Hypovolemic Shock Flashcards
How is shock defined?
A condition where tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs and cellular function.
What systems does shock affect?
All body systems
How is hypovolemic shock defined?
Fluid loss of 15% or greater.
How is hypovolemic shock defined?
A shock state resulting from decreased intravascular volume due to fluid loss
How is cardio genie shock classified?
A shock state resulting from impairment or failure of myocardium
How is septic shock classified?
A circulatory shock state resulting from overwhelming infection causing relative hypovolemia
How is neurogenic shock classified?
A shock state resulting from loss of sympathetic tone causing relative hypovolemia
How is anaphylactic shock classified?
A circulatory shock state resulting from severe allergic reaction producing overwhelming systemic vasodilation, relative hypovolemia.
How would burns lead to hypovolemic shock?
If the burns caused a fluid shift from intravascular to interstitial space
What does the sympathetic nervous system maintain?
It maintains the muscle surround arteries, arterioles in sympathetic tone,.
What does MAP stand for?
Mean arterial pressure
What does the MAP need to be for the cells to receive oxygen and nutrients to sustain metabolism?
At least 65
How do you find pulse pressure?
Systolic - diastolic
True or false:
Pulse pressure and stroke volume is the same thing.
True
How do you find cardiac output?
Heart rate x Stroke volume
How do you find MAP?
Cardiac Output x Peripheral vascular resistance
CO x PVR
How many stage of shock are there?
3
What is the first stage of shock?
Compensatory
What is the second stage of shock?
Progressive
What is the third stage of shock?
Irreversible
What detect the sustained drop in MAP?
Baroreceptors
During the compensatory stage of shock what does the SNS cause?
- vasoconstriction
- increased HR
- increased Heart contractility
During the compensatory stage why does the SNS do what it does?
To maintain Blood pressure and cardiac output
During the Compensatory stage of shock why does the body shunt blood from skin, kidneys, and GI tract?
To maintain perfusion to heart and brain
During the compensatory stage of shock what does acidosis occur from?
Anaerobic metabolism
During the compensatory stage of shock: what increases edge to acidosis and what may it cause?
Respiratory rate increases.
May cause compensatory respiratory alkalosis
In the compensatory stage of shock what may occur to the patients mental state?
They may become confused
During the compensatory stage of shock: what should the nurse report in terms of blood pressure and pulse pressure?
A BP of 90 or less
A drop of 40 or greater in narrowing pulse pressure
During the Progressive Stage of Shock mechanisms that regulate what can no longer compensate?
BP
During the Progressive Stage of Shock: what decreases due to the inability for the mechanisms that regulate BP no longer being able to compensate?
BP and MAP
During the Progressive stage of shock what do all of the organs suffer from?
Hypoperfusion
During the Progressive Stage of Shock: What does inadequate perfusion of the heart lead to?
Dysrhythmias and cardiac ischemia
During the Progressive Stage of Shock: what does the furthering of vasoconstriction compromise?
Cellular perfusion
During the Progressive Stage of Shock: Why would the patients mental status further deteriorate?
From decreased cerebral perfusion
During the Progressive Stage of Shock: What happens to the patient due to decreased cerebral perfusion?
They become lethargic or loses consciousness
During the Progressive Stage of Shock: When the lungs begin to fail what begins to occur to the lungs?
Pulmonary edema, alveoli collapse, increased CO2 levels, and the respirations become rapid and shallow.
During the Progressive stage of shock: What does MAP fall below and what can no longer be maintained?
It falls below 70 and GFR cannot be maintained
During the Progressive Stage of Shock: What may occur are a complication of shock?
Disseminated intravascular coagulation (DIC)
If the progressive stage of shock happens where does the patient need to be transferred to?
ICU
What type of extremes does the nurse need to prevent if they are in the progressive stage of shock?
Prevent temperature extremes
During irreversible shock: The organ damage becomes…
Severe
When is the judgement that shock is in the irreversible stage made?
Only in retrospect
Which stage of shock is characterized by normal blood pressure? A. Initial B. Compensatory C. Progressive D. Irreversible
B. Compensatory
What are the diagnostic test used to identify all types of shock?
CBC
CMP
ABG
Urine specific gravity, osmolarity
What medication do you give to a patient with hypovolemic shock?
Vasoactive medications
What type of replacement needs to be give to a patient with hypovolemic shock?
Fluid and blood replacement
How do you need to place the bed when a patient is in shock?
Modified trendelenburg; the patients bed below the hips must be raised about the head.
In terms of fluid replacement for someone in shock: what is the ratio rules associated with crystalloids?
3:1 rule
What are the complications of fluid replacement?
Fluid overload and pulmonary edema
What is the prototype drug for fluid replacement?
Normal serum albumin
What is the primary use of normal serum albumin?
Restoration of plasma volume and blood proteins
What is the adverse effect of normal serum albumin?
Protein overload
How often should vital signs be taken when administering vasoactive medications?
Every 15 minutes or more often
When is vasoactive medications administered?
When fluid therapy alone does not maintain MAP.
What does vasoactive medications do?
They stimulate the SNS and support hemodynamics status.
How are vasoactive medications administered?
Through a central line
What is the prototype drug for vasoconstrictors?
Epinephrine
What are the advantages of epinephrine?
Increases blood pressure by vasoconstriction, increases cardiac contraction and cardiac output.
What are the disadvantages of the vasoconstrictors?
Increase after load which increases cardiac workload
Compromise perfusion to the skin, kidneys, lungs, and GI tract
What do inotropic drugs for shock do?
Increase the strength of myocardial contraction, increase cardiac output
What is the disadvantage of inotropic drugs for shock?
Increases O2 demand.
What are the adverse effects of inotropic drugs?
Dysrhythmias, hypertension, gangrene
What does nutritional therapy have to do with the treatment of shock?
Nutritional support need to meet increased metabolic, energy requirements to prevent further catabolism.
True or false:
The most common colloid solution used to treat hypovolemic shock is 5% albumin?
True
When caring for a patient in hypovolemic shock who is receiving large volumes of IV isotonic fluid, the nurse should monitor for symptoms of: A. Hyperthermia B. Pain C. Pulmonary edema D. Tachycardia
C. Pulmonary edema
