N420 Exam 3 Shock

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Author:
MeganM
ID:
290688
Filename:
N420 Exam 3 Shock
Updated:
2014-12-09 08:54:21
Tags:
shock
Folders:
TAMHSC,N420
Description:
Shock & MODS
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  1. Normal PAWP.
    8-12 mmHg
  2. Normal CVP.
    2-6 mmHg
  3. Normal SVR
    900-1200
  4. MAP needed to perfuse vital organs.
    >60 or 65
  5. Why would SvO2 be low (<60)?
    • O2 is insufficient (hemorrhage, hypovent, severe anemia, CO poisoning, low O2)
    • OR
    • O2 demand increased (fever, increased metab)
  6. Why would Sv02 be high (above 80%)?
    • O2 demand has declined (cells dying?)
    • OR
    • O2 supply has increased
  7. Nursing axns w/in first 3 hrs of sepsis.
    • measure lactate level
    • obtain blood cultures prior to abx treatment
    • administer broad spectrum abx
    • crystalloids for hypotention OR
    • lactate > 4 (20mL/kg)
  8. Nursing axns for first 6 hrs of sepsis.
    • vasopressor for hypotension to maintain MAP>65
    • measure CVP (tgt 8-12; 12-15 if mech vent)
    • measure SvO2 (tgt 70% or above)
    • re-measure lactate if needed
  9. Early signs of cardiogenic shock.
    • normal or decreased BP
    • increased HR, SVR, preload
    • decreased CO
    • cool skin
  10. Late signs of cardiogenic shock.
    • More decreased BP
    • More increased preload & afterload
    • more decreased CO
  11. Treatment for cardiogenic shock.
    • decrease fluids
    • give diuretics
    • vasodilators to reduce pre-and afterload
    • pulmonary vasodilators
  12. Early signs of hypovolemic shock.
    • BP falling pulse pressure
    • increased HR, SVR (afterload), CO
    • decreased preload
    • cool skin
  13. Treatment for neurogenic shock.
    atropine & phenylephrine
  14. Treatment for hypovolemic shock.
    • Locate & resolve source of fluid loss
    • fluid rsusc to maintain PAWP 10-17
  15. Med of choice to raise CO.
    dobutamine
  16. If cardiogenic shock exists in the presence of pulmonary edema, how should you position the pt?
    high Fowler with legs down to decrease futher venous return to left ventricle
  17. A urine specific gravity of ______ indicates hypovolemia.
    > 1.020
  18. When administering vasodilators such as nitroprusside, to counteract effects of vasopressors, if a drop in BP occurs, what should you do?
    • decrease vasodilator infustion rate FIRST
    • then increase vasopressor
    • (HESI p.28)
  19. When administering vasodilators such as nitroprusside, to counteract effects of vasopressors, if BP INCREASES, what should you do?
    • decrease vasopressor rate first;
    • then increase vasodilator rate
    • (HESI p.28)
  20. For a pt in shock, BGL should be maintained at what level?
    140-180 mg/dL (HESI p.28)
  21. A Pt receives a blood transfusion and has low back pain, flushing, tachycardia, hypotension, chills, & fever. What should the nurse do first?
    • Stop the transfusion (acute hemolytic rxn)
    • change tubing, then continue IV saline
    • give diuretics as prescribed
  22. A pt receives a blood transfusion and has sudden chills & fever, h/a, flushing, anxiety, & muscle pain. What should the nurse do first?
    • Give antipyretics
    • (febrile non hemolytic rxn; most common)
  23. A pt receives a blood transfusion and has  flushing, itching, & urticaria. What should the nurse do first?
    Give antihistamine (mild allergic rxn)
  24. A pt receives a blood transfusion and has anxiety, urticaria, wheezing, & progressive cyanosis. What should the nurse do first?
    • STOP transfusion; initiate CPR if necessary.
    • (anaphylactic & severe allergic rxn)
  25. A pt receives a blood transfusion and has cough, dyspnea, pulmonary congestion, h/a, & hypertension.  What should the nurse do first?
    • Place pt in upright posn w/ ft in dependent posn
    • administer diuretics, O2, morphine
    • SLOW IV rate
  26. A pt receives a blood transfusion and has rapid onset of chills, HIGH fever, vomiting, hypotension (or shock).  What should the nurse do first?
    • (SEPSIS)
    • Ensure patent airway
    • obtain blood for culture
    • admin prescribed abx
    • VS q 5 min til stable
  27. The _______ stage of shock encompasses use of mechanical ventilation, altered consciousness, and profound acidosis.
    irreversible
  28. The __________ stage encompasses decreased urinary output, confusion, and respiratory alkalosis.
    compensatory
  29. The _________ stage involves metabolic acidosis, lethargy, rapid, shallow respirations.
    progressive
  30. Why is dopamine used during cardiogenic shock?
    To increase renal flow

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