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NRSG 200: Med Surg 3 > [Exam 4] Stages of Shock Chart > Flashcards

[Exam 4] Stages of Shock Chart Flashcards

1
Q

What are the three stages?

A

Compensatory, Progressive, Irreversible (MODS)

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2
Q

What is shock?

A

A type of life-threatening condition or injury that has caused inadequate tissue perfusion , with organs not being perfused with adequate oxygen.

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3
Q

Compensatory: what is occuring here?

A

Body is compensating here

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4
Q

Compensatory: What are the main things that happen here?

A

BP remains WNL
Vasoconstriction
Increased HR/Contractility
Shunting of Blood to vital organs

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5
Q

Compensatory: Why does blood pressure remain the same?

A

Catecholamines get released. Epi/Norepi get released causing increased HR and contracility. That is why BP remains WNL

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6
Q

Compensatory: What happens since Epi and Norepi is getting released?

A

vasoconstriction of the whole body

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7
Q

Compensatory - CMs: What respiratory changes occur?

A

RR > 20
PaCO2 < 32
PaO2 < 80

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8
Q

Compensatory - CMs: Why does respirations go up initially?

A

Because they are trying to get rid of carbon dioxide and are trying to get more oxygen inside of the body since organs can sense they don’t have enough

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9
Q

Compensatory - CMs: Why would you see a decreased PaCO2?

A

Because the patient is blowing off all of the CO2, leading to respiratory alkalosis

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10
Q

Compensatory - CMs: What cardiovascular changes occur?

A

BP: WNL
Hr: SNS stimulation leads to increase
HR and Contracility of heart increased bc of epi and norepi
MAP > 65

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11
Q

Compensatory - CMs: Why do you want MAP greater than 65?

A

That shows that there is adequate tissue perfusion

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12
Q

Compensatory - CMs: What neurologic changes occur?

A

Restlessness, agitation, anxiety, confusion

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13
Q

Compensatory - CMs: Why do the neurologic changes occur?

A

BEcause they are hypoxic and not receiving enough oxygem

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14
Q

Compensatory - CMs: What changes occur with renal?

A

Urine output decreasing because they aren’t vital organ and are not being perfused.

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15
Q

Compensatory - CMs: What hepatic changes occur?

A

Hyperglycemia, because the body is stressed and due to catacholimines being released. During stress, glucose levels increase

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16
Q

Compensatory - CMs: What GI changes occur?

A

Bowel sounds are decreased because they arent getting perfused

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17
Q

Compensatory - CMs: What changes occur with s kin?

A

Skin is cold and clammy is blood is pulled from skin, causing sweat glands to release.

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18
Q

Compensatory - CMs: What type of shock do you see warm skin?

A

Sepsis, because this is caused by an infection. Patients will have a fever and will be warm.

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19
Q

Compensatory - Medical Mx: Biggest thing we can do?

A

Identify the cause, because this is how we reverse it

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20
Q

Compensatory - Medical Mx: What can we do to help treat?

A

Fluid replacement
O2
Meds to maintain BP and adequate perfusion

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21
Q

Compensatory - Medical Mx: What type of fluid is used for replacement?

A

Isotonic fluids such as NS or LR.

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22
Q

Compensatory - Medical Mx: Why is LR used?

A

It helps buffer some of the acidosis as medications are given

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23
Q

Progressive: Why has it progressed?

A

Because the normal compensatory mechanisms can no longer keep up , a long iwht blood pressure

24
Q

Progressive: What happens to MAP and blood pressure?

A

MAP falls and SBP < 90 (or drop of 40 from baseline)

25
Q

Progressive: What happens first in progressive?

A

Overworked heart cannot pump effectively, becoems dysfunctional

26
Q

Progressive: What occurs next with progressive?

A

Increased capillary permeability and inflammatory response and coagulation cascade is activated

27
Q

Progressive - CMs: What changes occur with Respiratory?

A

RR increasing and becoming shallow because they cannot get enough oxygen.
Crackles
Decreased O2 because decreased blood flow

28
Q

Progressive - CMs: Why does pulmonary vasoconstriction occur with respiratory?

A

Due to infalmmatory response that leads to decreased pulmonary perfusion leaidng to hypoperfusion of alveoli

29
Q

Progressive - CMs , Respiratory: Why are crackles heard?

A

Because of nondirect injury to lungs. inflammatory response kicked in and ARDS has developed.

30
Q

Progressive - CMs , Cardio: What happens to MAP , and BP?

A

MAP < 65 , SBP < 90 or drop > 40 from baseline
HR> 150
Increased capillary permeability
Narrowing pulse pressure

31
Q

Progressive - CMs , Cardio: What is a narrowing pulse pressure?

A

Normal pressure if 120/80. This is the gap between systolic and diastolic. It means that they are coming closer together

32
Q

Progressive - CMs: What neurologic changes occur?

A

Lethargy and loss of consciousnes may occur because the brain continues to not be perfused.

33
Q

Progressive - CMs: Why may HR increased?

A

Because the heart is stressed and trying to keep up with demand. Stressed heart can lead to what? Dysrhythmias and accelerated heart rate.

34
Q

Progressive - CMs: Patients prone to go into AFIb may be put on what?

A

Beta blocker to leave HR down so that they dont go tachycardic. `

35
Q

Progressive - CMs: What renal changes occur?

A

Increased BUN, Creatinine
Decreased GFR
Output < 30
Metabolic Acidosis

36
Q

Progressive - CMs: What hepatic change occurs?

A

Decreased blood flwo to liver decrease ability to metabolize meds and waste products like ammonia and lactic acid.

37
Q

Progressive - CMs: What changes occur in liver specifically?

A

Can’t filter bacteria leading to infection, impaired glucose production, increased LFTs and BIli and decreased clotting factors.

38
Q

Progressive - CMs: What changes occur with GI?

A

Decreased bowel sounds, impaired nutrient absorption, stress ulcers, bloody diarrhea due to necrosis , and translocation of bacteria leading ot increased inflammatory response

39
Q

Progressive - CMs: What hematolic changes occur?

A

Inflammatory mediators released activating coagulation system to establish hemeostasis leading to DIC

40
Q

Progressive - CMs: What is DIC? (Dissementiated Vascular Coagulation)

A

Patient has an injury. Coagulation gets set off. All clotting factors can sent ot that injury making patient prone to bleeding elsewhere. Basically all clotting factors used

41
Q

Progressive - CMs: What are some signs of DIC?

A

Bruises, petechiae, increased PT and PTT, and decreased platelets.

42
Q

Progressive - CMs: What changes occur with the skin?

A

It becomes mottled, petechiae, bruises,

Central cyanosis

43
Q

Progressive - CMs: Medical management deends on what

A

type of shock and decompensation

44
Q

Progressive - CMs: What will be given to treat this?

A

IV fluids, meds, support the respiratory and cario system

45
Q

Progressive - CMs: What kind of meds will be given to support blood system?

A

Vasopressors - Epinephrine, Norepinephrine, Dopamine,

Inotropes - Dobutamine , Dopamine at low doses (help with contracility)

46
Q

Progressive - CMs: Difference between inotrope and vasopressor?

A

Inotropes help with contracility of the heart

Vasopressors help with clamping down on the vessel to constrict it

47
Q

Progressive - CMs: What are vasoactive meds?

A

They can either clamp down on the vessels but also vasodilate. Nitro can decrease afterload to the heart by vasodilating

48
Q

Progressive - CMs: Aside from from meds and support respiratory and cardio, what else can be done?

A

Hyperglycemia control, enteral nutrition, PPI or H2 blockers or heparin.

49
Q

Progressive - CMs: Why is enteral nutrition improtant?

A

They need more calories because of increased metabolic rate. This can also help decrease peptic ulcer formation.

50
Q

Progressive - CMs: Why would a PPI or H2 Antagonist be used?

A

This helps with ulcers and helps decrease gastric secretion. This helps decrease the eating away of GI tissue

51
Q

Progressive - CMs: Why would heparin be given?

A

This is given if clotting cascade has been activated, this is given to help break up the clot.

52
Q

Irreversible (MODS): Why is this difficult to identify?

A

Sometimes we don’t know when they have entered this tage

53
Q

Irreversible (MODS): How will they respond to vasopressors?

A

Will become unresponsive because body can no longer compensate and blood pressure will continue to drop

54
Q

Irreversible (MODS): What is this?

A

Organ ddamage is so severe, patient does not respond to treatment and cannot survive

55
Q

Irreversible (MODS): What happens to organs in the body?

A

They all begin to die and shut down.

NRSG 200: Med Surg 3 (46 decks)

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