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TPN, SCI, Shock
Exam 2
76
Nursing
Undergraduate 2
03/30/2011

Additional Nursing Flashcards

 


 

Cards

Term

 

If abruptly discontinued, isotonic dextrose can be administered for 1-2 hours to prevent rebound hypoglycemia (watch for weakness, faintness, sweating, shaking, feeling cold, confusion, & increased HR)

Definition

 

 

Guidelines for discontinuing TPN

Term

 

  • decrease infusion rate
  • monitor VS
  • notify MD
  • treat respiratory distress by sitting pt upright and administering O2 as needed

Definition

 

 

NSG interventions for Fluid Overload (P.C. of PN)

Term

  • hypovolemic
  • cardiogenic
  • neurogenic
  • anaphylactic
  • septic

Definition

 

 

List types of shock

Term

 

A systolic bp of < 90 mm Hg is considered immediately reportable.

 

A previously stable bp that shows a downward trend of 5 mm Hg at each 15 min. reading should also be reported.

Definition

 

When would you report bp to MD?

Term

 

Rise in lactic acid levels correlate with severity of shock.

 

Serum lactate level of >4 mmol/L = cause for concern

Definition

 

 

What role does lactic acid play in shock?

 

 

Term

  • Bp not sustained, SNS cannot maintain tone
  • Anaerobic metabolism
  • pooling, sludging, blood in capillary beds
  • confused, decreased LOC, disoriented or unconscious
  • Bp unobtainable, slow, irregular HR, RR
  • Respiratory & cardiac arrest

Definition



S&S of shock: Irreversible stage

Term

Angina Pectoris

stable = relieved by rest and/or nitro

 

unstable = pre-infarction

 

Intractable/refractory = severe/incapacitating

 

variant (Prenzmetal's) = pain at rest (reverse ST seg.)

 

Silent Ischemia = ECG changes w/stress test; pt reports no pain

Definition

Clinical syndrome characterized by episodes/paroxysms of pain/pressure in anterior chest.

Caused by insufficient coronary blood flow resulting in a decreased O2 supply when there is increased myocardial demand for O2 in response to physical exertion or emotional stress.

Term

Angina Pectoris

EKG = T wave inverted, ST seg depressed

 

[image]

Definition

  • lasts 3-5 mins, transient
  • vasoconstriction, increased HR, increased contractility & Bp R/T increased O2 needs of the heart
  • myocardial cells become ischemic w/in 10 secs of coronary artery occlusion
  • after several mins. of ischemia, heart pumping function is reduced
  • reductino of pumping depreives ischemic cells of O2 & glucose (produce lactic acid which impairs L ventricular function = pain develops)
  • If blood flow restored w/in 20 mins, no permanent damage.

 

Term

  • Immobility causes calcium to leave bones, causes hypercalcemia (muscle weakness, N&V, confusion -- inceased calcium level)
  • diet: limit dairy products & other sources of calcium
  • importance of hydration
  • danger of renal calculi
  • watch for pulmonary edema

Definition

 

SCI: Fluid & Electrolyte balance

Term

  • range of motion prevents joint stiffness
  • special mattress
  • pressure sores common (brings them back to hospital)
  • may require surgical procedures, flaps, wound vacs, etc.
  • the pt doesn't always know this because they can't feel it.
  • they can burn themselves & not know it

Definition

 

 

SCI: Skin integrity, mobility

Term

Hypernatremia

 

normal sodium level = 135-145 meq/L

 

*If you've got a Na problem, you've got a fluid problem

 

*Brain does not like it when sodium is messed up.

Definition

Dehydration: too much sodium, not enough water

 

causes: hyperventilation, heat stroke, DI

 

S&S: dry mouth (already exp. a mild level of dehydration), thirsty, swollen tongue (severe cases), neuro changes

 

TX: restrict sodium, dilute client w/IV fluids, daily weights, I&O, lab work

Term

 

hyponatremia (dilution!)

 

Too much water; not enough Na

 

*Brain does not like it when Sodium is messed up

Definition

causes: vomiting or sweating then drinking H2O for fluid replacement (replaces water & dilutes blood), psychogenic polydypsia (loves to drink), D5W (sugar & water), SIADH (too many letters = too much water)

 

S&S: headache, seizure, coma, neuro changes

 

TX: hypertonic saline (packed w/particles) - if having neuro probs.; 3% NS or 5% NS = client needs Na, not water

Term

 

Normal potassium = 3.5 - 5.0 mEq/L

 

hyperkalemia

 

*if kidneys not working well, serum K+ will rise

 

causes: kidney troubles, aldactone (makes you retain k+)

Definition

S&S: Begins with muscle twitching, then proceeds to weakness, then flaccid paralysis

 

ECG: bradycardia, tall/peaked T waves, prolonged PR intervals, flat or absent P waves, widened QRS conduction blocks ventricular fibrillation

*Life threatening arrythmias!*

 

TX: dialysis, calcium gluconate (decreases arrythmias), glucose & insulin (insulin carries glucose & k+ into cell), watch for hypoglycemia & hypocalcemia w/insulin, kayexalate

Term

Women: SCI won't affect fertility

  • can become prenant & bear a child
  • tremendous difficulty raising one
  • BCP's C/I becuase of danger of clots (educate about contraception)
  • If sexually active, need another method of BC.
Sexual Functioning: Assess value system, sexual orientation, previous sexual function, availability of caring partner, remaining capability & sensation, upper extremity strength/hip function

Definition

 

 

SCI: Sexuality

Term

  • Biggest problem in traction & frames: staring at ceiling and floor, feel like going crazy
  • injury will impose permanent limitations
  • hard to maintain emotional equilibrium
  • expect emotional outbursts, grieving, anger
  • self-concept disturbance, altered family process ("Nothing is ever the same after the accident..."

Definition

 

 

SCI: Stimulation

Term

  • most responsibility on nurse to begin with 
  • depending on location & nature of injury, can take increased responsibility
  • must be able to direct others in how things need to be done

Definition

 

 

SCI: Hygiene

Term

  • immediate: paralytic ileus, require TPN
  • may need NG decompression
  • high incidence of stress ulcers
  • proton pump inhibitors (protonix)
  • may need tube feedings eventually

Definition

 

 

SCI: Nutrition

Term

  • Long term: problems w/anorexia (depression), bony, prone to breakdown

  • Obesity (eating from boredom + no exercise)
    • harder to move, also more skin problems (skin breakdown in their folds)

Definition

 

 

SCI: Weight changes

Term

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
Remote chance of autonomic dysreflexia when using.

Alternate methods of stimulation may or may not be acceptable.

Definition

 

 

SCI: Erectile dysfunction

Term

  • separate long term care area
  • transfers, ICU to acute care to rehab, stressful & frightening: less controlled atmosphere & new people each time
  • many barriers still exist, despite progress w/architecture in public bldgs, educational institutions, ADA laws

Definition

 

 

SCI: Issues with Rehabilitation

Term

  • elevate HOB, identify & remove stimulus
  • empty distended bladder (check for kink in tubing if foley)
  • change position if pressure sore
  • D/C sexual activity
  • Disimpact, using nupercainal ointment

Definition

 

 

Treatment of Autonomic Dysreflexia

Term

 

 

Autonomic Dysreflexia

Definition

  • above level of injury, person feels parasympathetic response
  • headache, flushing, sweating, vasodilatation
  • message can't get down to lower areas

Term

  • oxygenation, attention to airway
  • assess lungs & breathing pattern (high cervical injury not compatible w/life; paralysis of accessory muscles & diaphragm makes effective breathing difficult)
  • attention to suctioning, hydration, nebulizer tx, position changes
  • may require trach
  • vulnerable to URI, atelectasis, pneumonia
  • if need to be intubated, use nasotracheal tube because cannot manipulate cervical spine

Definition

 

 

SCI: Nursing Care

Term

 

 

hypovolemic shock

Definition

  • shock state resulting from decreased intravascular volume due to fluid loss
  • impaired oxygenation from inadequate CO resulting from decreased intravascular volume
  • loss of blood volume (hemorrhage, GI bleed), loss of intravascular fluid through skin (dehydration), loss of fluid from intravascular compartment (3rd spacing), vomiting, diarrhea

Term

 

Neurogenic shock

Definition

  • loss of sympathetic innervation prohibits vasoconstriction of blood vessels; vessels respond to parasympathetic signals, dilate
  • inadequate venous return, cardiac output decreases, O2 carrying capacity decreases
Causes: SCI, Adrenergic blockers, insulin reaction, emotional stress, drug overdose, massive loss to sympathetic tone (persistent vasodilatation w/loss of symp. tone), pooling of blood = decreased venous return, decreased HR = parasympathetic

Term

TX varies by cause:

  • careful fluid balance
  • adrenergic drugs (pressors)
  • Increase Bp and HR
S&S: hypotension w/bradycardia, dry/warm skin rather than cool, moist skin
(parasympathetic stimulation, because sympathetic is unable to respond)

Definition

 

 

TX for neurogenic shock

 

S&S of neurogenic shock

Term

cardiac output x peripheral resistance

 

[systolic Bp + 2(diastolic Bp)] divided by 3

 

*Must exceed 65 mm Hg for cells to receive enough O2 & nutrients to sustain life.

Definition

 

 

Mean Arterial Pressure (MAP):

 

How is it calculated?

Term

 

 

cardiogenic shock

Definition

Shock state resulting from impairment or failure of the myocardium; impaired ability of the heart to pump.

 

heart not pumping adequately (elderly, diabetics, anterior MI w/damage to L ventricle);

also noncoronary causes and ineffective cardiac funtion from cardiomyopathies, valvular damage, tamponade, dysrhythmias

Term

 

  • supplemental O2 
  • CP: morphine
  • hemodynamic monitoring, fluids
  • monitor BNP, cardiac enzymes, telemetry
  • dopamine, nitroglycerine, antidysrhythmics
  • may need stent, thrombolysis, intra-aortic balloon pump or other ventricular assist. device

 

Definition

 

 

TX for cardiogenic shock:

Term

  • Traditional signs: lower Bp, increased HR, change in mentation, decresed UO (may not reveal problem soon enough!!!)
Growing realization that other measures are needed:

serum lactate levels, base deficit, new technologies to understand what is happening at cellular level

Definition

 

 

Signs that client is in a state of shock

Term

  • VS
  • airway mgmt.
  • O2 therapy
  • IV access (2 lines)
  • bedrest
Other care depends upon kind of shock.

Definition

 

 

General care for Shock Client:

Term

  • Hydralazine
  • Nifedipine
  • monitor Bp
    • client must know about this phenomenon
    • failure to resolve causes CVA, blindness, status epilepticus, death

Definition

 

Medications for autonomic dysreflexia:

Term

 

 

Neurogenic shock

Definition

  • develops as a result of the loss of autonomic nervous system function below the level of the lesion
  • vital organs are affected, causing decreased Bp, decreased HR, decreased CO, as well as venous pooling in the extremities & peripheral vasodilation. Respiratory problems; unable to perspire
  • low dose anticoagulant therapy, anti-embolism stockings or pneumatic compression devices

Term

 

  • muscles atrophy, bone loss
  • paraplegics need to build up upper body for transfers, take weight off coccyx
  • great advances in wheelchair design, sports for SCI pts.
  • ROM to avoid deposits in joints, contractures
  • braces to assist w/lower extremity strength
  • May have problems w/muscle spasms: managed pharmacologically
  • Spasticity affects same muscles that were flaccid during period of spinal shock: may peak at 2 years & then diminish (many have ongoing spasticity)

 

Definition

 

 

SCI:  Activity & Exercise

Term

 

  • patterns altered by lack of exercise, frustration, depression, anxiety about the future

 

Definition

 

 

SCI: Comfort, rest, & sleep

Term

  • loss of vasomotor control, so move toward temperature of environment
  • cannot perspire below level of injury, at risk of overheating
  • immobility: cannot generate heat
COLD can cause bradydysrhythmias and cardiac arrest: WATCH TEMPERATURE.

Definition

 

 

SCI: Temperature

Term

  • Foley to begin with to monitor fluid balance
  • SCI damage affects bladder and bowel
  • BLADDER: intermittent catheterization often best approach
  • BOWEL: suppository or stimulation may cause reflex emptying or may need manual disimpaction

Definition

 

 

SCI: Elimination

Term

  • announce yourself when entering room
  • time turning schedule to take meals & visitors into account
  • pad bony prominences, inspect frequently!
  • prism glasses, taped music, encourage visitors
  • expect anger & frustration

Definition

 

 

NSG: Rotorest bed, stryker frames, turning frames

Term

  • pin care
  • do not grasp vertical supports or bang device
  • pt may expect full return of function when halo removed, may believe halo (& not injury) causing problems
  • difficult adjustment when halo removed & scope of disability apparent

Definition

 

NSG: Halo vest

 

*provides immobilization of spine allowing early ambulation

Term

  • methylprednisolone: anti-inflammatory
  • vasopressors: tighten up vasculature
  • anticoagulants: avoid clots
  • analgesics: pain
  • muscle relaxants:
    • long term: Baclofen and Dantrium
    • short term: cyclobenzaprine (Flexiril) *in acute care with certain procedures

Definition

 

 

SCI: Meds

Term

 

 

Autonomic Dysreflexia

Definition

  • acute emergency that occurs as a result of exaggerated autonomic responses to stimuli that are harmless in normal people: 
    • distended bladder (most common)
    • distention/contraction of the visceral organs, expecially bowel (constipation)
    • stimulation of the skin (tactile, pain, thermal stimuli, pressure ulcer)
  • EMERGENCY!!!

Term

  • remove the triggering stimulus & avoid complications
  • immed. place pt in sitting position to decrease Bp
  • rapid assessment to identify/alleviate cause
  • bladder emptied via urinary catheter
  • rectum examined for fecal mass
  • skin examined; stimulus removed
  • if these measures do not relieve the htn & excruciating headache, a ganglionic blocking agent is admin. slowly by IV route.

Definition

 

 

NSG: Autonomic Dysreflexia

Term

 

  • paroxysmal htn
  • pounding headache, blurred vision
  • sweating above level of injury
  • flushing, splotchy face & neck
  • nasal congestion
  • bradycardia
  • nausea

 

Definition

 

 

S&S of Autonomic Dysreflexia

Term

  • In neurogenic, may have hypotension & pooling of blood in extremities.
  • bradycardia from unopposed vagus
  • after being flat, may require tilt table, gradual position changes, elastic stockings
  • circulation affected by immobility; pressure sores
  • change position frequently, inspect skin at regualr intervals
  • wheelchair: special cushion to distribute weight, "pushups", lifting wt. from chair
  • tachycardia may indicate inflammatory process
  • risk of phlebitis, DVT: elastic stockings, minianticoagulants, SCD, kinetic beds

Definition

 

 

SCI: Nursing Care: 

Circulation

Term

  • Meds: 
    • vasoactive meds = maintain Bp & CO (increased O2 demand of heart may cause decreased Bp or compromised perfusion)
    • sympathomimetics
    • vasodilators
    • antidysrhythmics
  • Position: supine w/legs elevated
    • Modified Trendelenburg: lower extremities are elevated 20 degrees, knees are straight, trunk is horizontal, head is slightly elevated

Definition

 

Meds & NSG care for cardiogenic shock

Term

 

 

hypocalcemia

 

normal labs: calcium 9.0 - 10.5 mg/dL

Definition

  • causes: hypoparathyroidism, radical neck, thyroidectomy (not enough PTH)
S&S: tight, rigid muscle tone, could have a seizure, stridor/laryngospasm (airway = smooth muscle), + Chvostek's, + Trousseau's arrythmias, DTRs increased, mind changes (wild, manic, staring, unpredictable), swallowing problems (esophagus is a muscle)

TX: Vit D, Sevelamer hydrochloride (Renegel), Calcium Acetate (Phoslo), Calcium Carbonate (Os-Cal), IV Ca+ = w/a heart monitor during admin.

Term

Fluid challenge

  • see if fluid administration improves circulation and O2 delivery
  • IV fluids: 
    • Crystalloid fluids:
      •   NS; 3:1 rule: 2/3 will go out into the tissues, not stay in the circulation
      • LR: lactate usually converted to bicarbonate in liver, combats acidosis (reason to give it)
        • If liver is not being perfused well, lactate stays in circulation & can cause more harm than good
    • 3% NaCl can help to restore circulating volume

 

Definition

 

 

What to do when pt is in shock & doesn't appear to be improving:

Term

 

  • supplemental O2 nasal cannula or mask
  • unconscious, respiratory distress: intubation and mechanical ventilation
  • IV fluids to restore circulating blood volume and increase Cardiac Output
  • NS most recommended

 

Definition

 

What to do to improve O2 delivery to pt in shock:

Term

 

 

Circulatory, or Distributive, shock

Definition

shock state resulting from displacement of blood volume creating a relative hypovolemia & inadequate delivery of O2 to the cells;

 

maldistribution of circulating blood; 

 

Septic, neurogenic, & anaphylactic are all forms of this state of shock.

Term

 

Heart & brain favored, Bp maintained

 

Systolic Bp > 90

Definition

 

 

Describe the compensated stage of shock:

reversible

Term
  • RR may increase, thirst, >20
  • Urinary output may decrease
  • Blood pressure still normal, though pulse pressure may narrow
  • pulse pressure = difference between diastolic & systolic Bp
  • Body temp may be up or down
  • skin cool & pale, exception: septic & neurogenic
  • Septic & neurogenic shock can actually result in pink & warm skin
  • BS may be hypoactive, possible distention
  • Liver: putting out more glucose in response to stress; glycogenolysis, insulin suppressed

 

Definition

 

 

Changes that occur in the more compensated stage of shock are:

Term
  • Place pt in Fowler's position
  • offer reassurance
  • monitor VS
  • Prep for thoracentesis or chest tube insertion
Prevention: 
*assist pt to remain still in Trendelenburg position during catheter insertion

S&S: absence of breath sounds on affected side, chest/shoulder pain, sudden SOB, tachycardia, cyanosis


 

Definition

 

NSG interventions:

 

Pneumothorax (Potential Complication of PN)

 

S&S: 

Term
  • replace tubing immediately
  • notify physician
  • replace cap/notify MD
  • turn Pt on left side & in head-low position
  • Administer O2
Prevention:
*examine all tubing connections
*Instruct pt in Valsalva maneuver for tubing/cap changes

S&S: Apprehension, Chest pain, dyspnea, hypotension, rapid/weak pulse, resp. distress, loud churning sound over pericardium

 

Definition

 

NSG Interventions:

 

Embolism (P.C. of PN)

 

What are the signs & symptoms of Embolism?

Term

Peripheral or central IV lines: If PPN, lipids are administered simultaneously to buffer & protect vein from irritation.

 

  • usual therapy (PPN) is 5-7 days
  • Do not admin formulas of more than 10% dextrose through peripheral veins (chemical phlebitis)
*Discontinue PN gradually to allow pt to adjust to decreased levels of glucose.
*Monitor hydration status, electrolyte levels, calorie intake, I&O, daily wts., & rate of infusion

 

Definition

 

 

TPN therapy:

How long is it? What precautions are taken & what does nurse monitor?

Term

S&S: coma, confusion, diaphoresis, elevated bg, thirst, fatigue, Kussmaul's Resp., restlessness, weakness

 

Nsg:

  • Notify MD, 
  • addition of insulin to PN solution may be prescribed
  • monitor blood/urine glucose levels, urine output, LOC

Definition

 

 

PC of TPN:

Hyperglycemia (r/t glucose intolerance)

 

NSG Interventions?

 

S&S?

Term

S&S: anxiety, diaphoresis, low Bp, weakness, shakiness

 

NSG: 

  • Monitor for symptoms 
    • weakness, tremors, diaphoresis, h/a, hunger, apprehension
  • Notify MD (isotonic dextrose may be admin for 1-2  hours)
  • Gradual decrease of PN prior to d/c'ing (don't stop feedings too abruptly)

Definition

 

PC of TPN:

 

Rebound hypoglycemia

 

S&S?

 

NSG interventions?

Term

Normal lab values:

Potassium 3.5 - 5.0 mEq/L

 

Hypokalemia

Definition

S&S: muscle cramps & weakness, **life threatening arrhythmias**, ECG changes: u waves, PVCs, ventricular tachycardia

 

causes of: vomiting, NG suction, diuretics, not eating

 

TX: Give K+, aldactone (potassium sparing), Eat K+

Term

  1. Compensated: Bp >90 systolic
  2. Progressive: Bp < 90 systolic
  3. Irreversible: not responding to TX
  • Watch that systolic pressure is >90: best to catch shock in this stage.
  • As a nurse, have an index of suspicion, know when someone is at risk for shock.

Definition

 

 

Describe the 3 stages of shock:

Term

 

 

Compensated stage

Definition

 

In this stage of shock, homeostatic mechanisms work to improve tissue perfusion: sustained stress response.

 

S&S: subtle changes, restless, irritable, apprehensive but oriented; HR may be increased, bounding, >100

Term

S&S:

cool skin, poor capillary refill, low Bp, orthostatic changes, problems with distribution of fluid volume.

 

Key: degree of volume depletion

Definition

 

 

S&S of hypovolemic schock:

Term

  • assess fluid loss: careful I&O, GI losses, skin, renal
    • consider hidden losses: obstructed bowel, ascites, losses from weeping burns, fistulas, internal bleed
  • Attention to BP, HR, RR, O2 sat
  • Skin color, temp, LOC, cap. refill, mucous membranes, pallor, cyanosis
Best outcome: transfusion to keep Hgb just above 7
(when giving prbc's, hope to see 1 unit of packed cells increase hgb by 1 number & hct by 3%)
RX: fluid & blood replacement
Issue of rebleeding in trauma pt w/restoration of fluid volume

Definition

 

 

NSG care for pt in hypovolemic shock:

Term

  • transfuse packed cells to keep Hct >30%
  • dobutamine infusion or norepinephrine to maintain Bp
  • keep CVP 8-12, MAP >65
  • Urine Output >0.5 ml/kg/hr
  • Wean from vent, remove lines as quickly as possible
  • tight glucose control, IV corticosteriods
  • DVT & stress ulcer prophylaxis

Definition

 

 

Guidelines for septic shock:

Term

 

 

shock

Definition

acute, widespread process of impaired tissue perfusion that results in cellular, metabolic, and hemodynamic derangement, leading to cellular dysfunction and death;

 

(when blood flow to tissues/cells, cardiac pump, vasculature or circulatory system & blood volume is inadequate/impaired, perfusion (adequate O2 & nutrients) to tissues is threatened/compromised)

Term

 

 

IV crystalloids

Definition

electrolyte solutions that move freely between intravascular & interstitial spaces, i.e., 0.9% Sodium Chloride (NS), Lactated Ringer's Solution (helps buffer acidosis that occurs in shock)

 

(*hypertonic crystalloid solution: 3% sodium chloride)

Term

 

 

colloids

Definition

 

 

large molecule IV solutions

Term

 

 

Progressive stage of shock

Definition

Stage of shock in which compensation becomes ineffective or detrimental; shock perpetuates.

*Need aggressive mgmt. to rescute!*

Cardiovascular: ventricular failure

Neurologic: SNS dysfunction, cardiac & respiratory depression, thermoregulatory failure, coma

 

Eventually: Pulmonary: Acute Resp. failure (ARDS)

Renal: ATN

Hematologic: DIC

GI tract failure, hepatic, pancreatic

Altered dynamics in capillary bed, profound vasocontriction

SIRS (Systemic Inflammatory Response Syndrome)

MODS (multiple organ dysfunction syndrome)

Term

S&S:

*listless, agitated, apathetic, confused, less *responsive, tachycardic, weak, irregular, thready, >150

*hypotension w/decreased pulse pressure

*systolic Bp <80-90 or decrease of 40 mm Hg

*Rapid, shallow resp.

*Oliguria, cold, clammy, maybe be cyanotic

*subnormal temp

*thirst if still alert

*hypoactive or absent bowel sounds

Definition

 

 

S&S of progressive stage of shock

Term

  • Hyperdynamic, progressive, "Warm phase"
    • vasodilatation, Bp maintained, febrile, warm, flushed skin, bounding pulse, RR increased, urine output adequate
  • Hypodynamic, irreversible "cold phase"
    • vasoconstriction, cool, Bp drops, HR and RR rapid, anuric, organ failure 

Definition

 

 

What are the two phases of septic shock:

Term

TX:

  • culture urine, wounds, blood, check lines, incisions, etc.
  • start on broad spectrum antibiotics until cultures come back
  • IV fluids: crystalloids, colloids, & blood products
  • CT scan, X rays to identify abscesses and infection

Definition

 

 

TX for septic shock:

Term

  • Itching, flushing, urticaria, full throat,
  • anxiety, tight chest, faintness, 
  • loss of consciousness
  • severe upper airway obstruction
  • edema leads to asphyxia
  • lower airway wheezing, bronchospasm
  • hypotension from profound vasodilation
  • vascular collapse

Definition

 

 

S&S of anaphylactic shock:

 

(occurs slowly over 6-12 hours, or rapidly over 5-30 mins)

Term

  • epinephrine (Adrenalin), Epipen
    • vasoconstrictor
  • diphenhydramine (Benadryl)
    • antihistamine
  • albuteral (Proventil)
    • for bronchospasm

Definition

 

 

Meds given for anaphylactic shock:

Term

 

  • Keep pt warm (while avoiding overheating)
  • avoid exposure & maintain normothermia (to prevent vasodilation)
  • Pain control measures
 

 

Definition

 

 

NSG:  Objectives in PACU

Term

 

 

Hypovolemic shock

Definition

Most common type of shock:

pallor, cool/moist skin, rapid breathing, cyanosis of lips, gums, tongue, rapid/weak/thready pulse, narrowing pulse pressure, decreased Bp, concentrated urine

Term

 

Hemorrhage -> hypovolemic shock -> death

Hemorrhage -> hypotension, rapid/thready pulse, decreased LOC, restlessness, oliguria, cold/pale skin, decreased CO, feelings of apprehension, "air hunger"

TX: pressure bandage, shock position (flat, legs elevated, knees straight)

 

Definition

 

 

S&S and TX for hemorrhage:

Term

  • IV fluids, blood/blood products, & medication that increases Bp
  • volume replacement w/LR, 0.9 Sodium Chloride, colloids, or blood component therapy. 
  • O2 admin
  • meds to reduce peripheral vascular resistance

Definition

 

 

TX for hypovolemic shock:

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