Shock & Dysrhythmias
What is the one type of shock where we usually see an INCREASE in body temperature?
Septic shock
What is an antihistamine we administer during anaphylactic shock?
diphenhydramine aka Benadryl
Morphine sulfate has which of the following effects on the body?
reduces preload
Someone is considered to be in tachycardia if their heart rate is greater than what?
100 bpm
The patient is experiencing anaphylaxis. Which drug would be administered to increase blood pressure and treat bronchospasm related to anaphylaxis?
Epinephrine
What drug do we use to treat full cardiac arrests and sever hypotension. Hint: it is classified as a vasopressor and works by stimulating receptors in the sympathetic nervous system
Epinephrine
What is the first line vasoconstrictor used to treat anaphylactic shock?
Epinephrine explanation: epinephrine causes vasoconstriction and can rapidly relieve symptoms of bronchoconstriction.
Do inotropic drugs increase or decrease cardiac output?
INCREASE cardiac output
What are Crystalloids?
IV solutions used for fluid replacement. They contain electrolytes in amounts resembling those of natural plasma. Unlike colloids, crystalloid solutions can readily leave the blood and enter the cells or tissues.
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic of the ECG strip?
"Spike" on the rhythm strip
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse?
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
The smallest squares seen on the ECG strip are how many seconds long?
0.04 seconds long
The PR interval which is measured from the beginning of the P-wave to the beginning of the QRS complex should be how long normally?
0.12 to 0.20 seconds This is 3 to 5 little squares.
The larger, bolded squares seen on the ECG strip are how many seconds long?
0.20 seconds long Tip: 15 of these boxes equal 3 seconds and 30 of these boxes is 6 seconds
The three fluid replacement agents used to treat shock are:
1) Blood Products (whole blood, platelets, fresh frozen plasma, packed red blood cells) 2) Colloids (Plasma protein fraction, normal serum albumin, Dextran 40, Hetastarch/Hesban) 3)Crystalloids (normal saline, lactated ringers, 0.45% normal saline, 5% dextrose in normal saline, 5% dextrose in water)
What are the 3 stages of shock in order?
1) Compensatory 2) Progressive 3)Irreversible
The four vasoconstrictors used to treat shock are:
1) Dopamine (Intropin) 2)Norepinephrine (Levophed) 3)Phenylephrine (Neo-synephrine) 4)Epinephrine
What should you do if you find someone you believe is in shock and you are waiting for help to arrive?
1) Keep them warm with blankets 2)Have them hold still and rest 3)Elevate the feet
Put these in the correct order of electrical conduction in the heart: AV node Purkinje Fibers Bundle of his Left and Right bundle branches SA node
1) SA node (the pacemaker) 2) AV node (the gatekeeper) 3) Bundle of his 4) Left and Right bundle branches 5)Purkinje Fibers
The patient's family is asking questions about the medications used in the treatment for shock. The nurse explains that dopamine is one of the drugs being used and that it works by: (Select all that apply) 1)At low doses, to cause increased blood flow to the kidneys 2)At high doses , to increase cardiac output 3)To cause vasoconstriction and increases blood pressure 4) At high doses to treat anaphylaxis 5) At low doses to treat anaphylaxis
1)At low doses, to cause increased blood flow to the kidneys 2)At high doses , to increase cardiac output 3)To cause vasoconstriction and increases blood pressure 4 & 5 are false. Dopamine is not used to treat anaphylaxis. Our first line vasoconstrictor for anaphylaxis is epinephrine.
What are the cellular effects of shock?
1)Mitochondrial damage (swelling) 2)Increased membrane permeability 3)Lysosomal membrane rupture 4)Cellular edema (swelling)
What are the four stages of the cardiac cycle?
1)Ventricular diastole (ventricles relax) 2)Atrial Systole (atrium contract) 3)Atrial diastole (atrium relax) 4)Ventricular systole (ventricles contract)
The inherent heart rate of the purkinje fibers is...
20-40 bpm
Which of the following considerations is most likely associated with administering norepinephrine (Levophed)? 1. Empyema 2. Hyperkalemia 3. Tissue necrosis 4. Hypokalemia 5. CNS Depression 6. Blurry Yellow vision disturbance
3. Tissue necrosis Explanation: If norepinephrine extravasates or leaves the blood vessel during administration, it can cause tissue necrosis.
In the plan of care, the MOST important intervention for a patient experiencing shock is assessing: 1)Temperature 2)Heart rate 3)Respirations 4)Blood Pressure
4) Blood pressure Shock causes severe HYPOtension
In reviewing a plan of care for a patient exhibiting the symptoms of anaphylaxis, which of the following medications would be avoided? 1. Antihistamines 2.Corticosteroids 3.Bronchodilators 4.Vasodilators
4. Vasodilators
The inherent heart rate of the AV node is...
40-60 bpm
Class 1 Hypovolemic shock is characterized by a blood loss of _______________________.
500-750 ml
Someone is considered to be bradycardic if their heart rate falls below what?
60 bpm
The inherent heart rate of the SA node is...
60-100 bpm. If all conduction is normal throughout the heart and the SA node starts off each electrical signal the heart rate should be between 60-100 bpm
Class 2 Hypovolemic shock is characterized by a blood loss of _______________________.
750-1500 ml
What drug do we give to treat supraventricular tachycardia? Hint: this drug slows conduction at the AV Node and inhibits the reentry pathway.
Adenosine
What age group is at an increased risk of sepsis?
Adults 65 years and older AND children less than 1 years old
What drug that works by blocking NA+ and K+ channels and elongating the action potential works to correct/treat ventricular arrhythmias?
Amiodarone hydrochloride
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?
Atrial Flutter
What is the medication we use to treat Bradycardia (low heart rate) and works by enhancing conduction through the AV node which in turn accelerates heart rate. Hint: this drug is classified as a antiarrhythmic
Atropine
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia?
Atropine.
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to avoid what?
Caffeinated beverages.
You are caring for a client who is in neurogenic shock. You know that this is a subcategory of what kind of shock?
Circulatory shock (distributive)
A blood loss of 1500-2000 ml puts you in what class of hypovolemic shock?
Class 3 Hypovolemic shock.
Blood loss of greater than 2000 mL puts you in what class of hypovolemic shock?
Class 4 Hypovolemic shock.
Is D5NS (5% dextrose in normal saline) a.... a) isotonic solution b)hypotonic solution c)hypertonic solution
D5NS is considered a c)hypertonic solution meaning it has a greater concentration of solutes than plasma. D5NS is considered a crystalloid.
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
Delayed conduction, producing a prolonged PR interval
How is digoxin (lanoxin) helpful in treating shock?
Digoxin is an inotropic drug. Digoxin increases myocardial contractility and cardiac output, thus rapidly bringing tissues their needed oxygen.
An abnormal allocation of blood flow with a normal cardiac output is best described as which of the following types of shock?
Distributive Shock explanation: distributive shock occurs due to abnormal distribution of blood flow in the vessels. This category of shock differs from the others in the sense that it occurs even though output of the heart is normal.
Which drug used to treat shock is BOTH inotropic and vasoconstriciting?
Dopamine (Intropin)
What are colloids?
Fluid replacement agents that are usually proteins or other large molecules that stay suspended in the blood for a long period and draw water molecules from the body's cells and tissues into the blood vessels.
When administering norepinephrine (Levophed), the nurse will monitor the patient for what possible adverse effect?
Hypertension explanation: when we treat sever hypotension with Levophed we can OVER correct the issue and cause the patient to become dangerously hypertensive.
A loss of intravascular fluid volume that results in a decreased cardiac output is best described as which type of shock?
Hypovolemic Shock explanation: Hypovolemic shock occurs due to a loss of intravascular fluid volume. In this shock state, the size of the vascular compartment stays the same, but the volume of blood or plasma is decreased. A reduction in intravascular volume results in a decreased venous return to the heart leading to decreased cardiac output.
The patient with severe burns has just been admitted to the hospital. The nurse will monitor for signs and symptoms of which type of shock?
Hypovolemic shock
The depleted volume that results from excessive vomiting is most likely going to lead to which type of shock?
Hypovolemic shock
What is the antidote for norpinephrine (Levophed) if necrosis occurs?
If extravasation occurs, the antidote, phentolamine (Regitine) can be infused into necrosed area to allow blood vessels to re-expand.
What is the major clinical use of dobutamine?
Increase cardiac output without dramatically increasing heart rate
Cardiac tamponade is most likely to cause obstructive shock through what mechanism?
Indirect pump failure explanation: unlike cardiogenic shock, obstructive shock results in decreased cardiac function by non-cardiac factors (indirect pump failure). The prevention of diastolic filling by a mechanical obstruction leads to decreased Cardiac output (CO) and increased afterload, and differing filling pressures.
Dobutamine (Dobutrex) is used to treat shock because:
It increases myocardial contractility WITHOUT significantly increasing heart rate.
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?
It is used to eliminate ventricular dysrhythmias.
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?
Lead wire dislodgment
What is the general malfunction that leads to distributive shock?
Lost Vascular Tone
Which positioning strategy should be used for a client diagnosed with hypovolemic shock?
Modified Trendelenburg
The primary cause of cardiogenic shock is ...
Myocardial infarction (MI)
A client with a history of depression is brought to the ED after overdosing on Valium. This client is at risk for developing which type of distributive shock?
Neurogenic Shock
A spinal cord injury that disrupts the sympathetic nervous system is most likely to lead to which of the following types of shock?
Neurogenic Shock explanation: neurogenic shock is caused by the loss of vascular tone normally supported by the sympathetic nervous system. It can stem from circumstances such as severe pain, anesthesia, stress, spinal cord injury, or head trauma.
Is Normal saline (0.9% sodium chloride) a... a) isotonic solution b)hypotonic solution c)hypertonic solution
Normal saline is a)isotonic solution and is considered a crystalloid.
Which intravenous solution is most appropriate for a patient in hypovolemic shock?
Normal serum albumin explanation: As a colloid, normal serum albumin draws water from the body's cells and tissues into the blood vessels, thus increasing the blood volume.
What type of shock is most likely to occur when there is a blockage of blood flow to the heart?
Obstructive shock explanation: obstructive shock occurs when a physical obstruction to blood flow occurs.
During shock, on a cellular level potassium K+ _____________ the cell and sodium Na+ and water H20 ___________________ the cell.
Potassium K+ LEAVES the cell - there is an efflux Sodium Na+ and Water ENTER the cell- there is an influx
A myocardial infarction (MI) is most likely to cause cariogenic shock through which mechanism?
Pump Failure explanation: direct pump failure may result from either systolic or diastolic dysfunction of the hearts pumping action leading to reduced cardiac output.
The visual of atrial repolarization (relaxation) is hidden in which part of the ECG?
QRS Complex
The primary mission or 'job' of the left side of the heart is to...
Receive freshly oxygenated blood from the lungs and push it out into the body
A systematic inflammatory response that results in excessive cellular activation and hypotension despite fluid resuscitation is most likely to lead to which type of shock.
Septic Shock explanation: septic shock is the presence of sepsis with hypotension despite adequate fluid resuscitation. It begins with an infection and leads to a systematic inflammatory response causing peripheral vasodilation, increased capillary permeability, excessive cellular activation, and increased coagulation.
Systole means ___________________. Diastole means __________________.
Systole means contraction. Diastole means relaxation.
Ventricular repolarization is represented by what part of an ECG?
T-wave
Ventricular depolarization (contraction) is seen on the ECG as .....
The QRS Complex
The SA node is located in the right atrium and is called the bodies pacemaker. The SA node causes what to initially contract?
The SA note is responsible for atrial depolarization. It causes the atria to contract.
Diastasis refers to ..
The brief pause between relaxation and contraction.
You respond to a call for help and discover someone in distress at your local shopping center. You observe that their skin is pale, clammy, and feels cold. You notice their breathing is rapid but shallow. The individual acts restless, anxious, confused, and complains of thirst. You conclude that...
This individual is most likely in shock.
How do burns lead to hypovolemic shock?
Through relative hypovolemia which involves fluid moving out of the vascular space into the extravascular space also known as third spacing. This is common in burn patients who experience increased capillary permeability causing third spacing of fluid.
You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages?
a rapid and bounding pulse
The P-wave on the ECG represents...
atrial depolarization (contraction) The SA node is responsible for the P-wave
What corticosteroid do we give during anaphylactic shock to dampen the acute inflammatory response?
hydrocortisone
Systolic dysfunction is the inability of the heart to ................ whereas diastolic dysfunction is the inability of the heart to...............
pump blood forward fill
The primary mission or 'job' of the right side of the heart is to...
to take the unoxygenated blood that it receives and deliver it to the lungs so it can be re-oxygenated. Think *Right side takes it *Right to the lungs
