Caring For Clients With Shock Flashcards
Four main categories of shock
Hypovolemic
Distributive
Obstructive
Cardiogenic
3 subdivided parts of distributive shock
Neurogenic
Septic
Anaphylactic
Most common type of shock
Hypovolemic (hemorrhagic) shock
Decreased blood volume with decreased filling of the circulatory system
Hypovolemic shock
Hemorrhage (frank and internal)
Example of Hypovolemic shock
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
In this shock, the volume of extracellular fluid is significantly diminished, primarily because of lost or reduced blood or plasma
Hypovolemic shock
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
Rarest type of shock
Neurogenic
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
Injury to the spinal cord or head
Overdoses of opioids, tranquilizers or general anesthesia cause this kind of shock
Neurogenic shock
In this shock the tone of the sympathetic nervous system is impaired, resulting in decreased arterial vascular resistance, vasodilation and hypotension
Neurogenic shock
Example of this shock is spinal cord injury
Neurogenic shock
Toxic reaction to gram negative bacterial infection
Septic shock
Has the highest mortality rate of the various types of shock
Septic shock
Associated with overwhelming bacterial infections
Septic shock
This shock is preceded by a systemic inflammatory response syndrome (SIRS)
(An inflammatory state without a proven source of infection)
Septic shock
A complication of overwhelming inflammation that results in massive cellular, tissue and organ injury
Multiple organ dysfunction syndrome
A result of septic shock & hypotension
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
Severe allergic reaction
Anaphylactic shock
Common allergic substances
Bee venom, latex, fish, nuts, penicillin (PCN)
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
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
Any condition that fills the thoracic cavity with fluid, air, or tissues can lead to this shock
Obstructive shock
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
