Nursing Pharmacology: Dopamine Administration
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Questions and Answers

What is the rationale for administering dopamine to a client with decreased cardiac output, rising creatinine level, and anuria?

  • To reduce inflammation and improve kidney function.
  • To dilate peripheral blood vessels and improve circulation.
  • To increase blood pressure and improve renal perfusion. (correct)
  • To decrease heart rate and reduce myocardial oxygen demand.
  • Which of the following precautions should be taken when administering IV dopamine?

  • Monitor the client's blood pressure frequently, especially during titration.
  • Administer the medication through a central line to avoid extravasation.
  • Ensure adequate hydration to prevent renal toxicity.
  • All of the above. (correct)
  • What is the optimal outcome for a client receiving dopamine for decreased cardiac output and anuria?

  • Reduction in inflammation and improvement in overall well-being.
  • Improved peripheral circulation and decreased edema.
  • Decreased heart rate and stabilized blood pressure.
  • Improved renal function and increased urine output. (correct)
  • What is the most likely outcome for a client with decreased cardiac output, rising creatinine level, and anuria, despite receiving dopamine?

    <p>Progressive kidney failure requiring permanent dialysis. (D)</p> Signup and view all the answers

    Which of the following is a key advantage of using an arterial line for hemodynamic monitoring?

    <p>Provides continuous blood pressure readings. (D)</p> Signup and view all the answers

    Why is it important to perform the Allen test before placing an arterial line?

    <p>To ensure adequate blood flow to the hand. (D)</p> Signup and view all the answers

    What is the advantage of a pulmonary artery catheter for hemodynamic monitoring?

    <p>Allows for accurate measurement of cardiac output. (B)</p> Signup and view all the answers

    What is the purpose of the phlebostatic axis in hemodynamic monitoring?

    <p>To ensure accurate blood pressure readings. (A)</p> Signup and view all the answers

    What is the primary goal of aggressive fluid resuscitation in sepsis management?

    <p>To increase blood pressure and decrease mortality (D)</p> Signup and view all the answers

    Which laboratory test is NOT typically included in the initial blood work for sepsis diagnosis?

    <p>Viral load testing (D)</p> Signup and view all the answers

    What is the recommended timeframe for administering antibiotics to a patient suspected of septic shock?

    <p>Within 1 hour upon arrival (A)</p> Signup and view all the answers

    Which of the following medications is commonly used as a vasopressor in septic patients?

    <p>Norepinephrine (B)</p> Signup and view all the answers

    What is a possible outcome if the fluid resuscitation in a septic patient is successful?

    <p>Normalization of blood pressure and improved organ function (A)</p> Signup and view all the answers

    What type of fluid solution is commonly used for resuscitation in sepsis management?

    <p>Crystalloid solution (D)</p> Signup and view all the answers

    Which of the following statements is true regarding the use of low-dose corticosteroids in septic shock management?

    <p>They are considered a last-line intervention (B)</p> Signup and view all the answers

    Which laboratory test is crucial for assessing the severity of sepsis and monitoring treatment response?

    <p>Serum lactate (A)</p> Signup and view all the answers

    What treatment is sometimes used to address DIC but is not considered routine?

    <p>Anticoagulants (A)</p> Signup and view all the answers

    What is NOT a recognized risk factor for developing MODS?

    <p>Regular exercise (D)</p> Signup and view all the answers

    Which statement accurately describes the physiological response leading to MODS?

    <p>Constant immune mediator release leads to oxidative stress and organ dysfunction. (B)</p> Signup and view all the answers

    What is the primary cause of infection following trauma that can lead to MODS?

    <p>Sepsis causing accelerated apoptosis (D)</p> Signup and view all the answers

    What impact does an increasing number of affected organs have on the mortality rate associated with MODS?

    <p>It increases the mortality rate. (C)</p> Signup and view all the answers

    Which treatment option is appropriate for fluid resuscitation in MODS?

    <p>Balanced crystalloids like LR (C)</p> Signup and view all the answers

    How does lactic acidosis contribute to MODS?

    <p>It signifies a shift to anaerobic metabolism. (C)</p> Signup and view all the answers

    Which demographic is at an increased risk for MODS due to extreme age?

    <p>Elderly adults aged 65 and older (C)</p> Signup and view all the answers

    What is the name of the medical triad that indicates cardiac tamponade?

    <p>Beck's Triad (B)</p> Signup and view all the answers

    Which of the following is NOT a symptom of cardiac tamponade?

    <p>Increased heart rate (C)</p> Signup and view all the answers

    What is the primary cause of sepsis?

    <p>Both tissue injury and infection (A)</p> Signup and view all the answers

    Which of the following is a hallmark of sepsis?

    <p>Both A and C (C)</p> Signup and view all the answers

    What is the significance of having at least 2 SIRS criteria components in diagnosing sepsis?

    <p>It confirms a systemic inflammatory response (B)</p> Signup and view all the answers

    Which of the following is an example of a SIRS criteria component?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the relationship between SIRS and sepsis?

    <p>Sepsis is a subset of SIRS (B)</p> Signup and view all the answers

    Which of the following is a potential cause of shock in the client?

    <p>Prolonged inadequate blood supply to cells (D)</p> Signup and view all the answers

    What is the primary consequence of vasodilation in sepsis?

    <p>Decreased blood pressure (B)</p> Signup and view all the answers

    What is the primary role of catecholamines in the body's response to hypotension?

    <p>Increase blood pressure through vasoconstriction (B)</p> Signup and view all the answers

    Which of the following is a hallmark of the progressive stage of shock?

    <p>Worsening metabolic acidosis (C)</p> Signup and view all the answers

    What is the primary function of renin in the body's response to shock?

    <p>Lead to the conversion of angiotensin I to angiotensin II, a vasoconstrictor (B)</p> Signup and view all the answers

    What is the significance of hyperventilation in shock?

    <p>It helps to compensate for metabolic acidosis (D)</p> Signup and view all the answers

    What is the primary concern regarding the client's restlessness?

    <p>It could be a sign of early shock (B)</p> Signup and view all the answers

    What are the clinical manifestations of shock in the refractory stage?

    <p>Multisystem organ failure and coma (C)</p> Signup and view all the answers

    Which vital sign finding is most likely to indicate the client is progressing towards shock?

    <p>Increased heart rate (B)</p> Signup and view all the answers

    What is the relationship between oxygen delivery (DO2) and oxygen consumption (VO2)?

    <p>DO2 and VO2 are directly related, but the relationship is not linear. (D)</p> Signup and view all the answers

    Which of the following is NOT a major factor in determining cardiac output?

    <p>Blood Pressure (A)</p> Signup and view all the answers

    What is the primary reason that oxygen delivery (DO2) is measured?

    <p>To assess the effectiveness of the cardiovascular system in delivering oxygen to the tissues. (B)</p> Signup and view all the answers

    Which of the following is an example of hypovolemic shock?

    <p>Severe burns (C)</p> Signup and view all the answers

    What is the significance of measuring oxygen consumption (VO2) in a critically ill patient?

    <p>It demonstrates the patient's ability to extract oxygen from the blood. (A)</p> Signup and view all the answers

    How does afterload affect cardiac output?

    <p>Increased afterload decreases cardiac output by increasing the pressure the ventricle must overcome to eject blood. (B)</p> Signup and view all the answers

    Why is it critical to monitor oxygen consumption (VO2) in a patient experiencing shock?

    <p>It allows clinicians to quantify the severity of the shock. (D)</p> Signup and view all the answers

    Flashcards

    Shock

    A life-threatening condition where the circulatory system fails to supply adequate oxygen to meet metabolic demands.

    Oxygen Delivery (DO2)

    The amount of oxygen delivered to tissues, evaluated through cardiac output and arterial oxygen content.

    Oxygen Utilization (VO2)

    The measure of how effectively tissues extract oxygen from the blood, normal levels are 60%-75%.

    Cardiac Output

    The volume of blood pumped by the heart per minute, crucial for delivering oxygen to tissues.

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    Preload

    The amount of blood in the ventricles at the end of diastole, influencing stroke volume.

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    Afterload

    The resistance the ventricles must overcome to eject blood during contraction.

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    Contractility

    The ability of the heart muscle to contract with strength, affecting cardiac output.

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    Hypovolemic Shock

    A type of shock caused by insufficient blood volume, often due to severe burns or fluid loss.

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    Neural compensation

    Physiological response to hypotension involving catecholamine release.

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    Endocrine compensation

    The kidneys release renin leading to angiotensin II and ADH release.

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    Progressive shock

    Stage of shock characterized by profound hypoperfusion and worsening acidosis.

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    Refractory shock

    Final stage of shock; irreversible, leading to multisystem organ failure.

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    Chemical compensation

    Chemoreceptors trigger responses to hypoxia leading to respiratory changes.

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    Hypotension triggers

    Factors that initiate a drop in blood pressure causing compensatory mechanisms.

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    Tachypnea

    Abnormally rapid breathing often due to hypoxia.

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    Metabolic acidosis

    A condition where the body produces too much acid or kidneys are not removing acid fast enough.

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    Cardiac Tamponade

    A condition where fluid accumulates in the pericardial sac, compressing the heart.

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    Beck's Triad

    A clinical syndrome of cardiac tamponade characterized by hypotension, jugular vein distention, and muffled heart sounds.

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    SIRS

    Systemic Inflammatory Response Syndrome, a clinical condition with two or more signs of inflammation.

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    Sepsis

    A severe response to infection involving SIRS criteria and positive cultures.

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    Septic Shock

    A critical condition resulting from sepsis characterized by persistent hypotension and increased mortality risk.

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    Symptoms of Cardiac Tamponade

    Include anxiety, restlessness, difficulty breathing, heart failure, edema, bleeding, and shock.

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    Cytokines in Sepsis

    Chemical messengers that get released excessively during sepsis, leading to inflammation.

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    Serum Lactate

    A blood test indicator of tissue hypoperfusion and lactic acidosis.

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    Vasodilation in Septic Shock

    Widening of blood vessels that decreases blood pressure, common in septic shock.

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    Blood Cultures

    Lab tests to detect infection-causing organisms in the bloodstream.

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    Complete Blood Count (CBC)

    A blood test measuring various components, including red/white blood cells and platelets.

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    Coagulation Studies

    Tests assessing blood’s ability to clot, important in sepsis management.

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    Aggravated Fluid Resuscitation

    A treatment for sepsis involving large volumes of fluids to maintain blood pressure.

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    Norepinephrine (Norepi)

    A vasopressor drug used to raise blood pressure in septic shock patients.

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    Corticosteroid Therapy

    Potential treatment option for septic shock, but low-dose effectiveness is uncertain.

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    Arterial Blood Gas (ABG)

    A test measuring oxygen, carbon dioxide, and pH in arterial blood.

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    Fresh Frozen Plasma

    A blood product used to treat clotting disorders.

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    Platelet Replacement

    The process of replenishing platelets in the blood for clotting.

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    Multiple Organ Dysfunction Syndrome (MODS)

    A severe response after injury or infection leading to organ failure.

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    Risk Factors for MODS

    Conditions increasing the likelihood of developing MODS include chronic disease and trauma.

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    Impact of MODS on Health

    MODS increases mortality and prolongs recovery affecting older adults more severely.

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    Lactic Acidosis

    Build-up of lactic acid due to inadequate oxygen for metabolism.

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    Oxidative Stress

    An imbalance between free radicals and antioxidants in the body.

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    Sepsis and MODS Connection

    Sepsis accelerates apoptosis, increasing risk of MODS.

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    Dopamine Administration

    A medication used to improve heart function and blood flow in patients with low cardiac output.

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    Cardiac Output Decrease

    A reduction in the volume of blood the heart pumps per minute, indicating reduced heart function.

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    Anuria

    A medical condition defined by the absence of urine output, often indicating kidney failure.

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    Creatinine Level Rising

    An increase in creatinine levels in the blood indicates impaired kidney function.

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    Pulmonary Artery Catheter

    A long catheter used to monitor hemodynamic status, including cardiac output and pressures.

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    Central Venous Pressure (CVP)

    The pressure in the central venous system, used to assess heart preload and fluid status.

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    Allen Test

    A test to assess the arterial blood supply to the hand before placing arterial lines.

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    Transducer Positioning

    The placement of a transducer at the phlebostatic axis for accurate hemodynamic measurement.

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    Study Notes

    Shock, Sepsis, & Critical Cardio

    • Shock is a life-threatening syndrome
    • The circulatory system can't supply adequate oxygen to tissues.
    • Oxygen delivery (DO2) is the amount of oxygen delivered to tissues
    • Oxygen utilization (VO2) reflects the relationship between oxygen delivery and extraction at tissue level.
    • CO = Cardiac output - amount of blood ejected every minute
    • Preload is blood in ventricles at end of diastole
    • Afterload is the resistance to flow that the ventricle must overcome to eject blood.
    • Contractility is the force of mechanical contraction.

    Learning Objectives

    • Explain pathophysiology for perfusion.
    • Explore risk factors that contribute to critically ill patients experiencing altered perfusion.
    • Describe the impact of altered perfusion on critically ill clients' overall health.
    • Differentiate clinical presentations in critically ill clients experiencing altered perfusion.
    • Explore roles of nurses caring for critically ill clients experiencing altered perfusion.
    • Apply the nursing process while caring for critically ill clients experiencing altered perfusion.

    Classification of Shock

    • Hypovolemic: Not enough blood volume (burns, significant blood loss)
    • Cardiogenic: Inadequate heart pumping.
    • Distributive: Disease causes poor vascular tone (sepsis, anaphylaxis).
    • Obstructive: Mechanical barrier to ventricular filling (cardiac tamponade, tension pneumothorax, PE).

    Assessment

    • Central Nervous System: Restlessness, confusion, irritability, lethargy, coma (prolonged).
    • Cardiovascular: Hypotension, narrow pulse pressure, tachycardia (then bradycardia, Skin color- cool, mottled, cyanotic (blood shunted), warm, flushed).
    • Peripheral pulses: Thready
    • Capillary refill: Sluggish
    • Respiratory: Tachypnea, ABG's, pulse oximetry
    • Renal: Oliguria (first), then anuria, increased creatinine.
    • Gastrointestinal: Hypoactive bowel sounds, nausea, vomiting.

    Pathophysiology: Distributive Shock

    • Decreased SVR & Perfusion
    • Septic shock: Inflammatory cytokines damage vessels & initiate clotting.
    • Anaphylactic shock: Severe hypersensitivity.
    • Neurogenic shock: Autonomic dysregulation caused by spinal cord injury above T6
    • Toxic shock: Infection from Staphylococcus aureus causes excessive cytokine activation.

    Stages of Shock

    • Compensatory: Neural & endocrine compensatory mechanisms.
    • Progressive: Failure of compensatory mechanisms, profound hypoperfusion, worsening metabolic acidosis, respiratory acidosis.
    • Refractory: Prolonged inadequate blood supply, cell death, multisystem organ failure, death imminent.

    Complications: Disseminated Intravascular Coagulation (DIC)

    • Blood clots throughout the body, block small blood vessels.
    • Risk factors: Pregnancy complications, blood infections, cancer, blood transfusions, liver dysfunction, shock, trauma, burns.
    • Clinical presentation: Bleeding, hypovolemia, hypotension, decreased CO & LOC, ecchymosis, hematoma, petechiae, tissue necrosis, dyspnea, epistaxis, conjunctival bleeding.
    • Lab diagnostics: Increased PT/PTT, decreased fibrinogen & platelets count.

    Complications: Multiple Organ Dysfunction Syndrome (MODS):

    • Extreme response to injury, sepsis, or burns.
    • Constant release of immune mediators leads to oxidative stress.
    • Cellular oxygenation decreased causing anaerobic metabolism & lactic acidosis.
    • The increase in metabolic acidosis leads to MODS, causing muscle and vital organ breakdown.
    • Risk Factors: Chronic disease, immunosuppressive therapy, extreme age, malnutrition, cancer, trauma, alcoholism, sepsis.
    • Clinical Presentation: Respiratory, cardiovascular, hepatic, gastrointestinal, integumentary, & central nervous system issues; often leading to death.

    Treatments & Therapies

    • Shock: IV fluids (at least 30ml/kg for first three hours), mechanical ventilation, IV antibiotics, norepinephrine (for MAP), blood components, advanced mechanical support (intra-aortic balloon pump, ECMO), nutrition.
    • Sepsis/Septic Shock: Aggressive fluid resuscitation, targeted antibiotics within 1 hour, Vasopressors, crystalloids (NS and LR), steroids, antihistamines & early intervention
    • DIC: Fresh frozen plasma, platelets, whole blood and anticoagulants, IV fluids (LR/NS), treatment of underlying cause
    • MODS: Supportive care, antibiotics, mechanical ventilation, IV fluids, and medications.

    Cardiac Tamponade

    • Fluid accumulation around the heart.
    • 3 Phases: Pericardial fluid builds up, ventricles can't expand fully, CO decreases rapidly.
    • Risk factors: central line placement, malignancies, infection, complications from MI, aortic dissection, previous high-risk surgery, aortic aneurysm, hypoparathyroidism.

    Cardiac Output

    • Blood ejected per minute.
    • Influenced by preload, afterload, and contractility.

    Other Important Information

    • Learning objectives
    • Different types of shock (hypovolemic, cardiogenic, distributive, obstructive).
    • Stages of shock (compensatory, progressive, refractory)
    • Treatment for each type of shock is crucial to preventing further complications.

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    Description

    This quiz explores the rationale, precautions, and outcomes associated with administering dopamine to clients experiencing decreased cardiac output and related conditions. It also covers hemodynamic monitoring techniques and the management of sepsis. Test your knowledge on key nursing concepts and pharmacological interventions.

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