FUNDA Flashcards
what are the 4 types of shock
cardiogenic, distributive, obstructive and hypovolemic shock
cause by heart pump failure such as MI, CHF, cardiac tamponade
Cardiogenic shock
most common causative agent of Nosocomial infection/bacterial such as staphylococcus arena and MSRA
Distributive/ septic shock
under of distributive shock are
-Anaphylactic shock- cause of allergic reaction such as meds
-Neurogenic shock- spine above T6 injury lead to Neurogenic shock
type of shock something is obstructing or getting in the way of blood going into and out of your heart or great vessels
obstructive shock
shock that is a serious condition caused by losing a large amount of blood or fluids.
hypovolemic shock
type of shock phase that is also known Non- progressive, has a adequate perfusion to tissue, it is Increased HR & RR
-warm, dry skin, pinkish skin (-) pallor
compensated phase
sign and symptoms compensated phase
1.N= BP is slightly elevated
tachy-tahcy- hyper
- normal UO, GI and peripheral perfusion
BQ: what is the earliest sign of shock*
Tachycardia/ hypertension
late sign of shock
hypotension
how many voids does the infants in a day
20- diluted
normal urine output?
30-60ml/hr or 2000-300ml/day
dependent is weight 0.5-1ml kg/hr
because water is 60% in out body
what is the N peripheral tissue
warm, dry skin, pinkish skin (-) pallor
what is the skin of the shock pt
moist
what type of shock phase that is progressive/ worsening. Inadequate perfusion to anemia, more blood is shunted to the vital organ
decompensated shock
what are the vital organs
brain, heart and lungs
s/sx of decompensted shock
Tach- tachy-Hypotension
-Decreased UO,GI, peripheral tissue- COOL CALMY SKIN, [+] pallor and cyanosis
-capillary refill 3 sec and above
-altered mental status (disorientation)
-ALOC- sleepy(somnolent)
BQ: what is the first orientation of the PX?
Orient Person-Place- Time (PPT)
Reflactory stage, permanent or terminal phase
Irreversible phase, last phase of shock
If the px is revive in irreversible phase called?
Refractory
Sx/ irreversible phase
1.Hypo-brady-brady
2. Anuria
3. GI-paralytic ilues
4. Peripheral tissue=pulselessness
5. Cell injury= increased hyperkalemia affect the heart
6. Anaerobic metabolism (no oxygen)
=lactic acid= metabolic acidosis
BQ: px in shock (assumed th worst) what is the findings?
Cool moist skin
If the pt is in irreversible phase and they’re revived, they will be
Amputated peripheral tissue
It is cause by burns, plasma in interstitial, hase edema but decrease BV
Fluid volume defecit
Dse’s with FVD
-Liver Dse- r/t decreased albumin and oncotic
-dehydration
-shock
-DKA
-Addisons Dse
-DI
Causes by SIADH, cushing, CHF, pulmonary edema, CKD/Renal failure
Fluid volune overload
Fluids in the alveoli with PINK FORTHY SPUTUM
Pulmonay edema
BQ: which fluid compartment get depleted first*
intravascular
BQ: how does your body compensated depleted intracellular
Interstitial
BQ:Intracellular is the last fluid comparted
Most severe in shock
What part of the body you assess if the elderly px has FVD*
Clavicle and forehead
What part of the body you assess if the adult px has FVD
Clavicle, sternum, forearm
What part of the body you assess if the infant px has FVD*
Abdomen
What part of the body you assess if the child px has FVD*
Thigh
Normal Cardiac output
4-11L/min
Normal BP
90/60 lowest normal
119/179 highest normal
120/80 boarderline
Normal Central venous pressure
2-8mmhg
Normal MAP (mean arterial pressure
70-100
Formula
SBP+ BDP (2)
———————-
3
What is yhe position in assessing JVD*
Semi fowlers
(+) edema and JVD
FVO
Lab findings in FVD
All is down
CO, BP, CVP, MAP
Labs in FVO
All is up
CO BP CVP MAP
Labs in hemodilution
All down
BUN NA Hgb Hct
Position in px has hemodilution
Upright to decrease the workload of your heart
Mgt for FVO
O2, restrict fluid, give diuretics and anti hypertension (betablocker) ace inhibitors
Labs of hemoconcentration
Increased all
BUN Na Hgb & Hct
What will happen the Hgb and Hct in bleeding
Decreases
Mgt for shock
- Airway &breathing
Head- tilt-chin -lift
Position in recovery position: left sidelying pisition
2.circulation
-lower extremity- femoral artery
Upper extremity- brachial artery
If infant- brachial artery (middle part of the upper arm)
Will you lossen the tourniquet in life and death situation
Never losen/ remove if not in the ER/DR
BQ: in ER room the ER nurse with px with multiple gunshot wound. What will you do first? Stop the bleeding or establish IV site?
Established IV site
2 large bore access
16-14G, isotonic and PNSS
In severe shock use Central line
Fastest in All route position
Intraosseus- to the bones, modified trendelenburg for rapid venous return to circulatory O2
If decreases BP what would you give
Epinephrine ( vasopressors) given only in FVD
C/I in FVO
what is the best indicator of fluid status?*
weight in the morning after voiding before meal
WOF: >1kg in 24hrs
weekly >3-5lbs
monitor I & O: accurate catheterization
pathognomonic sign of hypoxia
restlessness- keeping moving in the bed
N O2 level 95-100%
RAAS is triggered by
decreased BP
- hypothalamus- increased thirst and drinking
- blood vessels- vasoconstriction
- adrenal gland- Na & H2o retention
result: increase BP
