Final chronic medsurg

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mmcgraw
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152384
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Final chronic medsurg
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2012-05-05 19:00:31
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final chronic medsurg
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final chronic medsurg
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  1. SIRS
    Systemic inflammatory response to infection

    • Cytokines are
    • released – anti-inflammatory

    • Stimulates
    • coagulation cascade

    Enhanced coagulation

    Develop microemboli – impairs blood flow

    • Fibrinolysis – to promote clot
    • breakdown

    • Coagulopathy – clots – breakdown – clots – breadkdown – prolongs clotting
    • time, decreased platelets
  2. Sepsis
    • systemic infection - Two or more manifestations of SIRS present
    • Temp > 38 C (100.4 F) or < 36 C (96.8 F),
    • HR > 90 bpm,
    • RR > 20 bpm or PCO2 < 32 mm Hg,
    • WBC > 12,000 or < 4,000
  3. Severe sepsis
    organ dysfunction, hypotension, hypoperfusion
  4. Septic shock!
    hypotension even with fluid resuscitation with lactic acidosis, oliguria, change in LOC
  5. MODS
    • progressive dysfunction of 2 or more organ systems as a
    • result of uncontrolled inflammatory response to illness or injury. (ARDS, DIC, Acute tubular necrosis, liver failure, cerebral infarction, lactic acidosis)
    • * lungs usaully first>ARDS
    • * use inotropic drugs or vasopressors!
  6. Distributive shock: Neurogenic
    • bradycardia, hypotension
    • * IV fluids, vasopressors, atropine
    • Skin wamr,dry ,flushed.
    • Hypothermic*rewarm slowly!
    • DVT formation from venous pooling>PE
    • Neuro deficits!
  7. Shock treatments
    • Worry about volume- I&O, daily wts, limit blood tests, ABCs, position slight elevation of lower extremeties*improves venous return. SCDs TEDs
    • Fluids: 250 mL to 2L(crystalloid)LR or NS(3ml/1ml blood lost)
    • Colloids: Albumin, plasmanate. Synthetics-dextran, hetastarch, mannitol.1L/24hrs
  8. For blood
    • 18-20 gauge
    • use NS-others cause cells to swell and burst.
    • Do NOT infuse with meds!
    • Filter
    • Stop if reaction, D/C , NS to KVO, send to lab, call MD and Labe, document!
  9. Why would you want to give early enteral intake for a person in shock?
    decreases hypermetabolism, bacteria translocation, diarrhea, and length of stay!
  10. What does hypothermia cause?
    • decreased contractility, decreased CO, decreased o2 delivery and decreased coagulation.
    • Also it increases stress on body.
  11. CARDIOGENIC AND DISTRIBUTIVE SHOCK MEDS
    • positive ionotropic agents-dopamine, dobutamine, norepinephrine.
    • *increases hearts froce of contraction, improves SV and BP, increases workload of heart> increases o2 demand!
    • * Note : becareful with ischemic heart disease!
  12. MEDS increases preload: hypvolemic shock and distributive shock
    • vasopressors
    • epi
    • norepi
  13. MEDS reduce preload: for cardiogenic shock
    nitro-lowers BP
  14. MEDS affect afterload
    • vasopressin-vasoconstrictors
    • epi-increases contractilit and venous return
    • nitro-decreases afterload and work of heart!
  15. What med would you give for a patient in shock with a HR below 40?
    atropine! (bradycardia symptomatic)
  16. Hypovolemic shock
    • external and or internal volume loss.
    • Hypotensive
    • tachycardia
    • tachypnea
    • oliguria
    • normothermic
    • cool,paleskin
    • decreased CO, CI,PAP,PAOP
    • increase SVR
    • cdecreased SVO2
    • *Eliminate or treat cause!
    • *fluid therapy!!!
  17. Septic shock
    • caused by gram neg or positive bacteria, viruses, fungi
    • hypotensive
    • tachycardic
    • tachypnea
    • increase UO, then oliguria
    • increased temp then decreased
    • skin warm then cool
    • color flushed then pale
    • increase CO, CI then decreased
    • decreased PAP, PAOP then increased
    • Decreased SVR
    • increased SVO2 then decreased
    • *antibiotics
    • *fluids
    • *vasopressors
    • *inotorpic
    • *recombinant human activated protein C
  18. Neruogenic shock
    • Massive dilation
    • decreased vascular tone
    • decreased SVR
    • decreased venous return
    • decreased CO
    • decreased tissue perfusion
    • impaired cellular metabolism
    • *vasopressors-dopamine-norepinephrine
    • *fluids
    • *REwarm slowly
    • *atropine or pacemaker
  19. Tranfusion reactions:Febrile
    • leukocyte incompatability
    • *antipyretics, use washed or filtered products.
    • *stop or slow!
  20. Transfusion reation: Mild allergic
    • sensitivity to plasma proteins- itching rash
    • *antihistamines!
  21. transfusion reaction: Circulatory overload
    • blood given to fast or whole blood, cardiac or renal insufficiency
    • *diuretics and O2, slow transfusion, 1/2 unit at time.
    • monitor I&O
  22. Transfusion reactions: Allergic
    bronchospasms or naphylaxis (24hrs)

    • STOP INFUSION!
    • *epi and steroids and O2
    • washed or filtered blood
  23. Transfusion reaction:Sepsis
    • STOP INFUSION!!!!
    • TACHY
    • HYPTENSIVE
    • FEVER
    • CHILLS
    • SHOCK
    • HAPPENS QUICK
    • *ANTIBIOTICS AND NEED CULTURE!
  24. MASSIVE BLOOD TRANSFUSION REACTION
    • If replacement exceeds total blood volume within 24hr
    • imbalance of blood elements
    • citrate toxicity, hypothermia, hypocalcemia, hyperkalemia
  25. Transfusion Associated- Graft Versus Host Disease (TAGVD)

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