Nursing the Shocked patient Flashcards
What is the defintion of Shock?
An acute circulatory failure resulting in inadequate tissue perfusion + energy production
In basic (I mean basic) terms, what is shock?
Acute
Circulatory
Failure
How does an acute circulatory faliure affect the body?
Results in inadequate tissue, nutrients perfusion + energy production
True or False
As shock develops, patients don’t deteriorate as quickly as you would think.
False, patient’s deteriorate very rapidly!
What are the 2 most vital aspects of preventing shock?
- Early recognition
- Treatment
What 3 things does Normal tissue perfusion, perfuse?
- Oxygen
- Nutrients
- Energy
Name 3 Cardiovascular abilities that Normal tissue perfusion relies on
- Cardiac output
- Circulating volume
- Peripheral vascular resistance
What is the combination of Vasoconstriction + Vasodilation in the peripheries called?
Peripheral Vascular Resistance
What is cardiac output?
The pumping output volume of the heart
If there is a reduction in any parameter results of normal tissue perfusion, during Shock, what are 3 potential resulting factors?
- Inadequate perfusion
- Trigger of compensatory mechanisms
- Altered efficacy of all systems
When the compensatory mechanisms are triggered during Shock, with a reduction of normal tissue perfusion, what is the most basic mechanism that is applied to the body, in order to cope?
Prioritzes the organs!
What 2 organs are prioritized when the compensatory mechanism is triggered, during shock?
A. Brain + Heart
B. Kidneys + Heart
C. Heart + Liver
A. Brain + Heart
How many stages of the shock are there?
A. 5
B. 4
C. 3
D. 6
C. 3
Name the 3 stages of shock (in order)
- Compensatory
- Decompensatory
- Irreversible
What the basic aim of body, in the 1st stage of shock, Compensatory shock?
Mechanisms are intiated in attempt to reduce the effects of shock on the body
State the 3 basic steps of Compensatory shock
- Baroreceptors in heart detect reduced cardiac output
- Hypoxia occurs in tissues
- Hypoperfusion of kidney
Describe the role of Baroreceptors in sub-stage 1 of Compensatory shock
- Baroreceptors in the heart detect changes in blood pressure in kidneys + vessels = reduced cardiac output
- This stimulates the release of adrenaline + non-adrenaline
- Results in increased heart rate + contractility
Contractility = Quickly pumping out more blood to improve blood volume
What does Hypoxia of the tissues in sub-stage 2 of Compensatory shock lead to?
- Hypoxia occurs due to lack of O2 tissue perfusion
- Results in metabolic acidosis
- Ventilation increases in order to address the acid-base balance
Ventilation increases = to gain more O2 to counteract the acidity
What does Hypoperfusion of the Kidney in step 3 of Compensatory shock lead to?
- Underperfusion of O2 to kidneys activates the Renin Aldosterone Angiotensingin (RAA) System
- Aldosterone acts no collecting ducts to retain Sodium Chloride (Na) + Water (H20)
- Additional - causes peripheral vasoconstriction
Name the hormonal compensatory mechanisim which regulates blood pressure in the body
The Renin Angiotensin Aldosterone System
Describe the RAA system
- Kidney releases Renin into blood + Liver releases Angiotensinogen into blood
- Renin (enzyme) > Angiotensinogen > Angiotensin I
- Angiotensin-converting enzyme (ACE) released from Pulmonary circulation into blood
- ACE > Angiotensin I > Angiotensin II (hormone)
- Angiotensin II stimulates =
- Vasoconstriction
- Uptake of more Na from convulted tubules of kidneys
- Triggers release of Aldosterone from renal cortex - Aldosterone stimulates water + Na retention (+ CNS)
- Stimulates Hypothalamus = Increase thirst
- Stimulates Posterior Pitutary = Produce antidiuretic hormone (water retention)
- Reduces Baroreceptor sensitivity/response*
- All increases blood pressure + volume
- Angiotensin II = works for onl
- = Reducing Baroreceptor response, prevents the system from counteracting it!
What happens if Compensatory shock isn’t treated, and the compensatory mechanisims in stage 1 start to fail?
The patient goes into stage 2 - Decompensatory shock
State the 4 basic sub-stages of Decompensatory shock
- Fluid + protein leak from circulation + into tissues due to peripheral vasodilation, increasing blood viscosity
- Acidosis increases*
- Gut becomes Ischaemic + bacteria enters the blood stream
- Comatose
Fluid leaking into tissues = Oedema in limbs
- = State known as ‘Acidotic’
What is the defintion of Ischaemic?
A state where blood flow is obstructed by partial or total blockage of an artery
What is the term used to describe the following situation:
“Fluid + proteins leak from the circulation and into the tissues.
This is due to peripheral vasodilation, and the viscosity of blood increases.”
Hypovolaemia!
What is the state called where bacteria leaks into the blood stream, during Decompensatory shock?
Sepsis!
How does Sepsis occur in Decompensatory shock?
The gut becomes Ischaemic, so the permability of the gut wall increases in attempt to gain more blood - increasing vulnerability to toxic bacteria, into the blood stream
What happens if Compensatory shock isn’t treated, and the decompensatory mechanisims in stage 3 start to fail?
The patient will go into stage 3
= Irreversible shock
True or False.
Stages 2 + 3 of shock are reversible
False.
Stage 2, Decompensatory is reversible.
Stage 3, Irreversible - isn’t.
What essentially occurs ( in very basic terms) in the last stage of shock?
Cell death, patient death.
State the 4 basic sub-stages of Irreversible shock
- Systemic Inflammatory Response Syndrome (SIRS)
- Disseminated Intravascular Coagulation (DIC)
- Multi-Organ Dysfunction (MOD)
- Death
What is stage 1 of Irreversible shock called?
Systemic Inflammatory Response Syndrome (SIRS)
What happens in the ‘Systemic Inflammatory Response Syndrome’ stage of Irreversible shock?
Inflammatory injury to one organ system > that causes damage to others
True or False.
SIRS can be caused by only Infectious causes.
False.
It can be caused by either Infectious or Non-infectious causes
What happens in the ‘Disseminated Intravascular Coagulation’ stage of Irreversible shock?
Activation of Haemostatic mechanisms > induces Prothrombotic stage > bleeding tendancies
Can’t clot well!
(Acronym)
What is the DIC infamously known as in the VP?
‘Death Is Coming’
What leads to the ‘MOD’ stage of Irreversible shock?
SIRS + Septic shock
What happens in the ‘Multi-Organ Dysfunction’ stage of Irreversible shock?
Multi-Organ Failure
(Shock)
What does SIRS stand for?
Systemic Inflammatory Response Syndrome
(Shock)
What does DIC stand for?
Disseminated Intravascular Coagulation
(Shock)
What does MOD stand for?
Multi-Organ Dysfunction
Including Stages 1, 2 + 3’s names!
Multi-Q !!
- State the 3 sub-stages of the 1st stage of shock.
- State the 4 sub-stages of the 2nd stage of shock.
- State the 4 sub-stages of the final stage of shock, number 3.
The 1st stage of shock is called = Compensatory
1. Baroreceptors in heart detect reduced cardiac output
2. Hypoxia occurs in tissues
3. Hypoperfusion of kidney
2nd stage is called = Decompensatory
1. Fluid + protein leak from circulation > into tissues due to vasodilation, Blood viscosity increases
2. Acidosis increase
3. Gut becomes Ischaemic + Sepsis occurs
4. Comatose
3rd/final stage is called = Irreversible
1. SIRS = Systemic Inflammatory Response System
2. DIC = Disseminated Intravascular Coagulation (Death Is Coming)
3. MOD = Multi-Organ Dysfunction
4. Death
Name the 4 main types of shock
- Hypovolaemic
- Septic (or Distributive)
- Cardiogenic
- Obstructive
What does Hypovol….
Scenario..
A 15 y/o CKCS has Endocarditis. He has collapsed + has signs of shock.
What type of shock is this?
Cardiogenic shock
Scenario..
A 5 y/o Cat has been involved in an RTA, knocked over by a car + has an arterial haemorrhage from its lower right hind leg.
What type of shock is this?
Hypovolaemic shock
(Due to blood loss)
Scenario..
A 6 y/o FE Lab has had a season around 6 weeks ago + is now V+ + depressed. The patient is showing severe signs of shock + is awaiting surgery.
What type of shock is this?
Septic shock
(Bacterial = Pyo!)
Scenario..
A 10 m/o GSD puppy has been admitted to the hospital w/severe D+ + diagnosed with/Parvo. The patient is severely dehydrated + is now showing signs of shock.
What type of shock is this?
Hypovolaemic shock
(Body is compensating for V+ + D+, so pulls fluid from cells»_space; Hypovolaemia)
Scenario..
A 14 y/o Cat has been diagnosed w/aortic thromboembolism + the patient is now showing signs of shock.
What type of shock is this?
Obstructive shock
(Embolism comes from Aorta)
