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Collaborative Care.docx

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NURS 287
Rick Nilson

Collaborative Care: Specific Measures Cardiogenic Shock  Overall goal is to restore blood flow to the myocardium by restoring the balance between oxygen supply and demand.  Definitive measures include thrombolytic therapy, angioplasty with stenting, emergency revascularization, and valve replacement.  Care involves hemodynamic monitoring, drug therapy (e.g., diuretics to reduce preload), and use of circulatory assist devices (e.g., intraaortic balloon pump, ventricular assist device). Hypovolemic Shock  The underlying principles of managing patients with hypovolemic shock focus on stopping the loss of fluid and restoring the circulating volume. o Fluid replacement is calculated using a 3:1 rule (3 ml of isotonic crystalloid for every 1 ml of estimated blood loss). Septic Shock  Patients in septic shock require large amounts of fluid replacement, sometimes as much as 6 to 10 L of isotonic crystalloids and 2 to 4 L of colloids, to restore perfusion.  Hemodynamic monitoring and arterial pressure monitoring are often necessary.  Vasopressor drug therapy may be added and vasopressin may be given to patients refractory to vasopressor therapy.  Intravenous corticosteroids are recommended for patients who require vasopressor therapy, despite fluid resuscitation, to maintain adequate BP.  Antibiotics are early component of therapy and are started after obtaining cultures (e.g., blood, wound exudate, urine, stool, sputu
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