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Advanced EVPC Yr2 > Nursing the Shocked patient > Flashcards

Nursing the Shocked patient Flashcards

1
Q

What is the defintion of Shock?

A

An acute circulatory failure resulting in inadequate tissue perfusion + energy production

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2
Q

In basic (I mean basic) terms, what is shock?

A

Acute
Circulatory
Failure

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3
Q

How does an acute circulatory faliure affect the body?

A

Results in inadequate tissue, nutrients perfusion + energy production

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4
Q

True or False

As shock develops, patients don’t deteriorate as quickly as you would think.

A

False, patient’s deteriorate very rapidly!

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5
Q

What are the 2 most vital aspects of preventing shock?

A
  1. Early recognition
  2. Treatment
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6
Q

What 3 things does Normal tissue perfusion, perfuse?

A
  1. Oxygen
  2. Nutrients
  3. Energy
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7
Q

Name 3 Cardiovascular abilities that Normal tissue perfusion relies on

A
  1. Cardiac output
  2. Circulating volume
  3. Peripheral vascular resistance
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8
Q

What is the combination of Vasoconstriction + Vasodilation in the peripheries called?

A

Peripheral Vascular Resistance

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9
Q

What is cardiac output?

A

The pumping output volume of the heart

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10
Q

If there is a reduction in any parameter results of normal tissue perfusion, during Shock, what are 3 potential resulting factors?

A
  1. Inadequate perfusion
  2. Trigger of compensatory mechanisms
  3. Altered efficacy of all systems
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11
Q

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?

A

Prioritzes the organs!

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12
Q

What 2 organs are prioritized when the compensatory mechanism is triggered, during shock?

A. Brain + Heart
B. Kidneys + Heart
C. Heart + Liver

A

A. Brain + Heart

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13
Q

How many stages of the shock are there?

A. 5
B. 4
C. 3
D. 6

A

C. 3

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14
Q

Name the 3 stages of shock (in order)

A
  1. Compensatory
  2. Decompensatory
  3. Irreversible
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15
Q

What the basic aim of body, in the 1st stage of shock, Compensatory shock?

A

Mechanisms are intiated in attempt to reduce the effects of shock on the body

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16
Q

State the 3 basic steps of Compensatory shock

A
  1. Baroreceptors in heart detect reduced cardiac output
  2. Hypoxia occurs in tissues
  3. Hypoperfusion of kidney
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17
Q

Describe the role of Baroreceptors in sub-stage 1 of Compensatory shock

A
  1. Baroreceptors in the heart detect changes in blood pressure in kidneys + vessels = reduced cardiac output
  2. This stimulates the release of adrenaline + non-adrenaline
  3. Results in increased heart rate + contractility

Contractility = Quickly pumping out more blood to improve blood volume

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18
Q

What does Hypoxia of the tissues in sub-stage 2 of Compensatory shock lead to?

A
  1. Hypoxia occurs due to lack of O2 tissue perfusion
  2. Results in metabolic acidosis
  3. Ventilation increases in order to address the acid-base balance

Ventilation increases = to gain more O2 to counteract the acidity

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19
Q

What does Hypoperfusion of the Kidney in step 3 of Compensatory shock lead to?

A
  1. Underperfusion of O2 to kidneys activates the Renin Aldosterone Angiotensingin (RAA) System
  2. Aldosterone acts no collecting ducts to retain Sodium Chloride (Na) + Water (H20)
  3. Additional - causes peripheral vasoconstriction
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20
Q

Name the hormonal compensatory mechanisim which regulates blood pressure in the body

A

The Renin Angiotensin Aldosterone System

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21
Q

Describe the RAA system

A
  1. Kidney releases Renin into blood + Liver releases Angiotensinogen into blood
  2. Renin (enzyme) > Angiotensinogen > Angiotensin I
  3. Angiotensin-converting enzyme (ACE) released from Pulmonary circulation into blood
  4. ACE > Angiotensin I > Angiotensin II (hormone)
  5. Angiotensin II stimulates =
    - Vasoconstriction
    - Uptake of more Na from convulted tubules of kidneys
    - Triggers release of Aldosterone from renal cortex
  6. Aldosterone stimulates water + Na retention (+ CNS)
  7. Stimulates Hypothalamus = Increase thirst
  8. Stimulates Posterior Pitutary = Produce antidiuretic hormone (water retention)
  9. Reduces Baroreceptor sensitivity/response*

- All increases blood pressure + volume
- Angiotensin II = works for onl

  • = Reducing Baroreceptor response, prevents the system from counteracting it!
22
Q

What happens if Compensatory shock isn’t treated, and the compensatory mechanisims in stage 1 start to fail?

A

The patient goes into stage 2 - Decompensatory shock

23
Q

State the 4 basic sub-stages of Decompensatory shock

A
  1. Fluid + protein leak from circulation + into tissues due to peripheral vasodilation, increasing blood viscosity
  2. Acidosis increases*
  3. Gut becomes Ischaemic + bacteria enters the blood stream
  4. Comatose

Fluid leaking into tissues = Oedema in limbs

  • = State known as ‘Acidotic’
24
Q

What is the defintion of Ischaemic?

A

A state where blood flow is obstructed by partial or total blockage of an artery

25
Q

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.”

A

Hypovolaemia!

26
Q

What is the state called where bacteria leaks into the blood stream, during Decompensatory shock?

A

Sepsis!

27
Q

How does Sepsis occur in Decompensatory shock?

A

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

28
Q

What happens if Compensatory shock isn’t treated, and the decompensatory mechanisims in stage 3 start to fail?

A

The patient will go into stage 3
= Irreversible shock

29
Q

True or False.

Stages 2 + 3 of shock are reversible

A

False.

Stage 2, Decompensatory is reversible.

Stage 3, Irreversible - isn’t.

30
Q

What essentially occurs ( in very basic terms) in the last stage of shock?

A

Cell death, patient death.

31
Q

State the 4 basic sub-stages of Irreversible shock

A
  1. Systemic Inflammatory Response Syndrome (SIRS)
  2. Disseminated Intravascular Coagulation (DIC)
  3. Multi-Organ Dysfunction (MOD)
  4. Death
32
Q

What is stage 1 of Irreversible shock called?

A

Systemic Inflammatory Response Syndrome (SIRS)

33
Q

What happens in the ‘Systemic Inflammatory Response Syndrome’ stage of Irreversible shock?

A

Inflammatory injury to one organ system > that causes damage to others

34
Q

True or False.

SIRS can be caused by only Infectious causes.

A

False.

It can be caused by either Infectious or Non-infectious causes

35
Q

What happens in the ‘Disseminated Intravascular Coagulation’ stage of Irreversible shock?

A

Activation of Haemostatic mechanisms > induces Prothrombotic stage > bleeding tendancies

Can’t clot well!

36
Q

(Acronym)

What is the DIC infamously known as in the VP?

A

‘Death Is Coming’

37
Q

What leads to the ‘MOD’ stage of Irreversible shock?

A

SIRS + Septic shock

38
Q

What happens in the ‘Multi-Organ Dysfunction’ stage of Irreversible shock?

A

Multi-Organ Failure

39
Q

(Shock)

What does SIRS stand for?

A

Systemic Inflammatory Response Syndrome

40
Q

(Shock)

What does DIC stand for?

A

Disseminated Intravascular Coagulation

41
Q

(Shock)

What does MOD stand for?

A

Multi-Organ Dysfunction

42
Q

Including Stages 1, 2 + 3’s names!

Multi-Q !!

  1. State the 3 sub-stages of the 1st stage of shock.
  2. State the 4 sub-stages of the 2nd stage of shock.
  3. State the 4 sub-stages of the final stage of shock, number 3.
A

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

43
Q

Name the 4 main types of shock

A
  1. Hypovolaemic
  2. Septic (or Distributive)
  3. Cardiogenic
  4. Obstructive
44
Q

What does Hypovol….

A
45
Q

Scenario..

A 15 y/o CKCS has Endocarditis. He has collapsed + has signs of shock.

What type of shock is this?

A

Cardiogenic shock

46
Q

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?

A

Hypovolaemic shock
(Due to blood loss)

47
Q

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?

A

Septic shock
(Bacterial = Pyo!)

48
Q

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?

A

Hypovolaemic shock
(Body is compensating for V+ + D+, so pulls fluid from cells&raquo_space; Hypovolaemia)

49
Q

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?

A

Obstructive shock
(Embolism comes from Aorta)

50
Q
A

Advanced EVPC Yr2 (28 decks)

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