CH 14 Shock Flashcards
second stage of shock, mechanisms that regulate BP no longer compensate, and the MAP falls below normal limits. Patients are hypotensive.
- Respirations are shallow and deep crackles can be heard.
- Tachy, could have dysrhythmias, and ischemia, CK-MB, troponin, and BNP could be increased.
- decreased LOC
- MAP falls below 70, BUN, creatinine increased.
- ALT, AST, LDH, and bilirubin are elevated
- GU ischemia causes risk of ulcers, and GI bleed.
progressive stage of shock
compensatory, progressive, and irreversible.
stages of shock
the first stage of shock in which the BP remains WNL, vasoconstriction, increased HR, and increased contractility( bc of epinephrine, and norepinephrine).
- blood is shunted from the organs such as skin, kidneys, GI to the brain, heart, and lungs to ensure adequate blood supply for vital organs.
- Patient may be cool, clammy with hypoactive bowel sounds, and decreased urine output
compensatory stage of shock
the body is typically in a state of metabolic acidosis, the respiratory system will try to compensate by removing excess co2 but usually ends up in compensatory respiratory alkalosis.
Compensatory stage of shock
a condition in which widespread perfusion to the cells is inadequate to deliver oxygen and nutrients to support vital organs and cellular function
shock
also called refractory stage of shock, it is the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.
- BP remains low.
- Renal and liver failure
- Overwhelming metabolic acidosis
- Respiratory failure
irreversible stage of shock
These measures can be taken in all types and phases of shock
- support the respiratory system with supplemental oxygen/ mechanical vent.
- fluid replacement to restore intravascular volume
- vasoactive meds to restore vasomotor tone and improve cardiac function
- nutritional support
general management strategies of shock
electrolyte solutions that move freely between intravascular and interstitial spaces. Can be used to restore fluid volume however; need more fluid with to restore volume than with a colloid.
crystalloid
large molecule IV solution
colloids
4-12 Hg
A normal right arterial pressure
the most common type of shock that is characterized by a decreased intravascular volume. Shock occurs when there is a decrease of 15%-30% or 750-1500 mL of blood.
hypovolemic shock
External fluid losses include: trauma, surgery, vomiting, diarrhea, diuresis, diabetes insipidus.
Internal fluid shifts: hemorrhage, burns, ascites, peritonitis, dehydration.
risk factors for hypovolemic shock
3: 1
- 3 mL of crystalloid solution for every 1 mL of estimated blood loss
3:1 rule
occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate( HR and SV are compromised) for the heart and tissues.
- The causes are either coronary(most often) or non coronary.
- Pt’s with an anterior wall MI are at greatest risk
Cardiogenic shock
- 2 to 6 L/min of oxygen want o2 sats above 90
- IV morphine for pain,anxiety and to dilate blood vessels
- hemodynamic monitoring
- Cardiac enzymes are monitored
- Fluid status maintained
- Vasoactive meds
inital treatment for cardiogenic shock
occurs when blood volume pools in peripheral blood vessels.
-Can be caused by a loss of sympathetic tone or by release of biochemical mediators from cells.
Three types are septic, neurogenic, and anaphylactic shock.
circulatory shock
immunosuppression extremes of age( very young and very old) malnourishment chronic illness invasive procedures diabetes
risk factors for sepsis
caused by widespread infection
sepsis
presents clinically like sepsis and is part of the initial continuum of sepsis. It is similar to sepsis except there is no identifiable source of infection.
SIRS systemic inflammatory response syndrome
vasodilation occurs as a result of a loss of balance between parasympathetic and sympathetic stimulation. Can be caused by: -spinal cord injury -spinal anesthesia -depressant action of medications -glucose deficiency
neurogenic shock
this type of shock occurs rapidly, and is life threatening. Ir occurs in patients already exposed to an antigen and who have developed antibodies to it.
Exposure to the antigen causes the mast cells to release potent vasoactive substances such as histamine or bradykinins.
anaphylactic shock
altered organ function in acutely ill patients that requires medical intervention to support continued organ function. It is another phase in the progression of shock states.
MODS multiple organ dysfunction syndrome
