ch 29 prepU

Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

A 47-year-old female with hypertension. Phenylephrine is an alpha-1 adrenergic agonist and a drug commonly used topically for relief of nasal and nasopharyngeal mucosal congestion and to produce mydriasis for ophthalmologic procedures. Phenylephrine acts as a vasopressor causing vasoconstriction of the arterioles. The vasoconstriction from phenylephrine use can increase peripheral resistance and blood pressure. People with hypertension should not take over-the-counter cold and allergy preparations containing phenylephrine because it can further increase their already elevated blood pressure

Which client is most likely to benefit from the administration of an adrenergic agonist?

A man who is in cardiogenic shock following a myocardial infarction. One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.

You are caring for a patient in shock whose condition is deteriorating. You are infusing IV fluids and giving medications as ordered. What type of medications are you most likely giving to this patient?

Adrenergic drugs. Adrenergic drugs are the main medications used to treat shock.

Which type of shock occurs from an antigen-antibody response?

Anaphylactic

An 80-year-old client has been brought to the Emergency Department in shock. The client is receiving dopamine . The nurse should prioritize the assessment for what potentially serious adverse effect?

Cardiac arrhythmia. Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older clients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes.

An understanding of the pathophysiologic rationale behind shock is something every nurse needs to have. Which of the following statements best describes the pathophysiology for shock?

Cells lack an adequate blood supply and are deprived of oxygen and nutrients

You are caring for a patient in hypovolemic shock. What is a priority nursing action for this client?

Check blood pressure and pulse. Hypotension and abnormal heart rate are common in patients suffering from shock. Blood pressure and pulse should be monitored continuously or at least every 5 to 15 minutes during acute shock and titration of vasopressor drug therapy. Other hemodynamic indices should be checked hourly.

The nurse is serving a breakfast tray to the client receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of a food preparation error when finding what on the tray?

Coffee. Clients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death. The nurse should counsel clients to avoid these ingredients.

A nurse is caring for a 25-year-old client who is being given an adrenergic drug for shock. Which action should the nurse do?

Continually assess the client for physiological changes and notify the primary care provider with changes.

You are admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. You know that an early sign that accompanies initial shock is what?

Cool, clammy skin. In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patient's skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases.

The nurse is caring for a client who is receiving an intravenous infusion of dobutamine. What nursing diagnosis has most likely prompted this intervention?

Decreased cardiac output. Dobutamine is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle. As such, it directly addresses a client's decreased cardiac output.

Phenylephrine (e.g., Neo-Synephrine, others) is a synthetic drug that acts on alpha-adrenergic receptors to produce vasoconstriction. Which of the following are actions of this drug? Choose all that apply.

Decreases cardiac output and renal perfusion Increases peripheral vascular resistance and blood pressure

You are caring for a client who is in neurogenic shock. You know that this is a subcategory of what kind of shock?

Distributive. Three types of distributive shock are neurogenic, septic, and anaphylactic shock.

The nurse is to adminsiter to the client regular doses of epinephrine as prescribed. Which nursing diagnoses is most appropriate for this client?

Disturbed Sleep Pattern, Insomnia Related to CNS Excitation.

Which would the nurse identify as a naturally occurring catecholamine?

Dopamine. Dopamine is a naturally occurring catecholamine. Dobutamine, ephedrine, and metaraminol are synthetic catecholamines.

A client with a history of allergies is prescribed an auto-injector for self-administration in case of an allergic reaction. The nurse understands that this device contains which drug?

Epinephrine

On a picnic to a local park, your long-term care residents are enjoying a walk through the flower gardens. One of the residents, who has Alzheimer's, cries out and grabs his shoulder. Reports indicate a large, fuzzy, flying insect landed on the resident's shoulder just prior to the cry. The resident begins to cough, has trouble breathing, and is quite flushed. During anaphylaxis, the drug of choice manages shock because of its rapid onset of action and antiallergic effects. What is the drug of choice?

Epinephrine

Which would the nurse expect to be given to a client experiencing acute bronchospasm?

Epinephrine

An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist?

Epinephrine. Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist.

You are caring for a patient in the ICU whose condition is deteriorating. You receive orders for dopamine, which is an intravenous vasoactive drug. What would be your priority assessment and interventions specific to the administration of vasoactive medications?

Frequent vitals, monitoring the central line site, and providing accurate drug titration

Sepsis is an evolving process, with neither clearly definable clinical signs and symptoms nor predictable progression. As the ICU nurse caring for a patient with sepsis, you know that tissue perfusion declines and the patient begins to show signs of organ dysfunction. What signs of end-organ damage would you expect to become evident?

Heart and respiratory rates are elevated. As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the patient begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (eg, renal failure, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs.

A client with significant burns develops shock and requires adrenergic drug therapy. The nurse interprets this as which type of shock?

Hypovolemic

A nurse may be asked to administer adrenergic drugs to clients with which conditions? (Select all that apply.)

Hypovolemic shock Respiratory distress Allergic reactions Cardiac arrest

You are caring for a patient in the compensation stage of shock. You know that in this stage of shock epinephrine and norepinephrine are released into the circulation. What positive effect does this have on your patient?

Increases myocardial contractility. To compensate in shock, the sympathetic nervous system releases endogenous catecholamines, epinephrine and norepinephrine, into the circulation. Epinephrine and norepinephrine increase heart rate and myocardial contractility, which may be counterproductive in cardiogenic shock because it increases a demand for oxygen by an already compromised heart. Venous return to the right atrium subsequently increases, as does blood sent to the lungs. Bronchial dilatation increases the amount of oxygenated air entering the lungs, followed by a more efficient exchange of oxygen and carbon dioxide (CO2).

In the field, emergency personnel are quick to treat the signs and symptoms of shock because it can quickly lead to organ failure and death. What causes the generalized metabolic acidosis?

Insufficient perfusion.

The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?

Monitoring for complications and side effects of treatment

Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs. For which of the following conditions would these drugs be used? Choose all that apply.

Myocardial infarction Asthma attack Anaphylaxis

The nursing instructor is discussing shock with the senior nursing students. The instructor tells the students that shock is a life-threatening condition. What else should the instructor tell the students about shock?

Occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider?

Systolic blood pressure below 100 mm Hg. The nurse must immediately report to the health care provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective.

You are caring for an 88-year-old client who was admitted to the ICU. The patient is suspected of being in cardiogenic shock. Which of the following observations could indicate that the patient is in shock?

Systolic blood pressure of 80 mm Hg. When monitoring patients for signs of shock, the nurse should check blood pressure, skin temperature, urine output, heart rate, orientation, and respiration. Patients in shock may exhibit a significant decrease in blood pressure (e.g., systolic blood pressure < 90 mm Hg), tachycardia, decreased respiratory rate and urine output (e.g., < 30 mL/hr), disorientation, and cold, clammy skin.

In a state of shock, compensatory mechanisms occur in the body. What is a compensatory mechanism to increase cardiac output during hypovolemic states?

Tachycardia

When caring for a client in shock, one of the major nursing goals is to reduce the risk that the client will develop complications. What does this require the nurse to do?

Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment and response

Epinephrine is the drug of choice for treatment of anaphylactic shock. Epinephrine acts by stimulating

beta receptors. At low doses, epinephrine stimulates beta receptors, which results in bronchodilation and increased cardiac output. At higher doses, the drug stimulates alpha receptors, which increases blood pressure.

Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure?

bronchiole

Epinephrine causes relaxation of:

bronchioles.

You are assessing your patient. When prioritizing the patient's care, you recognize that your patient is at risk for hypovolemic shock when

fluid circulating in the blood vessels decreases

An adrenergic drug would be prescribed to produce what physiological effect?

increased heart rate. Adrenergic drugs cause an increase in heart rate and respiratory rate.

A need for additional education on the administration of epinephrine is needed when a new nursing graduate indicates that epinephrine can be effectively administered by what route?

oral. Administration of epinephrine is by inhalation, injection, or topical application. Oral administration of the drug is not effective because enzymes in the GI tract and liver destroy it.

What second-line vasopressor is likely to be prescribed when norepinephrine proves ineffective at treating hypotension? Select all that apply.

phenylephrine vasopressin epinephrine

Adrenergic drugs mimic the effects of stimulating what part of the nervous system?

sympathetic

Your 69-year-old patient is started on IV dopamine for management of hypotension following open-heart surgery. As you care for the patient, you monitor him for adverse effects of the drug, including

tachycardia. Potential adverse effects of dopamine include tachycardia, dysrhythmia, and angina.

Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels?

α1 receptors. Vasoconstriction of peripheral blood vessels occurs as the result of stimulation of α1 receptors. Stimulation of these receptors regulates the release of neurotransmitters and decreases the tone, motility, and secretions of the GI tract. Stimulation of these receptors increases the heart rate and force of myocardial contraction. Stimulation of these receptors leads to vasodilation of the peripheral vessels and also causes bronchodilation.

Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation?

β2 receptors,