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Preoperative Nursing Management > Hypovolemic Shock > Flashcards

Hypovolemic Shock Flashcards

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1
Q

How is shock defined?

A

A condition where tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs and cellular function.

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2
Q

What systems does shock affect?

A

All body systems

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3
Q

How is hypovolemic shock defined?

A

Fluid loss of 15% or greater.

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4
Q

How is hypovolemic shock defined?

A

A shock state resulting from decreased intravascular volume due to fluid loss

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5
Q

How is cardio genie shock classified?

A

A shock state resulting from impairment or failure of myocardium

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6
Q

How is septic shock classified?

A

A circulatory shock state resulting from overwhelming infection causing relative hypovolemia

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7
Q

How is neurogenic shock classified?

A

A shock state resulting from loss of sympathetic tone causing relative hypovolemia

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8
Q

How is anaphylactic shock classified?

A

A circulatory shock state resulting from severe allergic reaction producing overwhelming systemic vasodilation, relative hypovolemia.

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9
Q

How would burns lead to hypovolemic shock?

A

If the burns caused a fluid shift from intravascular to interstitial space

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10
Q

What does the sympathetic nervous system maintain?

A

It maintains the muscle surround arteries, arterioles in sympathetic tone,.

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11
Q

What does MAP stand for?

A

Mean arterial pressure

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12
Q

What does the MAP need to be for the cells to receive oxygen and nutrients to sustain metabolism?

A

At least 65

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13
Q

How do you find pulse pressure?

A

Systolic - diastolic

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14
Q

True or false:

Pulse pressure and stroke volume is the same thing.

A

True

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15
Q

How do you find cardiac output?

A

Heart rate x Stroke volume

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16
Q

How do you find MAP?

A

Cardiac Output x Peripheral vascular resistance

CO x PVR

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17
Q

How many stage of shock are there?

A

3

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18
Q

What is the first stage of shock?

A

Compensatory

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19
Q

What is the second stage of shock?

A

Progressive

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20
Q

What is the third stage of shock?

A

Irreversible

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21
Q

What detect the sustained drop in MAP?

A

Baroreceptors

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22
Q

During the compensatory stage of shock what does the SNS cause?

A
  • vasoconstriction
  • increased HR
  • increased Heart contractility
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23
Q

During the compensatory stage why does the SNS do what it does?

A

To maintain Blood pressure and cardiac output

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24
Q

During the Compensatory stage of shock why does the body shunt blood from skin, kidneys, and GI tract?

A

To maintain perfusion to heart and brain

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25
Q

During the compensatory stage of shock what does acidosis occur from?

A

Anaerobic metabolism

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26
Q

During the compensatory stage of shock: what increases edge to acidosis and what may it cause?

A

Respiratory rate increases.

May cause compensatory respiratory alkalosis

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27
Q

In the compensatory stage of shock what may occur to the patients mental state?

A

They may become confused

28
Q

During the compensatory stage of shock: what should the nurse report in terms of blood pressure and pulse pressure?

A

A BP of 90 or less

A drop of 40 or greater in narrowing pulse pressure

29
Q

During the Progressive Stage of Shock mechanisms that regulate what can no longer compensate?

A

BP

30
Q

During the Progressive Stage of Shock: what decreases due to the inability for the mechanisms that regulate BP no longer being able to compensate?

A

BP and MAP

31
Q

During the Progressive stage of shock what do all of the organs suffer from?

A

Hypoperfusion

32
Q

During the Progressive Stage of Shock: What does inadequate perfusion of the heart lead to?

A

Dysrhythmias and cardiac ischemia

33
Q

During the Progressive Stage of Shock: what does the furthering of vasoconstriction compromise?

A

Cellular perfusion

34
Q

During the Progressive Stage of Shock: Why would the patients mental status further deteriorate?

A

From decreased cerebral perfusion

35
Q

During the Progressive Stage of Shock: What happens to the patient due to decreased cerebral perfusion?

A

They become lethargic or loses consciousness

36
Q

During the Progressive Stage of Shock: When the lungs begin to fail what begins to occur to the lungs?

A

Pulmonary edema, alveoli collapse, increased CO2 levels, and the respirations become rapid and shallow.

37
Q

During the Progressive stage of shock: What does MAP fall below and what can no longer be maintained?

A

It falls below 70 and GFR cannot be maintained

38
Q

During the Progressive Stage of Shock: What may occur are a complication of shock?

A

Disseminated intravascular coagulation (DIC)

39
Q

If the progressive stage of shock happens where does the patient need to be transferred to?

A

ICU

40
Q

What type of extremes does the nurse need to prevent if they are in the progressive stage of shock?

A

Prevent temperature extremes

41
Q

During irreversible shock: The organ damage becomes…

A

Severe

42
Q

When is the judgement that shock is in the irreversible stage made?

A

Only in retrospect

43
Q 
Which stage of shock is characterized by normal blood pressure?
A. Initial
B. Compensatory
C. Progressive
D. Irreversible
A

B. Compensatory

44
Q

What are the diagnostic test used to identify all types of shock?

A

CBC
CMP
ABG
Urine specific gravity, osmolarity

45
Q

What medication do you give to a patient with hypovolemic shock?

A

Vasoactive medications

46
Q

What type of replacement needs to be give to a patient with hypovolemic shock?

A

Fluid and blood replacement

47
Q

How do you need to place the bed when a patient is in shock?

A

Modified trendelenburg; the patients bed below the hips must be raised about the head.

48
Q

In terms of fluid replacement for someone in shock: what is the ratio rules associated with crystalloids?

A

3:1 rule

49
Q

What are the complications of fluid replacement?

A

Fluid overload and pulmonary edema

50
Q

What is the prototype drug for fluid replacement?

A

Normal serum albumin

51
Q

What is the primary use of normal serum albumin?

A

Restoration of plasma volume and blood proteins

52
Q

What is the adverse effect of normal serum albumin?

A

Protein overload

53
Q

How often should vital signs be taken when administering vasoactive medications?

A

Every 15 minutes or more often

54
Q

When is vasoactive medications administered?

A

When fluid therapy alone does not maintain MAP.

55
Q

What does vasoactive medications do?

A

They stimulate the SNS and support hemodynamics status.

56
Q

How are vasoactive medications administered?

A

Through a central line

57
Q

What is the prototype drug for vasoconstrictors?

A

Epinephrine

58
Q

What are the advantages of epinephrine?

A

Increases blood pressure by vasoconstriction, increases cardiac contraction and cardiac output.

59
Q

What are the disadvantages of the vasoconstrictors?

A

Increase after load which increases cardiac workload

Compromise perfusion to the skin, kidneys, lungs, and GI tract

60
Q

What do inotropic drugs for shock do?

A

Increase the strength of myocardial contraction, increase cardiac output

61
Q

What is the disadvantage of inotropic drugs for shock?

A

Increases O2 demand.

62
Q

What are the adverse effects of inotropic drugs?

A

Dysrhythmias, hypertension, gangrene

63
Q

What does nutritional therapy have to do with the treatment of shock?

A

Nutritional support need to meet increased metabolic, energy requirements to prevent further catabolism.

64
Q

True or false:

The most common colloid solution used to treat hypovolemic shock is 5% albumin?

A

True

65
Q 
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
A

C. Pulmonary edema

Preoperative Nursing Management (15 decks)

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