenation.
44
General Shock Mx: Why is Lactated Ringers given more often than normal saline?
Because it has a lactate ion in it. It contains bicarb and will help buffer.
45
General Shock Mx: What is 0.9% NS usually used for?
To expand volume, dilute medications and keep vein wide open
46
General Shock Mx: What is Lactated Ringers usually used for?
Fluid resuscitation
47
General Shock Mx: What do 0.9% NS and Lactated Ringers have in commmon?
they are both isotonic and have ethe same osmolarity as body fluid
48
General Shock Mx: What is D5W usually used for?
Usually isotonic but once in body, metabolizes glucose and becomes hypotonic
49
General Shock Mx: What is D5 1/2 NS and D5NS usually used for?
USed for Na and Volume replacement. Go slow, monitor BP, pulse rate, and quality of lung sounds as well is serum NA and output.
50
General Shock Mx: Who would you not give D5W to?
Infants or head injury patients. Will cause cerebral edema
51
General Shock Mx: Why must you be careful with giving patients too much fluid?
Can throw them into fluid volume overload, causing pulmonary edema and abdominal compartment syndrome.
52
General Shock Mx: What are colloid solutions?
They are similar to plasma and plasma proteins. Molecules too large to pass through capillary membrane.
53
General Shock Mx: What kind of solutions are colloid?
This includes albumin and plasmonate. These are volume expanders.
54
General Shock Mx: Wh are crystalloid and colloid solutios not used?
Because they are quite pricey. To get extra volume, can give NS or LR.
55
General Shock Mx: Complications of fluid administrtion include what
cardiovascular overload or pulmonary edema.
56
General Shock Mx: How do you know if fluid resuscition is successful?
Can look at output. If adequate urine output produced, thats how you know.
If CVP (2-6) placed, can tell. If it is increased, then you know that they are maintaining fluid volume status
57
General Shock Mx: How do you know if the patients are becoming fluid overloaded?
Looking and listening for lung sounds. Were they clear to begin with and now you hear crackles?If so, may need to back off on fluid.
58
General Shock Mx: Patients will be sick, so they may have central line or arterial line or pulmonary artery catheter. What must you watch for with these patients?
CATBI. A central line associated bloodstream infection. Make sure dressings are inclusive. and intact.
59
General Shock Mx: Patients will need nutritional support why?
To address the metabolic requirements.
60
General Shock Mx: Patient will be on vasoactive medication why?
Will also see them on vasoactive medication to restore vasomotor tone and improve cardiac function.
61
Shock Mx - Vasoactive Med Therapy: When you think of vasoactive meds, what can they cause?
Constriction of those vessels , causing them to clamp down
Or they can also vasodilate.
62
Shock Mx - Vasoactive Med Therapy: How will these meds act for someone in shock??
They will always be vasoconsricting because we need to get the blood pressure up.
63
Shock Mx - Vasoactive Med Therapy: What changes will this cause inside of the body?
Increase myocardial contractility strength
Regulate HR
Reduce myocardial resistance
Initiate vasoconstriction
64
Shock Mx - Vasoactive Med Therapy: How will the medications be selected?
By their action.
65
Shock Mx - Vasoactive Med Therapy: What are the different types of medications available?
Inotropes - Help with squeeze
Vasodilators - They Vasodilate
Vasopressors
66
Shock Mx - Vasoactive Med Therapy: What is important for us to do as nurses when someone is on this?
Monitor VS's. Will be on cardiac monitor and will have arterial pressure line to give continuous blood pressure readings.
67
Shock Mx - Vasoactive Med Therapy: Why would vasopressors also be titrated?
To maintain a certain blood pressure. They will be titrated to keep the MAP > 65.
68
Shock Mx - Vasoactive Med Therapy: What precaution must you take for someone on norepinephrine?
You never want to just shut it off. You want to titrate slowly to make sure you give patient time to compensate to get off of medication.
69
Shock Mx - Vasoactive Med Therapy: What are some examples of inotropic agents?
Dobutamine (Dobutrex)
Dopamine (Intropin)
Epinephrine (Adrenalin)
Milrinone (Primacor)
70
Shock Mx - Vasoactive Med Therapy: What is the desired action of shock?
Improve contractility, increase stroke volume, increase cardiac output
71
Shock Mx - Vasoactive Med Therapy: Disadvantage of inotropic agents?
Increase oxygen demand of the heart
72
Shock Mx - Vasoactive Med Therapy: Examples of vasodilators?
Nitroglycerin (Tridil)
| Nitroprusside (Nipride)
73
Shock Mx - Vasoactive Med Therapy: Directed action of vasodilators?
Reduce preload and afterload, reduce oxygen demand of heart
74
Shock Mx - Vasoactive Med Therapy: Disadvantages of vasodilators?
Causes hypotension
75
Shock Mx - Vasoactive Med Therapy: Example of vasopressors?
Norepinephrine (Levophed)
Dopamine (Intropin)
Phenylephrine (Neo-Synephrine)
Vasopressin (Pitressin)
76
Shock Mx - Vasoactive Med Therapy: Desired action of vasopressors?
Increase blodo pressure by vasoconstriction
77
Shock Mx - Vasoactive Med Therapy: Disadvantage of vasopressors?
Increase afterload, thereby decreasing cardiac workload. Compromises perfusion to skin, kidneys, lungs, GI tract`
78
Shock Mx - Vasoactive Med Therapy: Why can some drugs be listed as both inotropes and vasopressors?
At lower dose, dopamine is inotrpope. At higher, is a vasopressor.
Medications can have multiple uses
79
Shock - Nutritional Support: Why is this important?
Patient have an increased metabolic rate and an increased caloric need. They need more energy.
80
Shock - Nutritional Support: How many calories do they usually need?
Around 3000 calories
81
Shock - Nutritional Support: What gets released early in shock in the body?
Catacholamines, which are usually released when you are physically are emotionally stressed
82
Shock - Nutritional Support: How do catacholamines affect the body?
It depletes the glycogen storage. That is why these patients need nutrition
83
Shock - Nutritional Support: What type of nutrition is preferred?
Enteral Nutrition. Will get feed through a tube feed and not through TPN through IV.
84
Shock - Nutritional Support: Enteral nutrition helps cut down what?
Stress ulcers, which may occur frequently because blood has shunted organs to vital organs, meaning GI tract is not getting enough blood. Helps reduce stress ulcers.
85
Shock - Nutritional Support: Patients should be put on some sort of anti-acid, H2 blockers, or PPI why?
Because they will help inhibit gastric acid secretion and therefore decrease possibility of stress ulcer
86
Hypovolemic Shock: How common is this?
Most common type of shock
87
Hypovolemic Shock: What is this?
You have decreased intravascular volume. Occurs when theres a reduction in intravascular volume by 15-30%. Patient has lost 750 - 1500 mL of circulatory blood/fluid.
88
Hypovolemic Shock: What can cause this?
Dehydration, severe edema, ascites (shifting of fluids), or blood loss (hemorrhage through surgery or accident trauma).
Decrease in intravascular volume
89
Hypovolemic Shock - Sequence of Events: What happens to the body once there is a decrease in intravascular volume?
Decreased venous return (decreased ventricular filling) --> Decreased stroke volume --> decreased cardiac output --> decreased tissues perfusion
90
Hypovolemic Shock - Sequence of Events: What happens to the body once there is decreased tissue perfusion?
You see an increase in lactic acid because thats where we flip from aerobic to anaerobic metabolism
91
Hypovolemic Shock Tx: What is the first step you should do ?
Identify and treat the cause. If there are bleeding, stop the bleeding and give them blood.
If losing fluid because nauseated or diarrhea, stop them.
92
Hypovolemic Shock Tx: What is the first thing given after your treat the underlying cause?
You want to give them fluid and blood replacement.
93
Hypovolemic Shock Tx: To replace fluid, we need to make sure that patient has what?
Two large gauge IVs that are 18 gauge or larger.
94
Hypovolemic Shock Tx: Fluid will be replaced according to what rule?
3-to-1 rule. Three mLs of crystalloids for every mL of blood loss.
95
Hypovolemic Shock Tx: What is another thing you can do instead of fluid and blood replacement?
You can do redistrubtion of fluid or pharmacologic therapy
96
Hypovolemic Shock Tx: How does redistribution of fluid work?
Involves modified trendelenburg position. Legs elevated which promotes return of blood to heart. Promotes the venous return
97
Hypovolemic Shock Tx: What meds can be given to reverse cause if they're having diarrhea?
Give them an anti-diarrheal
98
Hypovolemic Shock Tx: What meds given if they are nauseated and vomitting?
Give them anti-emitics. This includes zofran and phenergan.
99
Hypovolemic Shock Tx: What meds can be given for DKA patient due to diuesis?
Treat cause and give them insulin due to hypoglycemia.
100
Hypovolemic Shock Tx: Meds given will focus on what
Treating the underlying cause that caused them to go into this
101
Hypovolemic Shock Tx: Patients are usually placed in trendelenburg when what happens to them?
When they become hypotensive, in hopes to raise blood pressure.
102
Hypovolemic Shock Tx: How to make sure you administer blodo and fluids safely?
By implementing safety measures and making sure you document what youre doing and monitor for complications
103
Hypovolemic Shock Tx: What are some things you would look out for with this population?
Vital signs (BP, HR, RR to make sure not fluid overloaded, O2 Sat, CVP, Lung Sounds, Lactate Levels)
Monitor ABGs
Fluid overload complications from abdominal compartment syndrome
104
Hypovolemic Shock Tx: What intervention can be given to help them out initially?
Can give them oxygen, because it increased amount of O2 carried by the hemoglobin in the blood.
105
Cardiogenic Shock: When does this occur?
When the hearts ability to contract and pump is impaired and the supply of oxygen in inadequate for heart and tissue.
106
Cardiogenic Shock: What changes occur in the body due to this?
Heart can't pump effectively leading to decreased CO. Oxygen blood not getting out leading to decreased MAP
107
Cardiogenic Shock: What are some causes of this?
MI that affected left side of heart.
Severe heart failure
Anything that impacts the heart can lead ot this
108
Cardiogenic Shock: What CMs can they develop?
Angina, Dysrhythmias, Fatigue, Impending Doom, Hemodynamically Unstable
109
Cardiogenic Shock - Mx: What is one of the first things you want to do?
Limit further damage. Want to correct the cause of this shock.
110
Cardiogenic Shock - Mx: How will we improve cardiac function?
By increasing cardiac contractility and decreased ventricle afterload. Achieved by increasing O2 to the heart muscle while also reducing O2 demand.
111
Cardiogenic Shock - Mx: What will these patients be put on?
Oxygen, trying to maintain at 95%
112
Cardiogenic Shock - Mx: Why would morphine be given?
This decreases preload and afterload taking demand off of heart
113
Cardiogenic Shock - Mx: How will these patients be monitored?
Hemodynamic monitoring.
This includes ART Line to get BP/ABGs. Also includes pulmonary artery catheter to give specific measurements about cardiac output. Also systemic vascular resistance to see how hard they pump to get over resistance.
114
Cardiogenic Shock - Mx: what labs will be drawn?
BNP - released when left ventricle is stretched
Cardiac markers for trends and MI
Telemetry looking for ST segment changes
115
Cardiogenic Shock - Mx: Why do we have to be careful with fluids?
They can easily give them too many fludis and throw them into fluid volume overload
116
Cardiogenic Shock - Mx: Meds will focus on what?
Improving contracility and decreasing the cardiac workload.
117
Cardiogenic Shock - Mx: Inotropic drugs do what to the heart?
Stimulate the myocardial beta-cells . Since includes dobutamine and dopamine. They increase contractility.
118
Cardiogenic Shock - Mx: Dopamine at low dosees helps with what
Contracility. At high doses, dopamine causes vasoconstriction
119
Cardiogenic Shock - Mx: Why does dopamine help with contracility?
Because you have an increased HR which helps with increased output.
120
Cardiogenic Shock - Mx: What medications will be given
Inotropes - Dopamine , Dobutamine.
Vasodilators - Nitro
Vasopressors - Levofed or Norepinephrine. Epinephrine
Anti-Rhythmics - Amiodarone , Lidocaine
121
Cardiogenic Shock - Mx: Vasodilators, Nitro, will assist with what?
Reduce preload and reduce afterload
122
Cardiogenic Shock - Nursing Mx: Once of the best things we can do for this is what
PRevent or identify increased patients at risk for potentially going into cardiogenic shock. Hard to prevent but we can stop progression by monitoring patieints closely.
123
Cardiogenic Shock - Nursing Mx: If patients are having agina, what can we do?
Give them nitroglycerin. Can also give O2.
124
Cardiogenic Shock - Nursing Mx: If starting patient on low-dose dodpamien at 2 mics/min, what is this supposed to be doing?
Helping with contracility of the heart. Should be looking for increased cardiac output.
125
Cardiogenic Shock - Nursing Mx: What should you always be assessing?
The IV sites because this is where you are going to be administering the medication.s that are vesicants. They can be dangerous to the vessel if IVs would infiltrate.
126
Cardiogenic Shock - Nursing Mx: What is included in the treatment for this?
```
Oxygen
Pain Control
Hemodynamic Monitoring
Labs
Fluids
Meds
Mechancal Assist Devices
```
127
Cardiogenic Shock - Nursing Mx: What mechanical assistive device can eb used?
IABP. Intra-Aortic Bloom Pump.
128
Cardiogenic Shock - Nursing Mx: What is a Intra-Aortic Bloom Pump (IABP)
Going in through femoral artery and into aorta. Inflates during diastole. Helps push blood back into coronary artery to help perfuse heart. Takes workload off of heart. Helps the heart recover, especially after MI.
129
Cardiogenic Shock - Nursing Mx: How can you enhance comfort and safety?
Reduce anxiety, if bloom pump in head must be placed flat to prevent RV bleed.
130
Distributive Shock: What is this?
Occurs when there has been intravascular blood volume that pools in periphery and in blood vessels. Usually caused by loss in sympathetic tone or released by biochemical mediators.
131
Distributive Shock: What kind of patients would have this
Those with sepsis, anaphylaxis, and neurogenic shock
132
Distributive Shock: In all types of this, what will happen to the blood vessels?
Will have massive arterial and venous dilation leading to peripheral blood pooling.
133
Distributive Shock: What is Anaphylactic shock?
There's been a tranfusion reaction , bee sting, or even peanuts.
134
Distributive Shock: How are those in anaphylactic shock treated?
With epinephrine.
135
Distributive Shock - Septic Shock: This tends to happen more with what type of patients?
Immunocompromised patients , increased age, some type of invasive procedure, something that's led to sepsis.
136
Distributive Shock - Septic Shock: What are some risk factors for this?
Immunosuppression (Patients who have had organ transplant), age (< 1 or > 65), malnourished, invasive procedures, chronic illnesses, multiple surgeries.
137
Distributive Shock - Septic Shock: What are some risk factors for neurogenic shock?
Spinal cord injury, spinal anesthesia,
138
Distributive Shock - Septic Shock: After the precipitating event occurs, what happens in body?
Vasodilation -> Inflammatory response -> maldistribution of blood -> decreased venous -> decreased cardiac output -> decreased tissuse perfusion
139
Distributive Shock - Septic Shock: Just remember that disributive shock has to do with what
Intravascular blood volume starts to pool in periphery so you have bad decreased blood venous return leading to decreased cardiac output leading to decreased tissue perfusion
140
Distributive Shock - Septic Shock: What are the different types of distribtive shock?
Septic Shock
Neurogenic Shock
anaphylactic Shock
141
Septic Shock: What is sepsis?
This is the most common type of distributive shock. Some type of infection, where they become septic and severely septic, leading to shock.
142
Septic Shock: It is important that we follow what bundles?
The CAUTI bundles, so the catheter associated UTIs and make sure they don't develop it that way.
VEntilattor associated pneumonia, maintain sterile technique in all procedures .
143
Septic Shock: What is the best way to prevent this?
Following all the protocols that are in place. These are done to ensure that no infections occur in patient.
144
Septic Shock: Number one way to prevent infection?
Hand hygiene
145
Septic Shock: So what occurs in sepsis?
Microorganism invades body which starts inflammatory response, patients has poor tissue perfusion with increased capillary permeability and vasodilation and clotting cascade.
146
Septic Shock: All shock tends to come back to what same patho?
Inflammatory response kicks in and increased capillary permeability, vasodilation, clotting cascade.
147
Septic Shock: What occurs in the early stages to the body?
BP is normal. Will have decreased response to fluid and increased HR.
148
Septic Shock: Patients in early stages also have an infection, which means how will they present and what should we monitor for?
They will have a fever, which leads to warm flesh skin for sepsis. May also have bounding pulse, increase lactic because of anaerobic metabolism switch.
AMS as well.
149
Septic Shock: What happens in the progressive stages?
Tissues become less perfused and more acidotic. All compensatory mechanisms fail leading to increase in BP. Non-responsive to treatment. Sepsis is in full-block shock.
150
Septic Shock: What happens once you are in full blown shock?
Blood pressure decreases, patients cool and pale and modeled (skin is purplish looking), decreased temperature, urine production stopped (failed kidneys) and progressing into multiple organ dysfunction/failure.
151
Septic Shock: What is the patho that occurs after infection happens?
Bacteria enters blood, causing fluid to leak from blood vessels leading to organ dysfunction
152
Septic Shock: Systemic Inflammatory Response Syndrome (SIRS) can also occur which is what?
Similar to sepsis. There is no identifiable source of infection. All symptoms of infection with increased temperature (>38) or low temp (<36), HR > 90 , RR >20. But cannot identify what is causing this.
153
Septic Shock: SIRS will be seen in what type of patient?
Patient where you try to rule out UTI , draw blood cultures and are negative, respiratory culture is negative. Can't figure what is going on.
154
Septic Shock - Mx: With sepsis, what is the most important thing to do here?
Early identification
155
Septic Shock - Mx: Why is early identification important?
Needs to be identified within 6 hours.
156
Septic Shock - Mx: What can you do to help identify this early?
Identify within 6 hours. Culture patients for blood, urine, sputum. Need to make sure cultures done before you start giving antibiotics.
157
Septic Shock - Mx: Initial dose of antibiotics need to be given how early?
Within 3 hours.
158
Septic Shock - Mx: What can you do once all cultures come back after 48 hours?
You can start treating them with broad spectrum antibiotics until you identify the specific culture.
159
Septic Shock - Mx: What is the first thing we will do for treatment?
Start the patient on fluid replacement. If they do not work, then you will switch them over to meds
160
Septic Shock - Mx: What vasopressors may be given?
Levifed, Norepinephrine or Dopamine to keep MAP > 65
161
Septic Shock - Mx: Hemoglobin will want to be kept at what level?
> 7 . If drop sbelow, you'll see PRBCs given , the packed RBCS. Its because patient is not getting enough oxygen to their tissue and are anemic.
162
Septic Shock - Mx: What prevention will we want to make sure we do?
DVT prevention. Make sure they don't develop blood clots in legs which can navigate to brain or lungs.
Stress ulcers with early feeds.
163
Septic Shock - Mx: Because clotting cascade has already liekly been activated, they are more likely to develop what
clots , making DVT prevention hard
164
Septic Shock - Mx: What is the most important thing to do when caring for patients?
Aspetic Techniques. For all procedure and continuing to monitor patients to make sure temps aren't elevated.
165
Septic Shock - Mx: Wht lab can be drawn for this?
Procalcintonin levels. Used to identify sepsis. 0.15 - 2 identifies infection. Above 2 shows they are septic.
WBC, BUN, ,Creatinine, C-Reactive Protein (shows inflammation within body)
Coag, aPTT, INR
166
Septic Shock - Mx: We should monitor antibiotic peaks and troughs meaning what
Those will need to be done for approrpaite dosage of antibiotics.
167
Septic Shock - Mx: What is the SOFA?
Sepsis related organ failure assessment score
168
Septic Shock - Mx: What does the SOFA look at?
Respiration, Coag Labs, Liver Functions, Cardiovascular.
For them not in ICU who have infection, gives score to help screen for development of sepsis , shock.
169
Septic Shock - Mx: What is the MUSE score?
Modified early warning system score
Great for helping track vital signs as well as LOC to pick up on any minor changes in patient that may indicate that they are declining. Extra safety check for nurse.
170
Multiple Organ Dysfunction Syndrome (MODS): What is this?
Irreversible stage, the last stage of the shock state where all the organs are shutting down
171
Multiple Organ Dysfunction Syndrome (MODS): Most commonly seen with who?
Septic patients.
172
Multiple Organ Dysfunction Syndrome (MODS): Where does this usually begin?
Lungs. First organ to show dysfunction. Will also see in cardiac, GI, Renal with kidneys failing.
Have gotten to last stage of shock.
173
Multiple Organ Dysfunction Syndrome (MODS): CMs of this?
Lungs failing. Will require more support and ventilating through higher vent setting.
174
Multiple Organ Dysfunction Syndrome (MODS): How will their labs change?
Will see BUN and Lactic Acid increasing.
Every system will start to fail
175
Multiple Organ Dysfunction Syndrome (MODS): What will happen to kdineys
No longer producing urine so creatinine and BUN will increase
176
Multiple Organ Dysfunction Syndrome (MODS): What happens to liver?
Susceptible to bleeding
177
Multiple Organ Dysfunction Syndrome (MODS): Cardiac system affected how
No longer responds to medications. Can give vasoactive medications to improve BP but will not respond to that.
178
Multiple Organ Dysfunction Syndrome (MODS): Why would these patients be mottled?
When you are giving them pressors, you are clamping down on all the vessels so theyre not getting blood flow to their toes . Toes starting to turn beyond mottled to black .
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Multiple Organ Dysfunction Syndrome (MODS) - Med Mx: What can you first do?
Try to control the initiating event and promote adequate organ perfusion. Do nutritonal support and as shock progresses , there is no coming back from it. Maximize patient comofrt
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Multiple Organ Dysfunction Syndrome (MODS) - Nursing Mx: What will this consist of?
Continuing to treat them until its identified that patients aren't going to return. Usually associated with septic shock, treat them sa though
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Multiple Organ Dysfunction Syndrome (MODS) - Nursing Mx: What must you support
The family members. Address end-of-life care and be promoting open communication and being there to educate patients family members. Don't give false hope.
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Multiple Organ Dysfunction Syndrome (MODS) - Nursing Mx: Is it possible to recover froom this?
Most likely not. Patients are more than likely to pass away.
