Critical care nursing clinics of North America
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The process of supporting the patient in shock with vasoactive infusions is never a static one. There are a variety of vasoactive infusions available; unfortunately, no one medication effectively corrects the numerous abnormalities in all forms of shock and no magic formula exists for combining medications to achieve optimum tissue perfusion. The nurse is challenged to utilize keen assessment skills and sophisticated monitoring techniques to follow the patient's response to changing vasoactive drug therapy. The nurse must collaborate with the physician and other health team members to integrate drug therapy with the other aspects of shock therapy, including fluid repletion, oxygenation and ventilation, metabolic support, and antibiotic therapy to facilitate the successful resuscitation of the patient in shock.
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Crit Care Nurs Clin North Am · Jun 1990
ReviewAdult respiratory distress syndrome. A complication of shock.
ARDS is a complex type of respiratory failure that usually is a complication of a catastrophic critical illness, such as shock. Mortality is high, especially in patients with septic shock and multisystem failure. Mortality often is related to complications of refractory hypoxemia. ⋯ The nurse has an important role in collaborating with the physician and respiratory therapist to support the patient's oxygenation, ventilation, and tissue oxygen delivery system. The nurse is responsible for performing highly sophisticated assessment of clinical and hemodynamic parameters to evaluate the effectiveness of therapy. A key role of the nurse is anticipating, recognizing, and reporting to the physician complications of hypoxemia and complications of therapy that can lead to sepsis, airway trauma, or failure of other organ systems.
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Shock is an acute widespread reduction in effective tissue perfusion that invokes an imbalance of oxygen supply and demand, anaerobic metabolism, lactic acidosis, cellular and organ dysfunction, metabolic abnormalities, and, if prolonged, irreversible damage and death. The pathophysiologic events in the various types of shock are different and complex with hemodynamic and oxygenation changes, alterations in the composition of the fluid compartments, and various mediators. ⋯ The clinical types of shock include hypovolemic, cardiogenic, distributive (septic), and obstructive. An understanding of the pathophysiologic changes, rapid diagnosis, appropriate monitoring, and appropriate therapy can reduce the high morbidity and mortality in shock states.
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Care of the child in shock requires careful and constant assessment of the child's systemic perfusion. In addition, oxygenation and ventilation must be supported. The child's heart rate must be maintained, since pediatric cardiac output often is directly related to heart rate. ⋯ The child should be prepared gently for any painful procedures, and realistic but compassionate communication with the entire family is essential. Through constant assessment and evaluation of patient response to therapy, the nurse is in the best position to detect early signs of compromise and to determine effectiveness of therapy. Therefore, it is imperative that the nurse possess a thorough understanding of the pathophysiology and clinical progression of shock in the child, as well as the rationale and potential complications of management.
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Septic shock is a life-threatening illness characterized by hypotension, impaired organ function and/or failure, and metabolic abnormalities. Septic shock can develop in patients infected with a variety of gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, spirochetes, protozoa, and parasites. Immediate recognition, diagnosis, and treatment are key elements in reducing the morbidity and mortality associated with this condition. ⋯ The beta-lactam antibiotics include all penicillins, cephalosporins, carbapenems, and monobactams. Penicillins with extensive gram-negative coverage include all the carboxy (carbenicillin, ticarcillin, and ticarcillin plus clavulanic acid) and ureido (piperacillin, mezlocillin, azlocillin) penicillins. The third generation cephalosporins (cefoperazone, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone, and moxalactam) have the broadest gram-negative coverage within the cephalosporin family.(ABSTRACT TRUNCATED AT 250 WORDS)