Ch 11 Shock, Sepsis, & Multiple Organ Dysfunction Syndrome Flashcards
Anaphylactic shock
Distributive shock state resulting from a severe allergic reaction producing an acute systematic Vasodilation and relative hypovolemia
Cardiogenic shock
Shock state resulting from impairment or failure of the myocardium
Colloids
Intravenous solutions that contain molecules that are too large to pass through capillary membrane’s
Blood products
Crystalloids
Intervenous electrolyte solutions that move freely between the intravascular compartment and interstitial spaces
Isotonic
Hypotonic
Hypertonic
Cytokines
Messenger substances that may be released by a cell to create an action at the site or may be carried by the bloodstream to a distant site before being activated (synonyms biochemical mediators, inflammatory mediators)
Distributive shock
Shock state resulting from displacement of intravascular volume creating a relative hypovolemia and an inadequate delivery of oxygen to the cells
Hypovolemic shock
Shock state resulting from decreased intravascular volume due to fluid loss
Multiple organ dysfunction syndrome
Presence of altered function of two or more organs in an acutely ill patient such that interventions are necessary to support continued organ function
Neurogenic shock
Shock state resulting from loss of sympathetic tone causing relative hypovolemia
Sepsis
Life-threatening organ dysfunction caused by a disregulated host response to infection
Septic shock
A subset of sepsis in which underlying circulatory and cellular metabolic abnormalities are profound enough to substantially increase mortality
Shock
Life-threatening physiologic condition in which there is an inadequate blood flow to tissues and cells of the body
Systematic inflammatory response syndrome
I syndrome resulting from a clinical insult that initiates an inflammatory response that is systematic, rather than localized to the site of the insult; a type of cytokine release syndrome also referred to as cytokine storm
Compensatory Mechanisms in shock
- Initial insult leading to shock state
Decreased tissue perfusion and oxygenation
- Increased sympathetic response increased heart rate increased blood pressure increased cardiac contractibility which leads to increased cardiac output. Decreased respiratory rate to increase oxygen saturation saturation and delivery
- Rennin-angiotensin Activation, which leads to increase reabsorption of sodium and water which leads to increased preload and decreased urine output. Increased catecholamines And cortisol to provide increased glucose for metabolism
- Restoration of tissue perfusion and oxygenation
Stages of shock
- Initial
- Compensatory
- Progressive
- Irreversible 
Inotropic agents
Improve contract reality, increased stroke volume, and increased cardiac output
Increase oxygen demand of the heart
Epinephrine Alpha and beta androgenic agent stimulates sympathetic nervous system, sympathetic agent
Dobutamine Stimulate my cardio beta receptors increase his strength of myocardial activity and improves CO
Dopamine stimulates beta one adrenergic receptors resulting in increased CO, stimulates dopamine receptors resulting in vasodilation
Vasodilators
Reduce preload and afterload, reduce oxygen demand on the heart
Causes Hypotension
Nitroglycerin relaxes vascular smooth muscle resulting in decrease in preload and blood pressure
Nitroprusside increases CO by decreasing afterload and producing peripheral and systematic vasodilation
Vasopressor agents
Norepinephrine functions as a peripheral Vaso constrictor by acting on alpha adrenergic
Epinephrine Stimulates Sympathetic nervous system
Dopamine
Pathophysiology of hypovolemic shock
Decreased blood volume
Decreased venous return
Decreased stroke volume
Decreased cardiac output
Decreased tissue perfusion
Circulatory distributive) shock
Septic shock
Neurogenic shock
Anaphylactic shock
Cardiogenic shock
Coronary
Noncoronary
Pathophysiology of circulatory shock
Precipitating event
Vasodilation
Activation of inflammatory response
Maldistribution of blood volume
Decreased venous return
Decreased cardiac output
Decreased tissue perfusion
Dobutamine (Dobutrex)
Adrenergic
Used to treat heart failure
Improves contractility, increases SV, increases CO
Nursing implications monitor for adverse effects, monitor vital signs for improvement, monitor EKG for arrhythmias, intake and outtake and labs for kidney perfusion, monitor LFT for dose adjustments, monitor fluid and electrolyte, monitor IV sites, Monitor MAP, Monitor central lines

Dopamine (Inotrpin)
Vasopressor/Adrenergic
Used to treat shock
to treat the symptoms of low blood pressure, and low cardiac output and improves blood flow to the kidneys. Dopamine may be used alone or with other medications. Dopamine belongs to a class of drugs called Inotropic Agents.
Improves contractility , increases SV, increases CO
Nursing implications monitor for adverse effects, monitor vital signs for improvement, monitor EKG for arrhythmias, and taken out taken labs for kidney perfusion, monitor LFT for dose adjustments, monitor fluid and electrolyte, monitor IV site, monitor M a P, monitor central lines
Epinephrine 
Vasopressor/Adrenergic
Used to treat shock to increase blood pressure and heart contractility
Improves contractility, increases SV, increases CO
Nursing implications monitor for adverse effects, monitor vital signs for improvement, monitor EKG for arrhythmias, and taken out taken labs for kidney perfusion, monitor LFTs for dose adjustment monitor fluid and electrolytes, monitor IV site, monitor MAP, monitor central lines
Norepinephrine
Vasopressor
Used to treat shock, to treat shock during a cardiac arrest to get sympathetic activity
Increases blood pressure by vasoconstriction
Nursing implications monitor for adverse effects, monitor vital signs for improvement, monitor EKG for arrhythmias, and taken out taken labs for kidney perfusion, monitor LFT for dose adjustments monitor fluid and electrolytes, monitor IV sites, monitor MAP, monitor central lines
Positive inotropic Medication
Dobutamine
Dopamine
Vasoactive medication
Increase BP by increasing vasoconstriction
Increase afterload leading to increase cardiac workload, decreased perfusion to skin kidney lungs and GI tract
Norepinephrine functions as a peripheral vasoconstrictor
Epinephrine stimulates SNS
Dopamine
