Page 2495 - Saunders Comprehensive Review For NCLEX-RN

g. Whole blood is effective but is not used
often as a treatment measure because
of the risk of transfusion reactions.
h. Administration of medications is
withheld until circulating volume has
been restored.
i. The primary goal for medication
therapy with shock is to improve
tissue perfusion.
j. Medications used to improve perfusion
in shock are administered
intravenously via an infusion pump
and often via a central line.

k. It is important to note that if the

shock state is cardiogenic in nature, the
infusion of volume-expanding fluids
may result in pulmonary edema;
therefore, restoration of cardiac
function is the priority for this type of
shock. Cardiotonic medications such as
digoxin, dopamine, or norepinephrine
may be administered to increase
cardiac contractility and induce
vasoconstriction.
l. Once improvement of perfusion is
achieved, interventions are then
directed toward the underlying cause
of the condition.
B. Sepsis
1. A group of symptoms or syndrome in response to an
infection that can include organ dysfunction related to
the infection.
2. The main causative organisms are gram-negative and
gram-positive bacteria; however, sepsis can also result
from viral, fungal, and parasitic infections.
3. Sepsis diagnostic criteria (Box 69-27)
C. Septic shock
1. Signs and symptoms include persistent hypotension
despite adequate fluid resuscitation requiring
vasopressors, along with decreased tissue perfusion
that progresses to tissue hypoxia.
2. In both sepsis and septic shock, the body’s immune
response to an invading microorganism is
exaggerated, resulting in the activation of
proinflammatory and antiinflammatory responses
and coagulation abnormalities.
a. Increased coagulation and decreased

2495