shock

cariogenic shock labs

Complete blood picture, comprehensive metabolic panel, magnesium, phosphorous, coagulation profile, thyroid-stimulating hormone. Arterial blood gas. Lactate. Brain natriuretic peptide. Cardiac enzyme test. Chest x-ray. Electrocardiogram.

Hypovolemic shock causes

Hemorrhage, Vomiting and Diarrhea, Dehydration, Third-space loss, Burns

septic shock

a serious condition that occurs when an overwhelming bacterial infection affects the body

absolute

absolutely out the body (blood)

The nurse plans to educate the parents of a child experiencing septic shock about the purpose of administering dobutamine intravenously to their child. What would the nurse include in this educational plan?

Dobutamine is used to improve cardiac contractility.

The nurse is assessing an acutely ill patient. When prioritizing the patient's care, the nurse should recognize that the patient is at risk for hypovolemic shock when:

Fluid circulating in the blood vessels decreases.

Cardiogenic shock treatment

IVF then vasopressors: NE, dopamine, dobutamine, nitro IV if ischemia IV bolus normal saline or lactate ringers

A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question?

"He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly."

The nurse determines that a patient in shock is experiencing a decrease in stroke volume when what clinical manifestation is observed?

Narrowed pulse pressure

Morphine sulfate has which of the following effects on the body

Reduces preload

When planning the care of the patient in cardiogenic shock, what does the nurse understand is the primary treatment goal?

Treat the oxygenation needs of the heart muscle

A client who is suffering a myocardial infarction is transported to the ED by ambulance. This client is at greatest risk for developing which type of shock?

cardiogenic shock

cardiogenic Physical assessment

•Tachypnea, pulmonary congestion •Pallor and cool, clammy skin •Decreased capillary refill time •Anxiety, confusion, agitation •↑ Pulmonary artery wedge pressure •Decreased renal perfusion and urinary output

labs

↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR). Can be caused by extensive burns, trauma and bleeding. increase HCT- hemoconcentration decrease HCT- actually hemorrhaging the RBCs oliguria- urine output of <30 ml/hr confusion, agitation - due to decrease blood flow to the brain

A nurse practitioner visits a patient in a cardiac care unit. She assesses the patient for shock, knowing that the primary cause of cardiogenic shock is:

A myocardial infarction.

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

hypovolemic shock signs and symptoms

- rapid, weak pulse - low bp - change in mental status - cyanosis - cool, clammy skin - increased respiratory rate

cardiogenic risk factors

-cardiac pump failure due to direct cardiac cause -MI -cardiomyopathy -HF -dysrhythmias -valvular rupture or stenosis -older adult clients at ↑ risk for MI and cardiomyopathy

Hypovolemic shock treatment

1. Control all obvious external bleeding via direct pressure. 2.Handle the patient gently and keep him or her warm. 3. Start oxygen as soon as you suspect shock, and continue it during transport. Treatment: Crystalloids preferred over colloids (D5W, NS, LR), Aggressive fluid replacement with up to 6 L; Blood products. Fix the underlying problem.

The nurse knows when the cardiovascular system becomes ineffective in maintaining an adequate mean arterial pressure (MAP). Select the reading below that indicates tissue hypoperfusion.

60 mm Hg

hypovolemic shock

A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.

A nurse assesses a client who is in cardiogenic shock. What statement best indicates the nurse's understanding of cardiogenic shock?

A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume.

relative

relative areas (in the body ) 3rd spacing.

cardiogenic early manifestations

•Tachycardia •Hypotension •Narrowed pulse pressure •↑ Myocardial O2 consumption

In the treatment of shock, which vasoactive drug results in reduced preload and afterload, reducing the oxygen demand of the heart?

Nitroprusside

Vasoactive drugs, which cause the arteries and veins to dilate, thereby shunting much of the intravascular volume to the periphery and causing a reduction in preload and afterload, include agents such as

Sodium nitroprusside