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Nursing Semester 3 > Cyndi - Week 13 - Exam 6 > Flashcards

Cyndi - Week 13 - Exam 6 Flashcards

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1
Q

what is the definition of shock?

A

↓ tissue perfusion that results in impaired cellular metabolism

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2
Q

what are the stages of shock?

A
  • compensatory (early - body can compensate)
  • progressive ( harder to compensate - organs may start to shut down)
  • irreversible (organ damage and cant bring back)
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3
Q

shock has _____ _____ wide effects.

A

body system wide

  • neuro
  • cardiac
  • respiratory
  • renal
  • GI
  • skin
  • ** multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF)
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4
Q

what are the neuro sxs of shock?

A

restlessness, confusion, anxiety, feeling of impending

doom, decreased LOC

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5
Q

what are the cardiac sxs of shock?

A

weak pulse, tachycardia, hypotension, dysrhythmias

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6
Q

what are the respiratory sxs of shock?

A

tachypnea, dyspnea, shallow or irregular

respirations, decreased O2 sat

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7
Q

what are the GI sxs of shock?

A

extreme thirst, nausea, vomiting

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8
Q

what are the renal sxs of shock?

A

decreased or no urine output

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9
Q

what are the skin sxs of shock?

A

chills, pallor, cyanosis, obvious hemorrhage or injury, temperature dysregulation, cool, clammy skin

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10
Q

what are the steps to SIRS or CARS?

A
  1. initial insult (MI; infection; trauma; burns; surgery)
  2. SIRS - systemic inflammatory response syndrome
  3. Recovery (w/ ↓ inflam response → CARS conmpensatory anti-inflam response syndrome) MODS, or death
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11
Q

what is SIRS?

A

Systemic Inflammatory Response related to injury or insult
• Activation of entire immune and coagulation systems
• Compensatory anti‐inflammatory response
• Many normal nursing interventions work to prevent SIRS

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12
Q

what is CARS?

A

Period of dangerously decreased immunity
• Reduced immune response that follows an intense SIRS episode
• Period of increased susceptibility to infection
– Especially to nosocomial infection

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13
Q

what is MODS?

A

Multi-Organ Dysfunction Syndrome

- failure of 2 or more organs from shock

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14
Q

what is the common cause of MODS?

A

• Sepsis is most common cause
– Aggressive, early infection treatment is key to prevention
– Optimize oxygenation and perfusion
– Maintain nutritional support

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15
Q

what are the characteristics of MODS?

A

Can affect any organ
• Not only those involved in original condition
• Complete assessment in these patients
Support failing organs specifically
– Most common to fail (resp, kidney, bowel)
– Late failing systems (heart and brain)

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16
Q

what are the general diagnostic tests for shock?

A 
There is no single study for diagnosis
• Frequent vital signs
• Labs
• 12 lead ECG
• CXR
• Continuous oximetry
• Hemodynamic monitoring
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17
Q

what are the labs used for shock?

A

CBC, CMP, BNP, Trop, others based on cause
– Lactic acid
– Blood culture

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18
Q

what are the types of shock?

A 
--Distributive shock (vasodilation)
• Septic
• Neurogenic
• Anaphylactic
--Hypovolemic shock (volume loss)
• Absolute
• Relative
--Cardiogenic shock (pump failure)
--Obstructive shock
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19
Q

what are two teaching points for shock?

A
  • stop whatever started it!!

- fix/check BP first!! give fluids

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20
Q

what is distributive shock? what are the 3 types?

A

An abnormality in vascular tone (dilation) that leads to a loss of BP, and a pooling of blood in the venous system
- septic, neurogenic, anaphylactic

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21
Q

what is septic shock?

A

widespread vasodilation caused by blood infection

- Bacteria, fungi, virus, parasite

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22
Q

what is neurogenic shock?

A

widespread vasodilation caused by spinal

fracture and related dysfunction of SNS and PSNS

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23
Q

what is anaphylactic shock?

A

widespread vasodilation caused by a severe histamine response to allergen

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24
Q

what is sepsis?

A

diagnostic criteria are used to ascertain exact status of

assessment on the sepsis spectrum

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25
Q

what is severe sepsis?

A

• Vasodilation causing maldistribution of blood flow to organs, showing
signs of organ failure
• Myocardial depression
• Respiratory failure

26
Q

what is septic shock?

A 
– hypoperfusion state caused by sepsis
• Despite adequate fluid resuscitation
• Systemic immune response
• Massive vasodilation of arteries
• Endotoxins released
• Massive vasodilation of arteries
• Serious risk of multiple organ failure!
27
Q

what is the criteria for SIRS?

A 
T: > 100.4 F; < 96.8F
RR: > 20
HR: > 90 
WBC: > 12,000; < 4000; > 10% bands
PCO2: < 32 mmHg
28
Q

what is the criteria for sepsis?

A

2 SIRS + confirmed or suspected infection

29
Q

what is the criteria for severe sepsis?

A

sepsis + signs of end organ damage + hypotension (SBP < 90) + lactate > 4 mmol

30
Q

what is the criteria for septic shock?

A

severe sepsis with persistent: signs of end organ damage + hypotension (< 90 SBP) + lactate > 4 mmol

31
Q

what are the compensatory sxs of septic shock?

A
  • Tachycardia
  • Pallor/can be flushed
  • Early shock warm skin
  • Tachypnea
32
Q

what are the progressive sxs of septic shock?

A
  • Hypotension (<90)
  • Urine output
  • Confusion
  • Lethargy
  • Cold and clammy skin
  • Organ dysfunction
33
Q

what are the diagnostic tests for septic shock?

A 
Diagnostic criteria for sepsis
• Obtain blood cultures before starting ATBs
• Lactic acid level
• CBC
– Leukocytosis or leukopenia
– Thrombocytopenia
• Elevated procalcitonin (PCT)
• Elevated CRP
• Creatinine level
• Liver enzyme levels
34
Q

what is the tx for sepsis?

A
  • EarlyATBs
  • Fluid resuscitation
  • Vasopressors
  • Respiratory protection
  • Insulin therapy as needed
  • Strict I&O with Foley
  • Enteral feeding
35
Q

what is the tx for septic shock?

A

• Administer broad spectrum antibiotics
– Obtain blood cultures prior to administration of ATBs
• Reduce work of breathing early mechanical ventilation
• Fluid resuscitation –
– Administer 30 mL/kg crystalloid for hypotension or lactate 4mmol/L
– Transfusion if needed
• Use vasoactive agents – after fluid resuscitationo keep MAP ≥ 65
• Measure lactate level
• Treat and monitor refractory hypotension or lactate > 4mmol/L

36
Q

what are the key parameters to monitor for septic shock?

A
  • Central Venous Pressure (CVP)
  • Mean Arterial Pressure (MAP) 65 – 90 mmHg
  • Urine output >0.5 ml/kg/hr
  • Mixed venous oxygen saturation >65%
  • Hematocrit >30%
37
Q

what are the two characteristics of neurogenic shock?

A

HYPOTENSION
– Loss of arteriole tone below spinal fracture
– SNS unable to compensate due to spinal fracture at
T‐5 or above
BRADYCARDIA
– From unopposed parasympathetic
response

38
Q

what is anaphylactic shock?

A

Acute life threatening hypersensitivity

reaction ‐ reaction can occur within minutes

39
Q

what are the sxs of anaphylactic shock?

A
  • Skin – itchy rash, hives
  • Angioedema – face, throat swelling
  • Respiratory – shortness of breath
  • Cardiac ‐ low BP, weak pulse
  • Gastrointestinal symptoms
  • Anxiety, feeling of impending doom
40
Q

what are the diagnostics for anaphylactic shock?

A

No specific diagnostic tests

41
Q

what is the goals for anaphylactic shock tx?

A

primary goal: ABCs

secondary goal: meds to reverse

42
Q

what is the tx for anaphylactic shock?

A 
-- Epinephrine ‐ Can be given SQ, IV, nebulizer, ETT
• Opposes effect of histamine
• Causes vasoconstriction + bronchodilation
• Antihistamine (Benadryl)
• Bronchodilators (Albuterol)
• Corticosteroids
• IV fluids for volume
Prevention is the best option!!
43
Q

what is the most common shock that occurs?

A

hypovolemic shock
• Usually due to blood loss
• Size of blood vessels normal, but volume of blood decreased

44
Q

what are the two types of hypovolemia?

A

absolute and relative

45
Q

what is absolute hypovolemia?

A
  • Hemorrhage
  • GI loss
  • Renal loss
46
Q

what is relative hypovolemia?

A
  • Fluid shift
  • Pooling of blood or fluid
  • Internal bleeding
  • Massive vasodilation
47
Q

what are the sxs of hypovolemic shock?

A
  • Rapid & shallow breathing
  • Tachycardia
  • Altered LOC
  • Hypothermia
  • Cool, clammy, mottled skin
  • Thirst and dry mouth
  • Decreased urine output
48
Q

what are the diagnostic tests for hypovolemic shock?

A
  • General shock tests PLUS:
  • Hgb, Hct
  • Urine specific gravity
  • Lyte
49
Q

what is the tx for hypovolemic shock?

A 
• Stop the loss of fluid
– Absolute
– Relative
• Restore blood volume
– Colloid (Blood or albumin)
– Crystalloid (NS or LR)
– Large bore IVs
– Warm fluid
• Vasopressors are not used for this kind
of shock – the pt needs fluids
50
Q

what is cardiogenic shock?

A

Caused by failure of heart
• Low cardiac output despite adequate fluid status
• Heart unable to meet O2 demand of body
• Major causes ‐ decompensated heart failure or acute MI
Mortality rate about 60%

51
Q

what are the diagnostic tests for cardiogenic shock?

A 
• Echocardiogram
• Cardiac markers
– Troponin
– CK‐MB
• B‐Type natriuretic peptide (BNP)
• Central venous pressure (CVP)
52
Q

what are the sxs of cardiogenic shock?

A
  • Chest pain
  • Jugular vein distention (JVD)
  • Tachycardia, ECG changes
  • Respiratory changes
  • Rales (crackles) in lungs
  • Hypotension (SBP)< 90 or MAP <65
  • Altered level of consciousness
  • Peripheral Vascular changes
53
Q

what is the main tx for cardiogenic shock?

A

Restore blood flow to the myocardium
• Decrease workload of the heart
– Cardiac catheterization
– Cardiac surgery

54
Q

what are the meds for cardiogenic shock?

A
  • nitrates
  • inotropes
  • diuretics
55
Q

what are the complications of cardiogenic shock?

A

respiratory failure and cardiac arrest

56
Q

what is obstructive shock?

A

Physical obstruction of blood flow that

causes decreased CO

57
Q

what are the causes of obstructive shock?

A

MI, PE, stroke

58
Q

T/F there are no specific diagnostic tests for obstructive shock

A

TRUE

59
Q

waht are the sxs of obstructive shock?

A

– Shock S/S
– JVD
– Pulsus paradoxis

60
Q

what is the tx for obstructive shock?

A

• Priority ‐ treat cause of the shock
• Supportive care with fluids, airway
support, oxygenation, etc.

Nursing Semester 3 (29 decks)

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