Exam 2 - shock Flashcards
hypovolemic shock occurs when ___ volume has decreased by how much
intravascular; 15-30%
types of crystolloids
LR, NS
types of colliods
albumin
blood products (PRBC, plt, plasma)
causes of hypovolemic shock
hemorrhage
D/V
DI
fistula drainage
hyperglycemia
diuresis
when does microcirculation and irreversible tissue damage occur with hypovolemic shock
> 40% blood loss
serial things to monitor with hypovolemic shock
H&H
electrolytes
lactate
ABG
central venous O2
hourly UOP
what defines cardiogenic shock
hearts ability to contract is impaired; supply of O2 is inadequate for the heart and tissues
2 types of cardiogenic shock
coronary vs. noncoronary
coronary cardiogenic shock
most common
acute MI with L ventricular damage
anterior wall MI
noncoronary cardiogenic shock
conditions that stress the heart:
severe hypoxia
acidosis
hypoglycemia
PTX
hypocalcemia
ineffective heart function:
valve damage
cardiac tamponade
arrhythmias
what to monitor with cardiogenic shock
BNP
troponin
cardiac enzymes
EKG
echo
CXR
early s/sx of cardiogenic shock
tachycardia
low BP
narrow PP
increase myocardial O2 consumption
cool, clammy skin
pallor
decreased cap refill
intravascular volume pools ____ blood vessels with distributive shock
peripheral
massive arterial and venous dilation promotes peripheral pooling
what are the 3 types of distributive shock
septic
neurogenic
anaphylactic
most common type of distributive shock
septic
cause of septic shocl
widespread infection or sepsis
commonly originates from bacteremia, PNA, urosepsis
gram +, gram -, parasites, fungi, viruses
will fluid resuscitation help with hypotension during sepsis/septic shock
No
s/sx of septic shock
increase coagulation
inflammation
tachycardia/hyperventilation
low UOP
altered neuro status
GI dysfunction
respiratory failure (common)
temperature dysreguation (core temps only)
hyperdynamic state (low CO, high SV)
neurogenic shock is a loss of balance between which 2 systems
PNS, SNS
predominant PNS stimulation causes vasodilation for an extended period leads to hypovolemic state
causes of neurogenic shock
spinal cord injury (T5 and above)
spinal anesthesia
depression of vasomotor center of medulla from drugs (opioids, benzos)
s/sx of neurogenic shock will be r/t which system
PNS
s/sx of neurogenic shock
warm, dry skin
low BP
bradycardia
temperature dysregulation
poikilothermia
will atropine help with bradycardia during neurogenic shock
No
what is pt with neurogenic shock at risk for and why
hypothermia d/t temperature dysregulation and piokilothermia
when can neurogenic shock occur after injury and how long can it last
30 minutes; up to 6 weeks
what interventions should be done for pt with suspected spinal cord injury
immobilize the pt
what intervention should be done for a pt with spinal anesthesia or epidural
keep HOB elevated 30 degrees
acute, life-threatening hypersensitivity reaction
anaphylactic shock
anaphylactic shocks is a ___ meditated response (body produced antibodies against the allergen)
IgE
anaphylactic shock can lead to ___ distress and ___ failure
respiratory distress (d/t laryngeal edema, severe bronchospasms)
circulatory failure (d/t massive vasodilation)
anaphylactic shock s/sx may occur ___
suddenly
s/sx of anaphylactic shock
anxiety
confusion
dizziness
CP
sense of impending doom
incontinence
HA
N/V
pruritus
flushing
angioedema
