- Email: [email protected]
Shock
Shock D O N N A E D W A R D S , MA, BSN, RN L U Z TAYLOR, MNSc RN, CCRN K A T Y V O R S T E R , MSN, RN, CS ACROSS 3. The hyperdynamic phase of septic shock is characterized by increased cardiac output and decreased _ _ (abbr). 5. The _ _ of cardiogenic shock remains high at 80%. 6. _ _ is a complex clinical syndrome that develops when there is inadequate tissue perfusion. 11. Massive vasodilatation and increased capillary permeability are the major factors related to the maldistribution of intravascular 13. The halhnark treatment for hypovolemic shock. 14. This type of shock is usually sudden in onset and results from a systcmic antigen-antibody response. 16. Loss of whole blood or _ _ , is the most common cause of hypovolemic shock. 17. Septic, neurogenic, and anaphylactic are three major types o f shock. 20. The drug of choice in anaphylaxis. 23. Etiology of hypovolemic shock includes dehydration, blunt or penetrating , and displaced fluid (third spacing). 24. The current term for a generalized inflammatory response occurring with sepsis, burns, and trauma (abbr). 25. The hallmark sign of _ _ shock is the impaired ability of the heart to pump. 26. The most common organism which causes septic shock is gram _ _ bacteria. 28. Stage of shock characterized by sympathetic nervous system effects. 29. Management of septic shock includes fluid replacement and _ _ Journal of PeriAnesthesia Nursing, Vol 15, No 3 (June), 2000: pp 221-223
30. Neurogenic shock is sometimes referred to as shock. DOWN 1. Pulmonary system failure (abbr). 2. is released from the mast cell in antigenantibody reactions. 4. Failure of the left _ _ to eject the circulating volume results in decreased cardiac output and inadequate tissue perfusion. 6. s h o c k is the widespread systemic response to sepsis. 7. The two phases of septic shock are the hyperdynamic phase and _ _ phase. 8. This type of shock is due to inadequate intravascular volume. 9. Previously referred to as multisystem organ failure (abbr). 10. To provide intravascular fluid replacement, the most appropriate fluids would be lactated or normal saline. 12. Drug that blocks histamine release. 15. If hypovolemic shock is diagnosed and treated early, the prognosis is _ _ 17. Positive inotrope frequently used for cardiogenic shock. 18. Neurogenic shock is caused by loss o f vasomotor function.
Donna Edwards', MA, BSN, RN, is the Emergency Department Nurse Manager; Luz Taylor, MNSc, RN, CCRN, is a Critical Care Instructor, and Katy Vorster, MSN, RN, CS, is the ADP Coordinator; at the Central Arkansas Veterans Healthcare System, Little Rock, AR. Address correspondence to Katy Vorster, MSN, RN, CS, No 4 Odell Dr, Conway, AR 72032. 9 2000 by American Society q['PeriAnesthesia Nurses. 1089-9472/00/1503~001053.00/0 doi : l O.1053/jpan.2000. 7514 221
EDWARDS, TAYLOR, AND VORSTER
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19. The major cause of cardiogenic shock is _ _ (abbr). 21. Septic shock is associated with severe _ _ 22. When replacing fluids and blood rapidly, they should be and filtered.
27. When a patient is in hypovolemic shock, elevate the to a modified Trendelenburg position.
PUZZLE
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9
9 9
| | []
| | | |
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| |
9
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9
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| |
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| m mmm m m m m m m m m
SHOCK
223
SOLUTION
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[] [] [] [] [] [] [] O W U W W W O ~ O W O m [] [] [] [] W [] [] [] [] [] [] E E E U U E m U W U g U ~ [ ] OmOWWW~ m EWNm [] [] [] [] [] [] E U U E S m m W E O m R ImUmmE [] [] [] [] [] [] [] [] [] [] [] U [] m~mmEm m m w m[]w [] [] [][] [] [] [] | | . . m . W miW m O UWl m O W E i[]
224
interventions, in addition to receiving ICU overflow from the rest of the hospital. If they want blood and guts, we can provide it. We practice very independently, particularly in on-call situations. Most of us have good relationships with our physicians; they respect our knowledge and judgement. We provide care to every age group in a variety of hospital, free-standing, and office-based settings. And yes, there are many opportunities to advance both at the bedside through certification and through graduate education. Nurse practitioners, clinical nurse specialists, and nurse anesthetists both come from and practice in perianesthesia settings. What about our patients and the public? How do we explain to them what it is that we do? I think that we must first begin by taking credit for what we do. D o n ' t be afraid to toot your own horn. Let the patient know that you are their best link to a positive and successful surgical experience. The information that you provide preoperatively enables patients and their families to prepare both physically and emotionally for the surgical experience. That warm blanket that you provide, the hand that you hold, the encouraging words during those first moments of wakefulness provide so much support and security to our patients in the Phase I area. When at all possible, follow up with those Phase I patients so that they can put a face with the kind actions that make such an impact on their
VALLIRE D. HOOPER recovery. When discharging the patient and their family to home, let them know again that you will be the link to their successful recovery. Do your best to give patients all of the information that they will need to succeed. What is it that we do? We do so much, and we do it so well that it is often hard to explain this wonderfully varied specialty in a sentence or 2. We do need to be able to explain this specialty, however, and we need to be able to explain it in a way that makes patients feel secure, students feel interested, and administrators feel like they cannot do without us. Do you have an answer for the next time that someone asks you just what do you do? Are you just a nurse? Do you just take blood pressures? Do you just do patient teaching? Those of us in the specialty know that we do so much more. What would you say? Think about it, write it down! Share it with your friends and colleagues. Tell the world what it is that we do. Tell them what perianesthesia nursing is all about. REFERENCES 1. Thomas CL: Taber's Cyclopedia Medical Dictionary (ed 18). Philadelphia, PA, EA. Davis, 1998. Available at http:// www.taber.com.AccessedApril, 2000. 2. American Society of PeriAnesthesia Nurses. Available at http://www.aspan.org.AccessedApril, 2000 3. American Society of PeriAnesthesia Nurses: Standards of Perianesthesia Nursing Practice 1998. Thorofare, NJ, ASPAN, 1998
30. Neurogenic shock is sometimes referred to as shock. DOWN 1. Pulmonary system failure (abbr). 2. is released from the mast cell in antigenantibody reactions. 4. Failure of the left _ _ to eject the circulating volume results in decreased cardiac output and inadequate tissue perfusion. 6. s h o c k is the widespread systemic response to sepsis. 7. The two phases of septic shock are the hyperdynamic phase and _ _ phase. 8. This type of shock is due to inadequate intravascular volume. 9. Previously referred to as multisystem organ failure (abbr). 10. To provide intravascular fluid replacement, the most appropriate fluids would be lactated or normal saline. 12. Drug that blocks histamine release. 15. If hypovolemic shock is diagnosed and treated early, the prognosis is _ _ 17. Positive inotrope frequently used for cardiogenic shock. 18. Neurogenic shock is caused by loss o f vasomotor function.
Donna Edwards', MA, BSN, RN, is the Emergency Department Nurse Manager; Luz Taylor, MNSc, RN, CCRN, is a Critical Care Instructor, and Katy Vorster, MSN, RN, CS, is the ADP Coordinator; at the Central Arkansas Veterans Healthcare System, Little Rock, AR. Address correspondence to Katy Vorster, MSN, RN, CS, No 4 Odell Dr, Conway, AR 72032. 9 2000 by American Society q['PeriAnesthesia Nurses. 1089-9472/00/1503~001053.00/0 doi : l O.1053/jpan.2000. 7514 221
EDWARDS, TAYLOR, AND VORSTER
222
19. The major cause of cardiogenic shock is _ _ (abbr). 21. Septic shock is associated with severe _ _ 22. When replacing fluids and blood rapidly, they should be and filtered.
27. When a patient is in hypovolemic shock, elevate the to a modified Trendelenburg position.
PUZZLE
[] m mmm mmmmmmmmm 9 9 9 9 mmmmm 9 9 9 9 []
9
9 9
| | []
| | | |
immmmm 9 9 9 9 9 mma 9 m m n m m m a m9 m m m m m9m m m m ,m [] 9 , , . , ammml 9 n||ll amammmmmmmmm 9 9 mm mu 9 9 mammmmmmm i =i9 m=9m m m n 9 i m m mI m m m m m m m mum
| |
9
m
9
a m m m m m m m 99 mum 9
|
| |
ammmmm
| m mmm m m m m m m m m
SHOCK
223
SOLUTION
~UUmUUUUW~ [] [] MW~U~WUW~m~
. w [][]m . [][] ~ H [] [] [] m m o u w w u ~ [] [] B m .m m u ~ D m m u ~ w[]M m [] [] [] U~mUWU []
[] [] [] [] [] [] [] O W U W W W O ~ O W O m [] [] [] [] W [] [] [] [] [] [] E E E U U E m U W U g U ~ [ ] OmOWWW~ m EWNm [] [] [] [] [] [] E U U E S m m W E O m R ImUmmE [] [] [] [] [] [] [] [] [] [] [] U [] m~mmEm m m w m[]w [] [] [][] [] [] [] | | . . m . W miW m O UWl m O W E i[]
224
interventions, in addition to receiving ICU overflow from the rest of the hospital. If they want blood and guts, we can provide it. We practice very independently, particularly in on-call situations. Most of us have good relationships with our physicians; they respect our knowledge and judgement. We provide care to every age group in a variety of hospital, free-standing, and office-based settings. And yes, there are many opportunities to advance both at the bedside through certification and through graduate education. Nurse practitioners, clinical nurse specialists, and nurse anesthetists both come from and practice in perianesthesia settings. What about our patients and the public? How do we explain to them what it is that we do? I think that we must first begin by taking credit for what we do. D o n ' t be afraid to toot your own horn. Let the patient know that you are their best link to a positive and successful surgical experience. The information that you provide preoperatively enables patients and their families to prepare both physically and emotionally for the surgical experience. That warm blanket that you provide, the hand that you hold, the encouraging words during those first moments of wakefulness provide so much support and security to our patients in the Phase I area. When at all possible, follow up with those Phase I patients so that they can put a face with the kind actions that make such an impact on their
VALLIRE D. HOOPER recovery. When discharging the patient and their family to home, let them know again that you will be the link to their successful recovery. Do your best to give patients all of the information that they will need to succeed. What is it that we do? We do so much, and we do it so well that it is often hard to explain this wonderfully varied specialty in a sentence or 2. We do need to be able to explain this specialty, however, and we need to be able to explain it in a way that makes patients feel secure, students feel interested, and administrators feel like they cannot do without us. Do you have an answer for the next time that someone asks you just what do you do? Are you just a nurse? Do you just take blood pressures? Do you just do patient teaching? Those of us in the specialty know that we do so much more. What would you say? Think about it, write it down! Share it with your friends and colleagues. Tell the world what it is that we do. Tell them what perianesthesia nursing is all about. REFERENCES 1. Thomas CL: Taber's Cyclopedia Medical Dictionary (ed 18). Philadelphia, PA, EA. Davis, 1998. Available at http:// www.taber.com.AccessedApril, 2000. 2. American Society of PeriAnesthesia Nurses. Available at http://www.aspan.org.AccessedApril, 2000 3. American Society of PeriAnesthesia Nurses: Standards of Perianesthesia Nursing Practice 1998. Thorofare, NJ, ASPAN, 1998