shock EAQ

While planning the management of oxygen delivery in a patient with shock, what appropriate measures should the nurse undertake? Select all that apply.

Administer supplemental oxygen as prescribed. * Space activities that increase oxygen consumption. * Space activities that decrease oxygen consumption. Monitor continuously by using a central venous catheter. * Encourage the patient to move around to increase lung expansion To optimize oxygen supply and ventilation in a patient suffering from shock, the activities that increase oxygen consumption should be evenly spaced. Mixed venous oxygen saturation should be monitored through a central venous catheter. The patient should not exert energy by excessive moving around because it increases oxygen demand.

The nurse is taking care of a patient with cardiogenic shock due to a myocardial infarction. The health care provider prescribes dopamine to be administered. What nursing intervention should the nurse perform for administering dopamine? Select all that apply.

Administer via a central line. * Monitor for tachydysrhythmias. * Administer with sodium bicarbonate. Monitor for peripheral vasoconstriction. * Monitor for dyspnea and pulmonary edema Dopamine is a positive inotropic agent used in cardiogenic shock. The drug may cause tissue sloughing, if infiltrated. Therefore it is administered through a central line and not via a peripheral line. The patient should be monitored for tachydysrhythmias caused by enhanced inotropic effects. There is also a risk of peripheral vasoconstriction, so the nurse should be observant for symptoms such as paresthesia and coldness of the extremities. The drug may get deactivated by an alkaline solution; therefore it should not be administered along with sodium bicarbonate. Because dopamine is not known to have an adrenergic action, it will not cause dyspnea and pulmonary edema.

The nurse is caring for a patient who has hypovolemic shock from hemorrhage. The nurse expects to find which clinical manifestation(s)? Select all that apply.

Anxiety * Tachycardia * Hypotension * Hypothermia Lactic acidosis Decreased capillary refill * In a patient with hypovolemic shock due to hemorrhage, assessment findings will be related to intravascular fluid loss that include cool skin, decreased capillary refill, hypotension, orthostatic changes, tachycardia, anxiety, and decreased urine output. Hypothermia is associated with spinal cord injury.

A patient in cardiogenic shock is prescribed a dose of sodium nitroprusside. What appropriate actions should the nurse perform to safely administer sodium nitroprusside? Select all that apply.

Avoid using with D5W. Protect solution from light. * Monitor the body temperature. Wrap infusion bottle with opaque covering.* Monitor the serum cyanide levels and signs of cyanide toxicity * Sodium nitroprusside is a vasodilator used in cardiogenic shock. The drug tends to release cyanide ions when exposed to sunlight. Therefore it should be protected from exposure to sunlight by wrapping the infusion bottle with an opaque covering. The patient's serum cyanide levels should be checked, and the patient should be monitored for signs of cyanide toxicity. This includes metabolic acidosis, tachycardia, altered level of consciousness, seizures, coma, and almond smell on the breath. The medication should be reconstituted with D5W only. Monitoring vital signs like body temperature is important but may not directly impact the treatment being administered.

Vasopressin has been prescribed for a patient in septic shock. What nursing interventions are important for this patient? Select all that apply.

Do not titrate. * Infuse at low doses. * Do not use with inotropic agents. Use in vasopressor-refractory patients. * Do not use in patients with coronary artery disease Vasopressin should be infused in low doses without titrating it, because titration can cause dose-related adverse effects. Vasopressin is usually used for patients who are vasopressor-refractory, for replacing the stores of physiologic vasopressin that are often depleted in septic shock. Inotropic agents can be added with vasopressin to increase tissue perfusion. Vasopressin can be given to patients suffering from coronary artery diseases, but it should be used with caution.

A nurse is taking care of a patient with hypovolemic shock from a motor vehicle accident (MVA). The health care provider prescribes human serum albumin for fluid replacement. What should the nurse do to safely administer this medication? Select all that apply.

Monitor for circulatory overload. * Use 5% solution of serum albumin. * Monitor for chills, fever, and urticaria. * Monitor for bleeding from potential sites. Prevent exposing the infusion to sunlight. Human serum albumin is used for increasing plasma colloid osmotic pressure and for rapid volume expansion. The patient should be monitored for circulatory overload. Because the patient is hypovolemic, a 5% solution of serum albumin should be used. Also, note that a 25% solution is used in patients with fluid and sodium restrictions. The infusion can cause mild side effects like chills, fever, and urticaria. Because the infusion is not reactive to light, protection from sunlight is not required, and it does not increase the risk of bleeding.

When considering the use of nitroglycerin for treating a patient with shock, what actions should the nurse perform? Select all that apply.

Monitor the heart rate. * Monitor the blood pressure. * Use a glass bottle for infusion. * Protect the solution from sunlight. Administer the solution through a central line Nitroglycerin is a vasodilator used in the treatment of cardiogenic shock. During medication with nitroglycerin, the patient's heart rate and blood pressure should be continuously monitored in order to prevent any chances of reflex tachycardia. Because plastics tend to adsorb nitroglycerin, glass bottles should be used for infusion to avoid adsorption. The drug can be administered through a peripheral line; a central line is not required. Because it is not photosensitive, the drug does not need to be protected from sunlight.

A patient is suspected to have septic shock due to untreated cellulitis in the lower extremity. What findings would the nurse expect to observe when assessing this patient? Select all that apply.

Rhonchi Crackles * Cyanosis Hyperventilation * Decreased urine output * In septic shock, the combined effects of the inflammatory mediators result in damage to the endothelium, vasodilation, increased capillary permeability, and neutrophil and platelet aggregation and adhesion to the endothelium. The patient with septic shock may develop crackles due to increased vasodilation and respiratory failure. Initially, the patient may hyperventilate to compensate, resulting in respiratory alkalosis. Symptoms such as decreased urine output are related to renal hypoperfusion. Rhonchi and cyanosis are symptoms of cardiogenic shock.

Vasopressor agents are prescribed for which types of shock? Select all that apply.

Septic shock * Neurogenic shock * Obstructive shock Cardiogenic shock Hypovolemic shock Septic shock occurs in response to an infection. It is associated with the release of cytokines and other inflammatory mediators, resulting in vasodilatation, increased capillary permeability, and platelet aggregation. Vasopressors will constrict the blood vessels and relieve hypotension. Neurogenic shock is caused by a severe injury to the CNS causing a loss of sympathetic stimulation of blood vessels resulting in vasodilatation. A fall in blood pressure can be restored by administering vasopressor agents that act by constricting the blood vessels. Obstructive shock is caused by an obstruction in the vessels of the heart or the heart itself. Restoring the circulation by treating the cause of obstruction will be beneficial for a patient with obstructive shock. Systolic or diastolic dysfunction of the heart results in cardiogenic shock. Treatment involves use of nitrates, inotropes, diuretics, and beta-blockers. A loss in the intravascular fluid volume causes hypovolemic shock. Treatment of hypovolemic shock includes restoring the fluid volume by infusion of blood or blood products and crystalloids.

When a patient suffers from hypovolemic shock due to loss of blood, the nurse should administer large volumes of packed red blood cells (RBCs). What should be the appropriate course of action for the nurse?

Warm the pack before administering. Check the patient's hypersensitivity to the product. Provide antibiotics based on the clinical condition. Replace clotting factors based on laboratory studies * When administering large volumes of packed RBCs, it is important to replace clotting factors to prevent coagulopathy. Because the pack contains only RBCs and not the clotting factors, it should be given extrinsically. Generally, the crystalloid and colloid solutions are warmed before being administered to avoid hypothermia. However, packed red blood cells should not be warmed, because high temperature can damage the red blood cells. The blood products are almost always cross typed and matched before administration. Antibiotics are not related to the administration of RBCs.