care of patient in acute biologic crisis

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CARE OF CLIENT IN ACUTE BIOLOGIC CRISIS

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Page 1: Care of Patient in Acute Biologic Crisis

CARE OF CLIENT IN ACUTE BIOLOGIC

CRISIS

Page 2: Care of Patient in Acute Biologic Crisis

OBJECTIVESGiven relevant questions, the students will be able to discuss

triage and principles in emergency nursing care.1. identify clinical situations where the client is in acute biologic

crisis2. distinguish acute biologic crisis situations in terms of:

a. etiologic factorsb. pathophysiologyc. clinical manifestations and laboratory examsd. complicationse. emergency treatment/management

3. Given a list of emergency drugs, the students will be able to:4. match these drugs with their corresponding actions and

therapeutic uses5. list common side effects and adverse reactions6. enumerate dosage and dosage administration

Page 3: Care of Patient in Acute Biologic Crisis

OBJECTIVES

7. determine/identify health care problems based on:a. health historyb. physical examinationc. laboratory examinations

8.Formulate relevant nursing diagnosis9. Discuss/demonstrate appropriate nursing

interventions10. Evaluate outcome of health care11. Verbalize appreciation on the influence of

Christian values in health care

Page 4: Care of Patient in Acute Biologic Crisis

DEFINITION

Emergency Management – refers to care given to patients with urgent and critical needs. However, because many people lack access to health care, the emergency department is increasingly used for non-urgent problems. Therefore, the philosophy of emergency management has broadened to include the concept that an emergency is whatever the patient or the family considers it to be.

Page 5: Care of Patient in Acute Biologic Crisis

Scope and Practice of Emergency Nursing

1. The emergency nurse has had specialized education, training, experience, and expertise in assessing and identifying patient’s health care problems in crisis situations.

2. The emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families, supervises allied health personnel, and teaches patients and families within a time-limited, high-pressured care environment

Page 6: Care of Patient in Acute Biologic Crisis

3. Nursing interventions are accomplished interdependently, in consultation with or under the direction of a physician or nurse practitioner. The strengths of medicine and nursing are complementary in an emergency situation. Appropriate nursing and medical interventions are anticipated based on assessment data. The emergency health care staff members work as a team in performing the highly technical hands-on skills required to care for patients in emergency situations.

4. Patients in the ER have a wide variety of actual or potential problems, and their condition may change constantly. Therefore, nursing assessment must be continuous, and nursing diagnoses change with the patient’s condition. Although a patient may have several diagnoses at a given time, the focus is on the most life-threatening ones; often both independent and interdependent nursing interventions are required.

Page 7: Care of Patient in Acute Biologic Crisis

Issues in Emergency Nursing Care

1. Documentation of Consent and Privacy2. Limiting Exposure to Health Risks3. Violence in the Emergency Department

a. Safety is the first priority. Safety is the first priority. Protection of the department provides protection for the patients, families, and staff.

b. Metal detectors, silent alarm systems, and secured entry into the department assists in maintaining safety.

c. Members of gangs and feuding families need to be separated in the ER, waiting room and later in the ward to avoid angry confrontations

d. Security personnel should be ready to assist at all times. The ER should be able to be locked against entry if security is at all in question.

Page 8: Care of Patient in Acute Biologic Crisis

Issues in Emergency Nursing Care

e. Patients from prison and those who are under guard need to be handcuffed to the bed and appropriately assessed to ensure the safety of the hospital staff and other patients.

e.1. never release the hand or ankle restraint (handcuff)e.2. always have a guard present in the room.e.3 place the patient face down on the stretcher to avoid injury from head-butting, spitting, or biting.e.4 use restraints on any violent patient as needed.e.5. administer medication if necessary to control violent behavior until definitive treatment can be obtained.f. In the case of gunfire in the ER, self-protection is a priority. There is no advantage to protecting others if the caregivers are also injured. Security officers and police must gain control of the situation first, and then care is provided to the others.

Page 9: Care of Patient in Acute Biologic Crisis

Issues in Emergency Nursing Care

4. Providing Holistic Care a. patient-focused interventions

☻ the unconscious patient should be treated as if conscious; that is, the patient should be touched, called by name, and given an explanation of every procedure that is performed.

b. Family-focused interventions

☻ The family is kept informed about where the patient is, how he/she is doing, and the care that is being given. Allowing the family to stay with the patient, when possible also helps allay their anxieties

Page 10: Care of Patient in Acute Biologic Crisis

Guidelines in Helping Family Members Cope with Sudden Death

1. Take the family to a private place.2. Talk to the family together, so that they can mourn

together.3. Reassure the family that everything possible was done;

inform them of the treatment rendered.4. Avoid using euphemisms such as “passed on”. Show the

family that you care by touching, offering coffee, water, and the services of the chaplain.

5. Encourage family members to support each other and to express emotions freely (grief, loss, anger, helplessness, tears, disbelief).

Page 11: Care of Patient in Acute Biologic Crisis

6. Avoid giving sedation to family members; this may mask or delay the grieving process, which is necessary to achieve emotional equilibrium and to prevent prolonged depression.

7. Encourage the family to view the body if they wish; this action helps to integrate the loss. Cover disfigured and injured areas before the family sees the body. Go with the family to see the body. Show acceptance by touching the body to give the family “permission” to touch.

8. Spend time with the family members to talk about the deceased and what he/she meant to them; this permits ventilation of feelings of loss. Encourage the family to talk about events preceding admission to the ER. Do not challenge initial feelings of anger and denial.

9. Avoid volunteering unnecessary information (e.g., the patient was drinking)

Page 12: Care of Patient in Acute Biologic Crisis

Principles of Emergency Care

☻ By definition, emergency care is care that emergency care is care that must be rendered without delay. must be rendered without delay. In an ER, several patients with diverse health problems-some life threatening, some not – may present to the ED simultaneously. One of the first principles of emergency care is triage.

TRIAGE – comes from the French word “trier”, meaning “to sort”. In the daily routine of the ER, triage is used to sort patients into groups based on the severity of their health problems and the immediacy with which these problems must be treated.

Page 13: Care of Patient in Acute Biologic Crisis

Systems

Categories1. Emergent – patients have the highest priority – their

conditions are life-threatening and they must be seen immediately.

2. Urgent – patients have serious health problems but not immediately life-threatening ones; they must be seen within 1 hour.

3. Nonurgent – patients have episodic illnesses that can be addressed within 24 hours without increased morbidity.

4. Fast Track – patients require simple first aid or basic primary care and may be treated in the ER or safely referred to a clinic or physician’s office

Page 14: Care of Patient in Acute Biologic Crisis

Triage Systems Levels1. Resuscitation – patients need treatment immediately to prevent

death.2. Emergent - patients may deteriorate rapidly and develop a major

life threatening situation or require time-sensitive treatment.3. Urgent – Patients have non-life threatening conditions but require

two or more resources to provide their care. If the patients’ vital signs deviate significantly from their baseline, they may require “up-triaging” to the emergent category.

4. Nonurgent- patients have non-life threatening conditions and likely need only one resource to provide for their needs.

5. Minor category – patients have no life-threatening conditions and likely require no resources to provide their evaluation and management.

☻ Resources are defined as imaging studies, medications administered IV or IM routes, and invasive procedures. Insertion of an indwelling catheter is an example of a one-resource procedure. Moderate sedation would be classified as a two-resource procedure because this requires frequent monitoring and IV medications.

Page 15: Care of Patient in Acute Biologic Crisis

QUESTIONS - ER

The following questions reflect the minimum information that should be obtained from the patient or from the person who accompanied the patient to the ER:

1. What were the circumstances, precipitating events, location and time of the injury or illness?

2. When did the symptoms appear?3. Was the patient unconscious after the injury or onset of

illness?4. How did the patient get to the ER?5. What was the health status of the patient before the injury or

illness?6. Is there a history of medical illness or previous surgeries? A

history of admissions to the hospital?

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7. Is the patient currently taking any medications, especially hormones, insulin, digitalis or anticoagulants?

8. Does the patient have any allergies, especially to eggs, latex, medications, or nuts?

9. Does the patient have any fears? Does the patient feel that he or she is in a situation in which he/she is unsafe?

10. When was the last meal eaten?11. When was the LMP?12. Is the patient under a physician’s care? What

are the name and location of the physician?13. What was the date of the patent’s most recent

tetanus immunization?

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Assess and Intervene☻ A systematic approach to effectively establish and treat

health priorities is the primary / secondary approach. The primary survey focuses on stabilizing life-threatening conditions. The ER staff work collaboratively and follow the ABCD (airway, breathing, circulation, disability method:

1. Establish a patent airway.2. Provide adequate ventilation, employing resuscitation

measures when necessary. (trauma patients must have the cervical spine protected and chest injuries assessed first).

3. Evaluate and restore cardiac output by controlling hemorrhage, preventing and treating shock, and maintaining or restoring effective circulation. This includes the prevention and management of hypothermia.

4. Determine neurologic disability by assessing neurologic function using the Glasgow Coma Scale.

Page 18: Care of Patient in Acute Biologic Crisis

Secondary Survey

☻ After these priorities have been addressed, the ER team proceeds with the secondary survey. This includes the following:

1. A complete health history and head-to-toe assessment2. Diagnostic and laboratory testing3. Insertion or application of monitoring devices such as

ECG electrodes, arterial lines, or urinary catheters.4. Splinting of suspected fractures5. Cleansing, closure, and dressing of wounds6. Performance of other necessary interventions based on

the patient’s condition.

Page 19: Care of Patient in Acute Biologic Crisis

SHOCK

☻ Is a syndrome in which the circulation or perfusion of blood is inadequate to meet tissue metabolic demands. Cellular anoxia will ensue and lead to tissue death unless the process is reversed.

☻During shock, the body struggles to survive, calling on all its homeostatic mechanism to restore blood flow

Page 20: Care of Patient in Acute Biologic Crisis

Classifications of Shock

1. Hypovolemic shock – refers to a state in which the volume contained within the intravascular compartment is inadequate for perfusion of body tissue. There is usually a 15%-25% reduction of intravascular volume.e.g., hemorrhagic shock – loss of whole blood about 1/3 of his normal blood volume

2. Cardiogenic shock – which occurs when the heart has an impaired pumping ability; it may be of coronary or noncoronary event origin.

3. Septic shock- which is caused by an infection4. Neurogenic shock- which is caused by alterations in vascular

smooth muscle tone, caused by either nervous system injury or complications associated with medications such as epidural anesthesia.

5. Anaphylactic shock – which is caused by hypersensitivity reaction.

Page 21: Care of Patient in Acute Biologic Crisis

Stages of Shock

1. Compensatory stage – the BP remains normal.– Vasoconstriction , increased HR, and

increased contractility of the heart – stimulation of the SNS and subsequent

release of cathecolamines. – The body shunts blood from organs to the

brain and heart

Page 22: Care of Patient in Acute Biologic Crisis
Page 23: Care of Patient in Acute Biologic Crisis

Compensatory Mechanism in Shock

Initial physiologic insult to shock state

Decrease in CO and tissue perfusion

SNS activation

Endocrine response

RAA activationVasoconstriction and activation of ADH - ↑ Preload

↑ BP, HR, and Myocardial contractility Renal system conserves Na and H2O -↑ Preload

↑ vascular compliance, blood volume and CO

Restoration of tissue perfusion

Page 24: Care of Patient in Acute Biologic Crisis

Medical Management

1. identifying the cause of the shock, correcting the underlying disorder so that shock does not progress, and supporting those physiologic processes that thus far have responded successfully to threat.

2. Fluid replacement and medication therapy must be initiated to maintain an adequate BP and reestablish and maintain adequate tissue perfusion.

Page 25: Care of Patient in Acute Biologic Crisis

Nursing Management

1. Monitoring Tissue Perfusiona.assess the patient at risk for shock systematically to

recognize the subtle clinical manifestations of the compensatory stage before the patient’s BP drops

b. Observe for changes in LOC, VS, urinary output, skin and laboratory values

c. Administer prescribed fluids and medications.

2. Reducing anxietya. provide brief explanations about the diagnostic and

treatment proceduresb. Speaking in a calm, reassuring voice and using

gentle touch also help ease the patient’s concerns.

3. . Promoting safety

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2. Progressive Stage – the mechanisms that regulate BP can

no longer compensate

– MAP (mean arterial pressure) falls below normal limits.

– Patients are clinically hypotensive; this is defined as a SBP of <90mmHg or a decrease in SBP of 40mmHg.

Page 27: Care of Patient in Acute Biologic Crisis
Page 28: Care of Patient in Acute Biologic Crisis

Assessment and Diagnostic Findings

1. Respiratory Effects– decompensation of the lungs increases the

likelihood that mechanical ventilation will be needed.– Respirations are rapid and shallow; crackles are

heard over the lung fields.– Decreased pulmonary blood flow causes arteriolar

O2 levels to decrease and CO2 levels to increase.– The hypoperfused alveoli stop producing surfactant

and subsequently collapse.– Pulmonary capillaries begin to leak, spilling their

contents, thus causing pulmonary edema, diffusion abnormalities (shunting), and additional alveolar collapse.

Page 29: Care of Patient in Acute Biologic Crisis

Assessment and Diagnostic Findings

2. Cardiovascular Effect - ischemia and dysrhythmia due to lack of adequate blood supply, the HR is rapid, sometimes exceeding 150 bpm. The patient may complain of chest pain and even suffer a myocardial infarction.

• Levels of cardiac enzymes increase.• myocardial depression and ventricular dilation may further impair

the heart’s ability to pump enough blood to the tissues to meet oxygen requirements.

3. Neurologic Effects- mental status deteriorates and occur with decreased tissue perfusion and hypoxia. Initially, patient may exhibit a subtle change in behavior or agitation and confusion. Subsequently, lethargy increases, and the patient begins to lose consciousness.

Page 30: Care of Patient in Acute Biologic Crisis

Assessment and Diagnostic Findings

3. Hepatic effects – decreased blood flow to the liver impairs the ability of the liver cells to perform metabolic and phagocytic functions. The patient is less able to metabolize medications and metabolic waste products, such as ammonia and lactic acid.

☻ Metabolic activities of the liver (gluconeogenesis and glycogenolysis) are impaired. The patients become more susceptible to infection as the liver fails to filter bacteria from the blood.

☻ Liver enzymes and bilirubin levels are elevated and the patient appears jaundiced.

4. Renal Effects – GFR decreases. ARF may develop (increased BUN, crea), fluid and electrolytes shift, acid-base imbalances and a loss of renal-hormonal regulation of BP.

Page 31: Care of Patient in Acute Biologic Crisis

Assessment and Diagnostic Findings

5. GI effects – can cause stress ulcers in the stomach, putting the patient at risk for GI bleeding. In the small intestine, the mucosa can become necrotic and slough off, causing bloody diarrhea.

6. Hematologic Effects – the combination of hypotension, sluggish blood flow, metabolic acidosis, coagulation system imbalance, and generalized hypoxemia can interfere with normal hemostatic mechanism.

Page 32: Care of Patient in Acute Biologic Crisis

Medical Management

☻ Will depend on the specific type of shock and its underlying cause. It also depends on the degree of decompensation in the organ system

1. optimizing intravascular volume2. supporting the pumping action of the heart3. improving the competence of the vascular system4. supporting the respiratory system5.Early enteral nutritional support, aggressive

hyperglycemic control with IV insulin and use of antacids, H2 receptor blockers or antipeptic agents to reduce the risk of GI ulceration and bleeding.

Page 33: Care of Patient in Acute Biologic Crisis

Nursing Management

1. Preventing complicationsa. monitor the patient for early signs of complications. It

includes evaluating blood levels of medications, observing invasive vascular lines for signs of infection, and checking neurovascular status if arterial lines are inserted.

b. frequent oral care, aseptic suction technique, turning, and elevating the head of the bed to prevent aspiration.

c. positioning and repositioning of the patient to promote comfort and maintain skin integrity.

2. Promoting Rest and comfort to minimize the cardiac workload.

3. Supporting family members

Page 34: Care of Patient in Acute Biologic Crisis

3. Irreversible (refractory) Stage – represents the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive

Medical Management:☻ Is usually the same as for the progressive

stage. Strategies that may be experimental may be tried to reduce or reverse the severity of shock.

Page 35: Care of Patient in Acute Biologic Crisis
Page 36: Care of Patient in Acute Biologic Crisis

Nursing Management1. carry out prescribed treatments, monitoring the patient,

preventing complications, protecting the patient from injury, and providing comfort.

2. Offer brief explanations to the patient about what is happening is essential even if there is no certainty that the patient hears or understands what is being said.

3. Simple comfort measures, including reassuring touches, should continue to be provided despite the patient’s nonresponsiveness to verbal stimuli.

4. As it becomes obvious that the patient is unlikely to survive, the family must be informed about the prognosis and likely outcome.

5. Opportunities should be provided, throughout the patient’s care, for the family to see, touch, and talk to the patient.

6. Close family friends or spiritual advisors may be of comfort to the family members in dealing with the inevitable death of their loved one.

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Overall Management Strategies in Shock

1. Fluid replacement to restore intravascular tone

Crystalloid • NSS• LRs

Colloid Solutions• Dextran

Page 38: Care of Patient in Acute Biologic Crisis

Overall Management Strategies in Shock

Complications of Fluid Administration☻ The most common and serious side effects of fluid

replacement are cardiovascular overload and cardiovascular overload and pulmonary edemapulmonary edema.

Management:1. Monitor frequently the urine output, changes in mental status, skin

perfusion, and changes in vital signs.2. Lung sounds are auscultated frequently to detect signs fluid

accumulation. Adventitious lung sounds, such as crackles may indicate pulmonary edema.

3. A CVP may be inserted to monitor the patient’s response to fluid replacement.

4. Vasoactive medications to restore vasomotor tone and improve cardiac function.

5. Nutritional support to address the metabolic requirements that are often dramatically increased in shock. Patient in shock may require 3000 calories daily. The release of catecholamines early in shock continuum causes depletion of glycogen stores in about 8-10 hours.

Page 39: Care of Patient in Acute Biologic Crisis

HYPOVOLEMIC SHOCK

☻ Is the most common type of shock and is characterized by a decreased intravascular volume. Body fluids is contained in intracellular and extracellular compartments. Intracellular fluids account for about 2/3 of the total body water. Hypovolemic shock occurs when there is a reduction in intracellular volume by 15%-25%, which represents a loss of 750 – 1300 ml of blood in a 70-kg person.

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Risk Factors for Hypovolemic Shock

A. External: Fluid Losses B. Internal: Fluid Shifts

1. Trauma 1. Hemorrhage

2. Surgery 2. Burns

3. Vomiting 3. Ascites

4. Diarrhea 4. Peritonitis

5. Diuresis 5. Dehydration

6. Diabetes Insipidus

Page 41: Care of Patient in Acute Biologic Crisis

Medical ManagementGoals:

1. restore intravascular volume to reverse the sequence of events leading to inadequate tissue perfusion

2. redistribute fluid volume 3. correct the underlying cause of the fluid loss

as quickly as possible.

Page 42: Care of Patient in Acute Biologic Crisis

Hypovolemic Shock Interventions:1. Treatment of the underlying cause

a. If hemorrhaging, applying pressure to the bleeding site or surgery to stop bleeding.

b. If due to diarrhea or vomiting, medications to treat diarrhea and vomiting are administered while efforts are made to identify and treat the cause

2. Fluid and Blood replacement 3. Redistribution of fluid4. Pharmacologic therapy

Page 43: Care of Patient in Acute Biologic Crisis

Nursing Management

1. Administering blood and Fluid safely

2. Implementing other measuresa. oxygen is administered to increase the

amount of oxygen carried by available hemoglobin in the blood.

b. The nurse must direct efforts to the safety and comfort of the patient.

Page 44: Care of Patient in Acute Biologic Crisis

CARDIOGENIC SHOCK

☻Occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues

Types:1. Coronary cardiogenic shock – occurs when a significant

amount of the left ventricular myocardium has been damaged.

2. Noncoronary cardiogenic shock – are related to conditions that stress the myocardium (e.g., severe hypoxemia, acidosis, hypoglycemia, hypocalcemia, and tension pneumothorax) as well as conditions that result in ineffective myocardial function (e.g., cardiomyopathies, valvular damage, cardiac tamponade, dysrhythmias)

Page 45: Care of Patient in Acute Biologic Crisis

Pathophysiology

Decreased cardiac contractility

Decreased stroke volume and cardiac output

Pulmonary congestion Decreased systemic tissue perfusion decreased coronary artery perfusion

Clinical Manifestations: Patients in cardiogenic shock may experience the pain of angina and develop dysrhythmias and hemodynamic instability.

Page 46: Care of Patient in Acute Biologic Crisis

Medical Management1. Correction of underlying causea. In the case of coronary cardiogenic shock, the patient may require thrombolytic

therapy, angioplasty, CABG, intra-aortic balloon pump therapy, or some combination of these treatments.

b. In the case of noncoronary cardiogenic shock, interventions focus on correcting the underlying cause, such as replacement of a faulty cardiac valve, correction of dysrhythmias, correction of acidosis and electrolyte disturbances, or treatment of the tension pneumothorax.

2. Initiation of First-Line treatmenta. supplying supplemental oxygenb. controlling chest painc. providing selected fluid supportd. administering vasoactive medicationse. controlling HR with medication or by implementation of a transthoracic IV

pacemaker.

3. Oxygenation via nasal cannula at 2-6 lpm4. Pain control – IV morphine sulfate.6. Laboratory marker monitoring (cardiac enzymes)

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Nursing Management

1. Preventing cardiogenic shocka. conserve patient’s energyb. restore adequate cardiac function and tissue

perfusion2. Monitoring hemodynamic status:

a. arterial linesb. ECGc. Cardiac, pulmonary and laboratory values

3. Administering medications and IV Fluids4. Maintaining Intra-aortic balloon counterpulsation5. Enhancing safety and comfort

Page 48: Care of Patient in Acute Biologic Crisis

CIRCULATORY SHOCK

☻Occurs when blood volume is abnormally displaced in the vasculature (e.g., when blood pools in peripheral blood vessels). Circulatory shock can be caused either by a loss of sympathetic tone or by release of biochemical mediators from cells.

Classifications:1. Septic shock2. Neurogenic shock3. Anaphylactic shock

Page 49: Care of Patient in Acute Biologic Crisis

PathophysiologyPrecipitating event

Vasodilation

Activation of inflammatory response

Misdistribution of blood volume

Decreased venous return

Decreased cardiac output

Decreased tissue perfusion

Page 50: Care of Patient in Acute Biologic Crisis

Risk Factors for Circulatory Shock

1. Septic Shock a. Immunosuppression

b. Extremes of age (< 1 yr and > 65 yr) c. Malnourishment d. Chronic illness e. Invasive procedures 2. Neurogenic Shock a. Spinal cord injury b. Spinal anesthesia c. Depressant action of medications d. Glucose deficiency 3. Anaphylactic Shock a. Penicillin sensitivity b. Transfusion reaction c. Bee sting allergy d. Latex sensitivity e. Severe allergy to some foods or medications

Page 51: Care of Patient in Acute Biologic Crisis

Septic ShockSeptic Shock: shock associated with sepsis; characterized by

symptoms of sepsis plus hypotension and hypoperfusion despite adequate fluid volume replacement

Medical Management:1. Identification of the cause of infection. Specimens of blood, sputum,

urine, wound drainage, and tips of invasive catheters are collected for culture using aseptic technique.

2. Any potential source must be eliminated. IV lines are removed and reinserted at other body sites. Antibiotic-coated IV central lines may be inserted to decrease the risk of invasive line-related bacteremia in high risk patients, such as elderly.

3. Fluid replacement must be instituted to correct the hypovolemia that results from incompetent vasculature and the inflammatory response.

4. Pharmacologic therapy.5. Nutritional therapy

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Nursing Management

1. All invasive procedures must be carried out with aseptic technique.

2. Monitor patient for signs of infection.3. Administer prescribed IV fluids and medications,

including antibiotic agents and vasoactive medications to restore vascular volume.

4. Laboratory values must be monitored.5. Monitor hemodynamic status

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Neurogenic Shock

☻vasodilation occurs as a result of a loss of balance between parasympathetic and sympathetic stimulation. The patient experiences a predominant parasympathetic stimulation that causes vasodilation lasting for an extended period leading to a relative hypovolemic state. However, blood volume is adequate, because the vasculature is dilated; the blood volume is displaced, producing hypotensive state resulting to a drastic decrease in the patient’s systemic vascular resistance and bradycardia. Inadequate BP results in the insufficient perfusion of tissues and cells.

Causes:1. Spinal cord injury, spinal anesthesia, or nervous system

damage.2. Depressant effect of medications or from lack of glucose.

Page 54: Care of Patient in Acute Biologic Crisis

Medical Management

1. restoring sympathetic tone, either through stabilization of a spinal cord injury or, in the instance of spinal anesthesia, by positioning the patient properly.

2. If hypoglycemia is the cause, glucose is rapidly administered

Page 55: Care of Patient in Acute Biologic Crisis

Nursing Management1. Elevate and maintain the head of the bed elevated at least 30

degrees to prevent neurogenic shock when a patient receives spinal or epidural anesthesia. Elevation of the head helps prevent the spread of the anesthetic agent up to the spinal cord.

2. In suspected spinal cord injury, neurogenic shock may be prevented by carefully immobilizing the patient to prevent further damage to the spinal cord.

3. Support CV and neurologic function until the usually transient episode of neurogenic shock resolves. Applying elastic compression stockings and elevating the foot of the bed may minimize the pooling of blood in the legs

4. Administration of heparin or LMWH (Lovenox) as prescribed, application of elastic compression stockings, or use of pneumatic compression of the legs may prevent thrombus formation.

5. Passive ROM of the immobile extremities helps promote circulation.

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Anaphylactic Shock

☻ occurs rapidly and is life-threatening. Because anaphylactic shock occurs in patients already exposed to an antigen and who have developed antibodies to it, it can often be prevented

☻It is caused by a severe allergic reaction when patients who have already produced antibodies to a foreign substance (antigen) develop a systemic antigen-antibody reaction.

Page 57: Care of Patient in Acute Biologic Crisis

Medical Management1. removal of the causative antigen2. Epinephrine is given for its vasoconstrictive effect.3. Diphenhydramine (Benadryl) is administered to reverse the

effects of histamine, thereby reducing capillary permeability.4. Nebulized medications such as albuterol (Proventil), may be

given to reverse histamine-induced bronchospasm.5. If cardiac and respiratory arrests are imminent or have occurred,

CPR is performed. Endotracheal intubation or tracheotomy may be necessary to establish an airway.

6. IV lines are inserted to provide access for administering fluids and medications.

Nursing Management:• assess patient for allergies or previous reactions to antigens (e.g.,

medications, blood products, foods, contrast agents, latex) and communicate the existence of allergies or reactions to others.

Page 58: Care of Patient in Acute Biologic Crisis