Caring For Clients With Shock Flashcards by Brandie Alnobani

Four main categories of shock

Hypovolemic
Distributive
Obstructive
Cardiogenic

How well did you know this?

Not at all

Perfectly

3 subdivided parts of distributive shock

Neurogenic
Septic
Anaphylactic

How well did you know this?

Not at all

Perfectly

Most common type of shock

Hypovolemic (hemorrhagic) shock

How well did you know this?

Not at all

Perfectly

Decreased blood volume with decreased filling of the circulatory system

Hypovolemic shock

How well did you know this?

Not at all

Perfectly

Hemorrhage (frank and internal)

Example of Hypovolemic shock

How well did you know this?

Not at all

Perfectly

This shock can develop when overall fluid volume is depleted from significant bleeding, such as during surgery, after trauma or after delivery of an infant

Hypovolemic shock

How well did you know this?

Not at all

Perfectly

In this shock, the volume of extracellular fluid is significantly diminished, primarily because of lost or reduced blood or plasma

Hypovolemic shock

How well did you know this?

Not at all

Perfectly

Sometimes called normovolemic shock because the amount of fluid in the circulatory system is not reduced, yet the fluid circulation does not permit effective tissue perfusion

Distributive shock

How well did you know this?

Not at all

Perfectly

Rarest type of shock

Neurogenic

How well did you know this?

Not at all

Perfectly

Shock that results from injury that affects the vastomotor center in the medulla of the brain or to the peripheral nerves that extend from the spinal cord to the blood vessels

Neurogenic shock

How well did you know this?

Not at all

Perfectly

Injury to the spinal cord or head
Overdoses of opioids, tranquilizers or general anesthesia cause this kind of shock

Neurogenic shock

How well did you know this?

Not at all

Perfectly

In this shock the tone of the sympathetic nervous system is impaired, resulting in decreased arterial vascular resistance, vasodilation and hypotension

Neurogenic shock

How well did you know this?

Not at all

Perfectly

Example of this shock is spinal cord injury

Neurogenic shock

How well did you know this?

Not at all

Perfectly

Toxic reaction to gram negative bacterial infection

Septic shock

How well did you know this?

Not at all

Perfectly

Has the highest mortality rate of the various types of shock

Septic shock

How well did you know this?

Not at all

Perfectly

Associated with overwhelming bacterial infections

Septic shock

How well did you know this?

Not at all

Perfectly

This shock is preceded by a systemic inflammatory response syndrome (SIRS)
(An inflammatory state without a proven source of infection)

Septic shock

How well did you know this?

Not at all

Perfectly

A complication of overwhelming inflammation that results in massive cellular, tissue and organ injury

Multiple organ dysfunction syndrome
A result of septic shock & hypotension

How well did you know this?

Not at all

Perfectly

Unlike other forms of shock, clients with this shock will have an elevated leukocytes count and initially manifest a fever accompanied by warm, flushed skin & a rapid bounding pulse

Septic shock

How well did you know this?

Not at all

Perfectly

Severe allergic reaction

Anaphylactic shock

How well did you know this?

Not at all

Perfectly

Common allergic substances

Bee venom, latex, fish, nuts, penicillin (PCN)

How well did you know this?

Not at all

Perfectly

Results of this shock are vasodilation, increased capillary permeability accompanied by swelling of the airway and subcutaneous tissues, hypotension and hives or an itchy rash

Anaphylactic shock

How well did you know this?

Not at all

Perfectly

This shock occurs when there is interference with the circulation of blood into and out of the heart, compromising the volume of blood that enters and leaves the heart en route to the lungs and tissues

Obstructive shock

How well did you know this?

Not at all

Perfectly

Any condition that fills the thoracic cavity with fluid, air, or tissues can lead to this shock

Obstructive shock

How well did you know this?

Not at all

Perfectly

Impaired filling of heart with blood due to mechanical impediment

Obstructive shock

Examples of this shock is Cardiac tamponade Dissecting aneurysm Tension pneumothorax

Obstructive shock

Decreased force of VENTRICULAR CONTRACTION leading to inadequate intravascular volume and tissue hypoxia

Cardiogenic shock

Myocardial infarction is an example of this shock

Cardiogenic shock

Heart contraction is ineffective, which reduces cardiac output in this shock

Cardiogenic shock

Cardiac output is the volume of blood ejected from the ____ ventricle per minute

Left

Leading cause of Cardiogenic shock

Myocardial infarction with subsequent heart failure

First stage of shock, during which several physiologic mechanisms attempt to stabilize the spiraling consequences

Compensation stage

If physiologic mechanisms are successful in the compensation stage _______ may be achieved

Homeostatic stability

Neurotransmitters that stimulate responses via the sympathetic nervous system

Catecholamines

A mechanism that restores blood pressure when circulating volume is diminished

Renin-angiotensin-aldosterone system

Low blood volume stimulates the pituitary to secrete

Antidiuretic hormone (ADH)

Promotes reabsorption of water that the kidneys would ordinarily excrete

ADH antidiuretic hormone

ADH is also known as

Vasopressin and andernocorticotropic hormone (ACTH)

Stimulates the adrenal glands to secrete corticosteroid hormones, which include glucocorticoids and mineralocorticoids

ACTH

play an active role in controlling sodium and water balance

ACTH Glucocorticoids Mineralocorticoids

These hormones promote fluid reabsorption and retention

ADH Corticosteroids

Stage that occurs as compensatory mechanisms fail.

Decompensation stage

In the decompensation stage the clients condition spiral into

Cellular hypoxia, coagulation defects and cardiovascular changes

Decreased oxygen reaching the cells

Hypoxia

As energy supply falls below the demand, these two acids increase, causing metabolic acidosis

Pyruvic and lactic acids

Decompensation stage equals

Metabolic acidosis

Blood pooling equals

Clots

Clots compromise ____ to deliver oxygen throughout the body

RBC

____ administered ____ in ____ for severe septic shock

Heprin Subcutaneous Abdomen

As cells become damaged, an ___response ensues

Inflammatory

In a coagulation defect, platelets become ___ and accumulate in the blood vessels of the volume depleted client

Sticky

Impaired ___ cells cannot maintain sufficient heart rate and force of contraction to circulate blood efficiently

Myocardial

In cardiovascular changes, ___ cells in the medulla can no longer sustain the stimulus for vasoconstriction

Brain

Stage when significant cells and organs become damaged. Clients condition reaches the point of no return

Irreversible stage

Client no longer responds to medical interventions. Multiple systems being to fail. Kidneys, heart, lungs, liver and brain cease to function

Irreversible stage

Critical assessment of client with shock SATA (5)

Vital signs LOL (changes in mentation) Skin Urine output Pulses

Early signs and symptoms are evident during this stage

Decompensation stage

This symptoms is particularly evident in the early signs and symptoms in the decompensation stage

Drops in BP

Numeric difference between systolic and diastolic BP

Pulse pressure

If a client has a BP of 120/80 the pulse pressure is

40 mm Hg

Health care personnel use the ___ and other assessment data to identify the severity of shock and estimate the approximate reduction in blood volume

Pulse rate

As cardiac output decreases, ___ ___ initially develops to increase cardiac output

Compensatory tachycardia

In neurogenic shock ___ occurs because there is a loss of compensatory sympathetic nervous system response

Bradycardia

In this shock, pulse volume becomes weak and thrash as circulating volume diminishes, in later stages the pulse may be slow and imperceptible. Pulse rhythm may change from regular to irregular

Neurogenic shock

In early stages the client is __, but in profound shock, as death nears, the respiratory rate__

Hungry for air Decreases

With exception of septic shock, ___ temperature is characteristic

Subnormal

___ is often the first sign of inadequate oxygen delivery to the tissues

Altered cerebral function

Mild ___, increasing ___, agitation and ____ can accompany shock. As the condition deteriorates, the client becomes ___ and ___ ultimately loosing consciousness

Anxiety Restlessness Confusing Listless Stuporous

__ may be administer to decrease anxiety and pain

Morphine

In clients with ___, cyanosis is more accurately detected by inspecting the ___ and __

Highly pigmented skin (African American) Conjunctiva Oral mucous membranes

Decreased cardiac output equals

Decreased urine output

Continued ____ indicates renal damage caused by reduced blood flow to the kidneys

Oliguria

ABG specimens are drawn from a direct ___ Or indwelling ___

Arterial puncture Arterial catheter

Measures the amount of oxygen bound to hemoglobin, or the saturated oxygen

Pulse oximeter

Normal oxygen saturation

95-100%

If spO2 level is about 90% it can be assumed that the PaO2 is

60mm Hg

CVP is the pressure of the blood in the ____

Right atrium or venae cavae

Fluid pressures in the ___ side of the heart is more meaningful

Left

Ratio followed to restore inteavascular volume via IV

3:1 3L of fluid administered for every 1L of fluid lost

Solutions used to increase osmotic pressure

Sodium, other electrolytes, glucose in water, colloid solution containing protein (albumin)

Measures to conserve blood & its oxygen carrying capacity (SATA) (4)

Draw minimum for lab analysis Reinfusing clients own blood collected in a closed circuit cell saver Administering erythropietin to stimulate bone marrow to manufacture RBCs Administering cryoprecipitate, factor VIII and thrombin to promote hemostasis

Main medications to used to treat shock

Andrenergic drugs

Drugs with alpha-andrenergic activity, increase peripheral vascular resistance and raise BP

Vasopressors

Two examples of vasopressors

Dopamine (Intropin) Norepinephrine (levophed)

If infusions of first line vasopressors such as dopamine and norepinephrine become ineffective, __ may be used

Vasopressin

Also know as ADH, causes contraction of arterial smooth muscle, raises BP and diverts blood to vital organs

Vasopressin

Drugs with beta-andreneric activity that increase heart rate and improve the force of the heart contraction are

Positive inotrooic agents

What med is a positive inotropic agent

Digoxin (Lanoxin)

Elevated WBC count supports which shock

Septic

Dyspnea or airway obstruction resulting from edema accompanies which shock

Anaphylactic

Low RBC count and hemoglobin correlate with which shock

Hypovolemic shock

ABG findings is essential for evidence of ___ and ___

Hypoxemia Metabolic acidosis