Chapter 37: Hemodynamic Shock Flashcards
Shock is a _______ progressing life-threatening process. Early detection with rapid response is necessary to improve client outcome.
rapidly
_____ is a state of inadequate tissue perfusion that impairs cellular function and can lead to organ failure.
Shock
Any condition that compromises _____ delivery to organs and tissues can lead to shock.
oxygen
Older adult clients can have reduced compensatory mechanisms and rapidly progress through the _____ of shock.
stages
________ secretions might not improve cardiac contractility or cause vasoconstriction as in younger adults due to decreased baroreceptor response.
Catecholamine
Decreased ability to compensate can cause sustained low ______ and blood pressure.
cardiac output
The type of shock is ______ by its underlying cause.
identitifed
______ shock is the failure of the heart to pump effectively due to a cardiac factor.
Cardiogenic
_______ shock occurs when a decrease in intravascular volume of at least 15% to 30%.
Hypovolemic
_________ shock is impairment of the heart to pump effectively as a result of a noncardiac factor.
Obstructive
______ shock is widespread vasodilation and increased capillary permeability. This includes neurogenic, septic, and anaphylactic shock.
Distributive
During the _____ stage of shock occurs with no visible changes in client parameters; only changes on the cellular level.
initial
All types of shock progress through the _____ stages and produce similar effects on body systems.
same
The _________ stage of shock measures to increase cardiac output to restore tissue perfusion and oxygenation.
compensatory (non-progressive)
The __________ stage of shock is when the compensatory mechanisms begin to fail.
progressive
The _______ stage of shock is irreversible shock and results in total body failure.
refractory
The stages of shock
Initial
Compensatory (non-progressive)
Progressive
Refractory
With ________ shock educate the client about ways to reduce the risk of a myocardial infarction (MI), such as exercise, diet, stress, reduction, and smoking cessation.
cardiogenic
With ______ shock advise the client to drink plenty of fluids when exercising or when in hot weather.
Hypovolemic shock
With ________ adivise the client to obtain early medical attention with illness or trauma and with any evidence of dehydration or bleeding.
Hypovolemic shock
With _______ shock educate the client about the manifestations of dehydration, including thirst, decreased urine output, and dizziness.
Hypovolemic shock
With _________ educate the client about wearing seat belts and helmets, and the use of caution with dangerous equipment, machinery, and burning.
obstructive
neurogenic
hypovolemic
With _____ shock adivse the client to obtain early medical attention with evidence of an infection, such as localized redness, swelling, drainage, fever, or urinary frequency and burning.
septic shock
With _____ shock advise the client to complete the entire course of antibiotics as directed.
septic shock
With _____ shock advise the client to wear a medical id wristband, avoid allergens and to have an _______ available at all times.
Anaphylactic shock
epinephrine pen
Teach the client and family how to use the ______ and to be alert to early manifestations of an allergic reaction with _______ shock.
epinephrine pens
anaphylactic
Older adult clients are at increased risk for MI and cardiomyopathy with ________.
cardiogenic shock
_________ due to a direct cardiac cause, such as MI, heart failure, cardiomyopathy, dyrhythmia, and valvular rupture or stenosis are risk factors for cardiogenic shock.
Cardiac pump failure
Excessive fluid loss from diuresis, vomiting, or diarrhea; or blood loss secondary to surgery, trauma, gynecologic/obstetric causes, burns, and diabetic ketoacidosis are risk factors for ______ shock.
hypovolemic
Older adult clients are more prone to dehydration due to decreased fluid and protein intake and the use of medications, such as diuretics. Minimal amounts of fluid loss (vomiting, diarrhea) can cause the older adult client to become dehydrated are risk factors for _______.
hypovolemic shock
Cardiac pump failure due to an indirect _______, such as a blockage of the great vessels, pulmonary artery, stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax and aortic dissection are all risk factors for ______.
cardiac factor
obstructive shock
There are three types of _____ shock: nurogenic, septic, anaphylactic.
distributive shock
______ shock occurs when there is a loss of sympathetic tone causing massive vasoldilation. Head trauma, spinal cord injury, and epidural anesthesia are among the causes.
neurogenic
_____ shock is when endotoxins and other mediators cause massive vasodilation. Most common cause is a gram-negative bacteria.
septic
______ is more frequent in older adult clients due to increased use of catheters in long-term care facilities and late detection of UTI (decreased sensation of burning, urgency).
Urosepsis
______ shock is when allergen exposure results in an antigen=antibody reaction causing massive vasodilation. Common causes include antibiotics, foods (e.g. peanuts), latex, and bee stings.
anaphylatic
Manifestations of hemodynamic shock can include
chest pain lethargy somnolence restlessness anxiousness dyspnea diaphoresis thirst muscle weakness nausea constipation
A physical finding of hemodynamic shock is hypoxia, tachypnea progressing to greater than _______, and hypocarbia.
40/min
A physical finding of hemodynamic shock is when the skin can be pale, ______ or _____ in color, cool, diaphoretic, warm, flushed with fever (distributive shock), and exhibit a rash (anaphylactic or septic shock).
mottled or dusky
A physical finding of ______ shock is is angioedema.
anaphylactic shock
A physical finding of _____ is wheezing.
shock
A physical finding of hemodynamic shock is decreased bp with narrowed ______.
pulse pressure
A physical finding of hemodynamic shock is _______ hypotension.
postural
Pulse that is weak, thready, or bounding is an expected finding of _______.
distrubitive shock
A physical finding of _____ shock is tachycardia.
hemodynamic
A physical finding of _____ shock is decreased central venous pressure.
hypovolemic shock
A physical finding of _____ shock is central venous pressure increased with increased systemic vascular resistance.
cardiogenic sock
A physical finding of ______ shock is decreased urine output and seizures.
hypovolemic shock
Lab tests for shock
ABGs
Serum lactic acid
Serum glucose and electrolytes
The ______ can show decreased tissue oxygenation (decreased pH, decreased PaO2, increased PaCO2).
ABGs
The serum ______ will increase due to anaerobic metabolism.
lactic acid
Serum glucose and electrolytes can ______ during shock.
increase
A lab test for ______ shock will test for cardiac enzymes such as _______ and troponin.
creatine phosphokinase
For ________ shock, there will be decreased with hemorrhage and increased with dehydration.
hypovolemic
For _____ shock you monitor ______ via blood, urine, and wound. You also want to do a coagulation tests as well such as PT, INR, aPTT.
Septic
cultures
Diagnostic procedures for hemodynamic monitoring (2)
arterial line insertion
pulmonary artery catheter insertion
Hemodynamic monitoring includes an ______ insertion monitors continuous blood pressure monitoring and blood specimens for ABGs and other tests.
arterial line
Hemodynamic monitoring includes a _______ which is inserted to measure central venous pressure, pulmonary artery pressures, and cardiac output.
pulmonary artery catheter insertion
Continuous hemodynamic monitoring is important to manage fluids and dosage of ________ medications.
inotropic
With a pulmonary artery catheter insertion the nurse must monitor the ______ during catheter insertion.
ECG
With a pulmonary artery catheter insertion the nurse must have _____ and equipment ready.
resuscitation medications
With a pulmonary artery catheter insertion the nurse must monitor the hemodynamic _______ and readings.
waveforms
With a pulmonary artery catheter insertion the nurse must confirm catheter placement using a ______.
chest x ray
With cardiogenic and obstructive shock use a _____ to assess changes associated with MI and dysrhythmias.
ECG
With cardiogenic and obstructive shock use an _______ for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, _______, and valve function.
echocardiogram
ejection fraction
With cardiogenic and obstructive shock use a ______ for cardiomegaly, cardiac tamponade, pulmonary emboli, cardiomyopathy, aortic dissection, or aneurysm, and pericardial effusion.
CT
With cardiogenic and obstructive shock use a _______ to identify coronary artery blockage.
cardiac catheritization
With cardiogenic and obstructive shock use a _____ to diagnose cardiomegaly and pneumothrorax, and to evaluate lungs.
chest x-ray
With hypovolemic shock investigate possible sources of bleeding which can be located in…
blood in the nasogastric drainage or stools
esophagogastroduodenoscopy
CT scan of the abdomen
With hypovolemic shock you should continuously monitor airway and ______.
vital signs
With hypovolemic shock you should provide hemodynamic support by administration of ____ and meds because a client who has suspected shock can be hemodynmaically unstable.
fluids
With hypovolemic shock you should have resuscitation equipment available when ______ the client to and from procedures.
transporting
When investigating hypovolemic shock explain all _____ to the client.
procedures
With shock monitor (6)
oxygenation status (priority)
vital signs
cardiac rhythm with continous cardiac monitoring
urine output: hourly, report if less than 20 mL/hr
LOC
skin color, temp, moisture, capillary refill, turgor
With shock explain procedures and findings to the client and family while providing _____.
reassurance.
With shock place the client on _____ oxygen, such as a 100% nonrebreather face mask. If the client has COPD, insert a _____ L/min nasal cannula and increase the oxygen flow as needed.
high flow
2L/min nasal cannula
When a patient is in shock be prepared to _____ the client. Have emergency resuscitation equipment ready.
intubate
When a patient is in shock maintain a ______ IV access.
patent
When a patient is in shock, to treat ______, place the client flat with his legs elevated to increase venous return.
hypotension
When a patient is in shock if a change in status occurs, notify the _________ and provider of the findings.
rapid response team
When a patient is in shock prepare for and maintain client care during _____ to the ICU, surgery, other specialty unit, or diagnostic area.
transfer
When a patient is in shock prepare for perform hemodynamic monitoring. Monitor CVP, PAP, CO, and pulse pressure. ____ continuous IV drips to maintain hemodynamic parameters as prescribed.
Titrate
Inotropic agents
milirinon lactate
dobutamine
Iontropic agents strengthens cardiac _______ and increases cardiac output.
contraction
Iontropic agents (milirinon lactate, dobutamine) should be administered by _______ with constant hemodynamic monitoring.
continuous IV infusion
Iontropic agents (milirinone lactate, dobutamine) can be ______ to maintain hemodynamic parameters.
titrated
Iontropic agents (milirinone lactate, dobutamine) can cause ______ in some clients.
vasodilation
Iontropic agents (milirinone lactate, dobutamine) are often administered in combination with a _____.
vasopressor
Vasopressors
Dopamine hydrochloride
norepinephrine
Vasopressors (dopamine hydrochloride, norepinephrine) strengthens cardiac contraction and increases ______.
cardiac output
Vasopressors (dopamine hydrochloride, norepinephrine) increases kidney perfusion at ______ doses.
low
Vasopressors (dopamine hydrochloride, norepinephrine) decreases kidney perfusion at ______ doses.
high
Administer vasopressors (dopamine, norepinephrine) should be administered via ______ with constant hemodynamic monitoring.
continuous IV infusion
Can titrate ______ to maintain prescribed hemodynamic parameters.
vasopressors
With vasopressors monitor _____ output.
urine
Administer vasopressors through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.
central line
Pituitary hormone _______ causes vasoconstriction, increases systemic vascular resistance, and increases BP.
vasopressin
Vasopressin is administered via ______ and can be titrated to maintain prescirbed hemodynamic parameters.
continuous IV infusion
With Vasopression monitor ______ output.
urine
Administer vasopressin through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.
central line
Sympathomimetics: Epinenphrine is a rapid acting ______.
bronchodilator
Sypathomimetics: Epinenphrine increases _______ and CO.
heart rate
With sympathomimetics: epinenphrine you need to monitor
bp, pulse, cardiac output
With sympathomimetics: epinephrine can cause sloughing if it infiltrates ______.
tissue
Opioid analgesics: morphine sulfate is used for ____ management.
pain
With Opiod analgesic: morphine sulfate monitor (5)
RR of clients who are non ventilated BP HR SaO2 ABGs
Use opioid analgesics cautiously in conjunction with ______ sedatives.
hypnotic
Assess and document the client’s pain level and response to medication with ________.
opioid analgesics: morphine sulfate
Opioid analgesics: morphine sulfate should be used cautiously due to the risk for increased _______ and hypotension.
vasodilation
When using opioid analgesics: morphine sulfate have ______ and resuscitation equipment available for sever respiratory depression in a client who is non ventilated.
naloxone
Proton-pump inhibitors: pantoprazole protects against _______ development.
stress ulcer
Proton-pump inhibitors: pantoprazole should not be ____ with other medications.
mixed
Anticoagulants (2)
low molecular weight heparin
enoxaprin sodium
Anticoagulants are used for phophylaxis of _____.
DVT
Anticogulants are usually administered ____.
subq
_____ can develop from severe hypotension and perfusion of ischemic cells, causing further tissue injury.
MODS
