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45 Cards in this Set
- Front
- Back
shock
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-decrease in blood flow to body tissues
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types of shock
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distributive-(neurogenic,septic, anaphylactic)
hypovolemic cardiogenic |
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initial stage of shock
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few signs
BP may be normal or slightly decreased SNS stimulation maintains perfusion |
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Compensatory stage of shock
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Fluid shift occurs
SNS stimulation maintains perfusion Bp may be decreased tachycardia, tachypnea, hyperpnea, decreased urine output, reports of thirst, hypothermia, LOC changes blood shunted away from skin-pale and cold fluid shift-tissue to vessel(dry oral mucousa, tenting |
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Progressive stage of shock
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failure of compensatory mechanisms
profound vasoconstriction aerobic to anaerobic metabolism causing metabolic acidosis(lactic acid release) listless, confused, BP less than 80, tachycardia, cold, pale, ogliguria hypothermia, cyanosis rapid thready weak pulse need 2 IV 16 gauge |
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irreversible stage of shock
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near death
comfort measure are taken BP=0 unconsciuos, unresponsive cheyne stokes, anuria, mottling, crackles |
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treating hypovolemic shock
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Hypovolemic-IV fluids- NS, colliods, albumin(hypertonic)
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treating cardiogenic shock
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preload reduction-diuretics
intra-aortic balloon pump NO fluids levophed *last resort* (profound vasoconstriction) Dobutamine & dobutrex-mimics or stimulates SNS to increase heart rythym to constrict blood vessels |
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treating septic shock
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anti-infectives
lots of fluids |
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treating anaphylactic shock
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Epinepherine, benadryl, steroids
need to restore breathing |
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treating neurogenic shock
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fluids, correct underlying problem
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Arterial line monitoring
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provides access for ABG samples
monitors BP ussually inserted in radial artery |
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blood transfusions
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indicated for-Hbg below 7, severe blood loss, surgery, anemia
must be typed and cross-matched(mix blood from donor & recipient to see reaction) 2 RN's must sign |
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types of blood products
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packed red blood cells-increases oxygen carrying capacity of blood
platelets- controls or prevents bleeding-pooled from several donors fresh frozen plasma-freezing preserves clotting factors |
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nursing considerations for transfusion
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large bore IV- 16 gauge
name, blood type, expiration date, unit #, pt. ID # Vitals before start start slowly must be infused within 4 hrs monitor for infusion reaction vitals frequently |
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signs of blood rejection and indications
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fever, warmth, itching, chills, itching, weakness, dyspnea, tachycardia, hypotension
stop infusion open normal saline check vitals obtain blood and urine samples may be treated with Lasix and benadryl |
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hypertension
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primary- no known reason
secondary- known underlyng cause |
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diagnosis of hypertension
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3 or more BP's 140/90
3 visits both arms check BUN CRE glucose & cholestrol |
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risk factors hypertension
non-modifiable |
age, sex, race, family history, obesity(central ab), smoking
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Blood pressure formula
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cardiac output x systemic vascular resistance
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cardiac output
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amount of blood pumped by ventricle in one minute
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influences on BP
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SNS- epinepherine,adreneline(tachy vasoconstriction)-beta blockers
Renal system-if Na & H2O are not excreting there will be retension-diurectics renin(angiotensen I&II impairment)ACe inhibitors Endocrine system-aldesterone(secretion of Na & H2O)impairment causes retension |
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modifiable risk factors for hypertension
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sodium intake
lipid levels alcohol sedentary lifestyle diabetes stress |
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signs of hypertension
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Silent killer(sometimes no sign)
headache, dizziness, angina, blurred vision, epitaxis |
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cardiac effects of hypertension
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left ventricle has to work harder causing heart to enlarge and get flabby from overuse leading to CHF
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cerebral effects of hypertension
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increased pressure causes rupture=stroke
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peripheral vascular effects of hypertension
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ischemic changes to lower extremeties
pain and necrosis result |
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renal effects of hypertension
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blood and oxygen are not getting to kidneys leading to renal failure
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retinal changes due to hypertension
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eyes are highly vascular
hemorrages occur from pressure |
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conservative trreatment of hypertension
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dash dietary
exercise cessation of smoking stress management |
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loop diurectics
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Lasix (furosemide) Decreases sodium
reabsorption in the loop of henle, promotes K excretion Monitor BP,K, I&O, dehydration |
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thiazide diurectics
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Hydrochlorothiazid
e (HCTZ) Hydrodiuril Prevents sodium and water reabsorption, promotes K excretion Sulfa based, check for allergies Monitor BP, K, I &O, dehydration |
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vasodilators
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Nitrates Cause systemic Check BP can
vasodilation, decrease preload and afterload/SVR, increase blood flow to the heart BP, cause headaches, flushing, and palpitations |
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Central Acting
Inhibitors |
Catapres,
Wytensin, Aldomet (older group) Act on the CNS in the brain, inhibits vasoconstriction Orthostasis |
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Alpha adrenergic
blockers |
Minipres, Hytrin
(older group) Peripheral vasodilators act directly on the blood vessel Orthostasis |
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Beta (adrenergic)
blockers |
Lopressor
(metoprolol), Tenormin (atenolol), Corgard (nadolol) Blocks response to SNS stimulation thereby preventing vasoconstriction and tachycardia. Results in decreased in heart rate and BP Check BP and pulse. Don’t administer to patients with COPD. Don’t stop abruptly. |
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Alpha and beta
blocker |
Normodyne
(labetolol), Coreg (carvedilol) Can be administer IV in a hypertensive emergency Close monitoring of BP, don’t administer to patient’s with COPD |
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Ace Inhibitors
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Ace inhibitors Capoten (captopril), t
Vasotec (enalapril) Inhibits conversion of angiotensin I to angiotensin II, thereby inhibiting vasoconstriction 1st line therapy, used to prevent heart failure and for renal protection in diabetics. Can lead to dry cough |
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ACE II (ARBS)-
angiotension receptior blockers |
Cozaar (lozartan)
Diovan Useful with renal patients Check BP and pulse, headache, dizzy, cough |
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Calcium channel
blockers |
Calan (verapamil)
Cardizem (diltiazem) Procardia (nifedipine) Relax smooth muscle in arterial walls, dilate coronary arteries Check BP and pulse Do not give to patients in heart block hypercalcemia-tetany |
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nursing considerations a-line
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treatment of hypertensive crisis
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signs of hypertensive crisis
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Hypertensive Crisis
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Rapid rise in BP
Systolic> 240 Diastolic > 120 Goal: prevent target organ damage of the heart, brain, or kidneys Rapid decrease can result in stroke Gradual reduction in BP (MAP) |
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Goal of treatment for hypertensive crisis
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prevent target organ damage of
the heart, brain, or kidneys |