Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
MED SURG III
EXAM 1 - SHOCK & MEDICATIONS
| Question | Answer |
|---|---|
| Activated Charcoal | Considered the universal antidote for drugs. |
| First Line Treatment of Alcohol Withdrawal | Benzodiazepines. (Chlordiazepoxide, Lorazepam, Clonidine). Followed by IV fluids and electrolytes, possible dextrose, supplemental vitamins, and high-protein diet. |
| WBI with a polyethylene glycol solution (e.g., Colyte) | may be used to remove toxic ingestions of long-acting, sustained-release drugs (e.g., many beta-adrenergic blockers, calcium channel blockers, and theophylline preparations) |
| Severe Lithium & Aspirin (Salicylate Poisoning) Antidote | Hemodialysis |
| Acetaminophen Antidote | Acetylcysteine is most beneficial if given within 8 hours of ingestion |
| Treatment of anticholinesterase overdose | diazepam or lorazepam to control seizures. |
| Theophylline Antidote | Activated Charcoal and a Cathartic |
| Cholinergic Drug Antidote | Atropine |
| Inotropic Medications | Increase cardiac output by mimicking the action of the SNS, activating myocardial receptors to increase contractility and HR. May also increase vascular tone, and increase preload |
| Vasodilators | Decrease afterload, decreasing the workload of the heart and oxygen demand |
| Dobutamine | Inotropic effects stimulating beta-cells to increase the strength of the myocardial activity, and improves cardiac output. Also produces a decreased pulmonary and systemic vascular resistance |
| Nitroglycerin | Vasodilator reducing preload. In higher doses can cause arterial vasodilation, reducing afterload as well. Often given with dobutamine, and increases cardiac output while minimizing cardiac workload. Also enhances blood flow to the myocardium, improving oxygen flow. |
| Dopamine | Sympathomimetic agent that has many affects based on the dosage. Can improve contractility, slightly increase HR, and may increase cardiac output. |
| Others | Norepinephrine, epinephrine, milrinone, vasopressin, phenylephrine, and angiotensin II. |
| Anaphylactic Shock | Distributive Shock state resulting from a severe allergic reaction producing an acute systemic vasodilation and relative hypovolemia |
| Cardiogenic Shock | Shock state resulting from impairment or failure of the myocardium |
| Distributive Shock | Shock state resulting from displacement of intravascular volume creating a relative hypovolemia and inadequate delivery of oxygen to the cells |
| Hypovolemic Shock | Shock state resulting from decreased intravascular volume due to fluid loss |
| Neurogenic Shock | Shock state resulting from loss of sympathetic tone causing relative hypovolemia |
| Septic Shock | A subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality |
| Shock | Physiologic condition in which there is inadequate blood flow to tissues and cells of the body |
| General Management Strategies in Shock | Support the respiratory system with oxygen and/or mechanical ventilation. Fluid replacement to restore intravascular volume. Vasoactive meds to restore vasomotor tone and improve cardiac function. Nutritional support to address the metabolic requirements that are often dramatically increased |
| Hypovolemia | Fluid Volume Deficit. Loss of water and electrolytes through vomiting, diarrhea, fistulas, fever, excess sweating, burns, blood loss, GI suction, third space fluid shifts. |
| Hypovolemia Symptoms | Acute weight loss, poor skin turgor, oliguria, concentrated urine, prolonged capillary refill, low CVP, low BP, flat neck veins, Dizziness, weakness, thirst, confusion, tachycardia, muscle cramps, sunken eyes, nausea, increased temp, cool, clammy skin |
| Hypovolemia Labs | Increased hemoglobin, hematocrit, serum & urine osmolality & specific gravity, Hyponatremia, increased BUN and Creatinine. |
| Hypervolemia Symptoms | Acute weight gain, peripheral edema, ascites, distended jugular veins, crackles, elevated CVP, SOB, increased BP, bounding pulse, cough, increased RR and urine output |
| Hypervolemia Labs | Decreased hemoglobin & hematocrit, serum & urine osmolality, hyponatremia & low specific gravity |
| Hypervolemia | Fluid Volume Excess. Compromised regulatory mechanisms, such as kidney injuries, HF, cirrhosis, prolonged corticosteroid therapy, severe stress, and hyperaldosteronism |
| Assessment of Hypovolemic Shock | Hypotension, narrowed pulse pressure, cognitive disturbances, tachycardia, rapid, shallow respirations, oliguria (less than 25 mL/hr), cool, clammy, pale skin |
| Prioritizing Care of Hypovolemic Shock | Treat underlying cause - If the patient is hemorrhaging, efforts are made to stop the bleeding or if the cause is diarrhea or vomiting, medications to treat diarrhea and vomiting are administered. Redistribution of fluid - Positioning the patient properly assists fluid redistribution, wherein a modified Trendelenburg position is recommended in hypovolemic shock. |
| Fluid Management in Hypovolemic Shock | 3:1 rule, with every 3 mL of crystalloid solution for each mL of estimated blood loss. Crystalloids (LR, NS), Colloids (Albumin), Blood Products (Plasma, Packed RBCs, & Platelets) |
| External Fluid Losses Leading to Hypovolemic Shock | Trauma, Surgery, Vomiting, Diarrhea, Diuresis, DKA, DI |
| Internal Fluid Shifts Leading to Hypovolemic Shock | Hemorrhage, Burns, Ascites, Peritonitis, Dehydration, Necrotizing Pancreatitis |
| Assessment of Cardiogenic Shock | BNP is monitored for ventricular dysfunction. Serum Lactate. ECG. Stroke volume and HR decrease or become erratic, BP falls, and tissue perfusion is reduced. Blood supply to tissues and organs are impaired. Weakens the hearts ability to bump, the ventricle does not fully eject its volume during systole. |
| Treatment of Cardiogenic Shock | Oxygenation, 2-6 L/min. Monitor ABGs, Pulse Ox, Ventilatory effort. Possible mechanical ventilation. Pain control (morphine). Hemodynamic monitoring (arterial line), Fluid therapy. |
| Compensatory Stage of Shock | Normal BP. HR above 100 bpm. RR over 20 breaths/min. Cold, Clammy Skin. Decreased Urinary Output. Confusion/Agitation. Respiratory Alkalosis |
| Progressive Stage of Shock | BP can no longer remain stable. MAP falls below normal limits. Systolic BP falls below 90 mm Hg. MAP below 65 mm Hg. HR greater than 150 bpm. Rapid, shallow respirations, crackles. PaO2 less than 80 mm Hg. PaCO2 greater than 45 mm Hg. Mottled skin, with petechiae. Urinary output less than 0.5 mL/hr. Lethargy. Metabolic Acidosis |
| Irreversible Stage of shock | Erratic HR. Requires intubation and mechanical ventilation and oxygenation. Skin presents with Jaundice. Anuric, Requires Dialysis. Unconscious. Profound Acidosis |
| Cardiogenic Shock Symptoms | Decreased cardiac contractility, decreased stroke volume & cardiac output, pulmonary congestion, decreased systemic tissue perfusion, decreased coronary artery perfusion. Pain, arrythmias, fatigue, feelings of doom, and hemodynamic instability |
| Intra-Aortic Balloon Counter pulsation (IABP) | Catheter with an inflatable balloon positioned in the descending thoracic aorta. Uses a internal counter pulsation through the regular inflation and deflation of the balloon. |
| Causes of Neurogenic Shock | Spinal cord injury, spinal anesthesia, medications that cause depressant, or from lack of glucose. |
| Neurogenic Shock Symptoms | Dry, warm skin, hypotension, bradycardia, insufficient perfusion to tissues and cells. If below the 5th cervical vertebra the patient will exhibit diaphragmatic breathing. If injury is above the 3rd Cervical vertebra the patient will immediately go into respiratory arrest. |
| Assessment of Septic Shock | Systemic Inflammatory Response Syndrome (SIRS) which is a type of cytokine release syndrome. A temperature greater than 101 or less than 96.8, tachycardia, tachypnea, high WBC count (over 12,000, or less than 4,000). Clots begin to form, disrupting cellular perfusion. Can result in life-threatening organ dysfunction. |
| Treatment of Septic Shock | Fluids are FIRST, followed by vasopressors which typically is norepinephrine. |
| Risk Factors for Septic Shock | Immunosuppression, Less than 1 year, older than 65 years, Malnourishment, Chronic Illness, Invasive Procedures, Emergent and/or Multiple Surgeries |
Created by:
Nursing.Student.Help
Popular Nursing sets