unit 4 Flashcards by britt rank

2 points to measure phlebostatic axis

at the level of the atrium

4th intercostal space

midaxilary line

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causes of hypovolemic shock

hemmorhge
V&D
diabtes insipidus
burn victim

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drug that helps remove potassium

polystyrene sulfonate

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3 Noninvasive modalities for Hemodynamic Monitoring

Noninvasive blood pressure
Assessment of jugular venous pressure
Assessment of serum lactate levels

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type of shock where

Follows invasion of a host by a microorganism

Systemic Inflammatory Response Syndrome (SIRS)
Widespread inflammatory response

Distributive Shock—Septic

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3 nursing interventions for a patient witha hemodynamic monitor

supine position

Leveling the air fluid interface to the phlebostatic axis

infection control

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with septic shock is lactate increased or decreased

Increased lactate

normal: 0.5-1 / sometimes 2

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2 treatments for decreased contractility

inotrope drugs:

digoxin

dobutamine

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cardiac output =

heart rate X stroke volume

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2 Obstructive Shock interventions for PE

PE: thrombolytic , fibrinolytic (TPA)

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7 Compensatory mechanisms of shock

More anti diuretic hormone produced 
Increase in cortisol 
Cool extremities 
Respiratory alkalosis
oliguric (renin angiotensin aldosterone)

Hyperglycemic
Tachycardia

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when the heart rate is too fast (SVT, AFIB, VTACH with pulse) as well as too slow (symptomatic sinus brady, blocks) can lead to _______ cardiac output

decreased

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3 Obstructive Shock causes

PE
Cardiac tamponade
Tension pneumothorax

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4 causes of cardiogenic causes

HF
Hypocalcemia
MI
Valve disease

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device measure preload on leftt side of the heart

PAP

pulmonaary artery pressure

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2 med treatment for decreased afterload

Vasoconstrictors (norepinephrine/levophed)

dopamine

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3 Invasive modalities for Hemodynamic Monitoring

Arterial pressure monitoring

Right atrial pressure/central venous pressure monitoring

Pulmonary artery pressure monitoring

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Normal PAOP/PAWP values are__________

wedge pressure

8-12 mm Hg

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medication that increases contractility

dobutamine

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4 causes of decreased preload

dehydration
V&D
hemmoraging
diabetes insipidus

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5 causes of decreased contractility

HF
Hypocalcemia
Hypoxia

MI
Drugs (too much beta blockers)

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with subclavian landmark for a Central venous pressure (CVP)/Right Atrial Pressure (RAP), one major risk factor is

pneumothorax

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device measure preload on right side of the heart

central venous pressure / right artrial pressure

CVP /RAP

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Stage of Shock where no obvious clinical signs

hypoperfusion starting

Initiation

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medication that is an antihistamine

diphenhydramine

how to calculate MAP

systolic BP + diastolic BP x 2 /3

treatment for increased preload

diuretics | fluid volume restiction

lab values for AKI

Elevated: BUN and creatinine, magnesium, potassium & phosphorous. Decreased: Hgb, platelets, calcium and GFR.

prior to insertion to verify collateral circulation in the extremity you want to do ________

Allen’s test white - does not have goog circulatiion pink- good circulation

2 causes of increased afterload

poorly controlled hypertension | pulmonary hypertension

treatment for increased contractility

Treat the cause Beta blocker for thyroid toxicosis

device that measure the afterload on the right side

pulmonary vascular resistance

part of the hemodynamic pressure monitoring where you can turn this section to get blood sample

stopcock

with septic shock is platelets increased or decreased

Decreased platelets

volume of blood in ventricle prior to contraction | at the end of diastoyle

preload

type of shock where Introduction of an antigen into a sensitive individual initiating an antigen-antibody response bronchoconstriction & vasodilation

Distributive Shock—Anaphylactic

3 nursing interventions for AKI

Daily weights, BUN, creatinine. Infection prevention, Monitoring peak and trough levels and dosage adjustments.

3 important components of hemodynamic pressure monitoring

special catheter for location saline filled noncompliant tubing pressure transducer

12 Distributive Shock—Septic clinical manifestations

Decreased LOC & BP Increased HR & RR Elevated PT & PTT Decreased platelets ``` Breif CO increased then decreased Increased WBC count Fever and chills Increased lactate Disseminated intravasculat coagulation ``` Warm flush skin Bounding pulses Hyperglycemic - early

normal cardiac output is _____

4-8L/ min

with discontinuating a Arterial Pressure Monitoring make sure to _____

hold pressure on site for several minutes

Stage of Shock where – inadequate tissue perfusion unresponsive to therapy

Refractory

resistance aginst flow

afterload

clinical manifestations of hypovolemic shock

``` decrease LOC dry mucus membranes tenting skin turgor cool clammy skin weak thready pulses tachycardia decrease BP decreased urine output ```

with septic shock is HR increased or decreased

increased

4 Obstructive Shock clinical manifestations caused by tension pneumothorax

deviated trchea absent lung sounds asymetrical chest expansion subq air

treatment for obstructive shock with cardiac temponade

periocardiocentesis

4 Cardiogenic Shock interventions

Dobutamine IV (increase contractility) Ace inhibitor: (decrease afterload) (prill) Diuretics: furosimide (decrease preload) Vasodilator: nitroglycerin (decrease

with septic shock is BP increased or decreased

decreased

4 manifestations of Progressive stage of shock

Hypotension Anerobic metabolism Acidodic Stuporus

6 Distributive Shock—Anaphylactic clinical manifestations

``` Urticaria (hives) Purritus Wheezing /stridor Angioedema (lips and tongue swell) Rash Decreased BP ```

3 causes of decreased afterload

Sepsis Anaflaxsis Too high med (vasodilation)

3 Obstructive Shock clinical manifestations caused by PE

PE: Chest pain , Blood tinged sputum, Dypsnea

medication that decreases preload

diuretics

3 nursing intervention for Central venous pressure (CVP)/Right Atrial Pressure (RAP)

setting up equipment properly sterile technique Leveling the air fluid interface to the phlebostatic axis

type of shock where Inadequate intravascular blood or fluid volume

Hypovolemic shock

2 treatments for obstructive shock with pneumathorax

needle decompression, chest tube

Invasive technique to monitor arterial blood pressure

Arterial Pressure Monitoring

normal cvp measurement

2-6mmhg

treatment of hypovolemic shock

``` IV fluid blood products (plasma) ``` - warm the fluids

Stage of Shock where – profound cardiovascular effects

Progressive

force of ventricular contraction how well the heart is pumping

contractillity

with a hemodynamic pressure monitor, how much pressure should you pump up?

300 milimeters of pressure

Distributive Shock—Septic cause

infection

2 things needed to asses AV fistula for hemodialysis

fell thrill | listen for bruit

4 clinical manifestations of decreased preload

decresed blood pressure cool pale skin tenting skin turgor dry mucus membranes

with septic shock is CO increased or decreased

Breif CO increased then decreased

Progressive dysfunction of two or more organ systems Can occur after any severe injury or illness Results in maldistribution of blood flow to organs

Multiple Organ Dysfunction Syndrome (MODS)

device that measure the afterload on the leftt side

systemic vascular resistance

5 clinical manifestations of cardiogenic shock

``` HF signs and symptoms Tachycardia Ddcreased urine output Weak thready pulses BNP over 100 ```

4 causes of increased preload

HF IV SIADH FVE

amount of blood that gets ejected with every heartbeat

stroke volume

with septic shock is RR increased or decreased

inreased

7 Distributive Shock—Anaphylactic cause

``` Beesting Ace inhibitors Shellfish Antibiotics Latex ``` Peanut Dyes

3 most common site for Arterial Pressure Monitoring

Radial Brachial Femoral

2 causes of increased contractility

Overstimulation of sympathetic nervous system Too much thyroid hormone (thyroid toxicosis)

5 clinical manifestations of decreased contractility

``` hypotension decreased LOC cool clammy skin weak pulses decreases urine output ```

Shock begins with cardiovascular system failure and an alteration in one of four components: (what can lead to shock)

Blood volume Myocardial contractility Blood flow Vascular resistance

type of shock where Heart fails to act as an effective pump

Cardiogenic Shock

9 clinical manifestations of incresed preload

``` Right sided heart failure symptoms: JVD prepherial edema ascities engorges organs (hepatamegly) ``` ``` left sided heart failure symptoms : dypsnea crackles decreased O2 sat restless pink frothy sputum (pulmonary edema) ```

3 med treatment for incresed afterload

Vasodilators (nitroglycerin, nitroprusside) Ace inhibitors Beta blockers (metoperlol)

treatment for decreased preload

IV fluids | blood products

6 Distributive Shock—Anaphylactic treatment

Bronchodilators: albuterol Airway management Steroids: methylprednisone Epinephrine (vasoconstrictor/bronchodilator) Antihistamine: diphenhydramine IV fluids / vasopressors:norepinephrine

4 Obstructive Shock clinical manifestations caused by cardiac tamponade

JVD muffled heart tones hypotension pulses paradoxas (BP down wtih inspiration)

with septic shock is PT & PTT increased or decreased

Increased | NORMAL PTT:60 - 70 SEC (normal PT: 11-13)

Clinical syndrome in which there is not enough oxygen to meet the body’s demands Impacts all body systems and can lead to organ failure and death

Shock

type of shock where Physical impairment to adequate circulatory blood flow result of trauma or complications in surgery

Obstructive Shock

3 clinical manifestations of increased contractility

bounding pulses headache hypertensive

5 Distributive Shock—Septic treatment

``` culture antibiotic (broad spectrum) fluids vasopressors: norepinephrine steroids: methylprednisone ```

3 reasons for Invasive modalities for Hemodynamic Monitoring

Hemodynamically unstable Extreme FVE or FVD Major surgery (open heart)

Stage of Shock where —compensatory mechanisms initiated body starts kickin in to help keep person alive

Compensatory

3 landmarks for Central venous pressure (CVP)/Right Atrial Pressure (RAP)

jugular subclavian femoral

mean arterial pressure should be ____

>70

senses the backpressure of the vessel

pressure transducer

3 clinical manifestions of increased afterload

high BP pale cool extremities decresed urine output

3 clinical manifestations of decreased afterload

hypotensive warm flushed skin bounding pulses

unit 4 Flashcards

(96 cards)