Pediatric Shock Flashcards
What is shock?
- A state of inadequate tissue perfusion resulting in inadequate oxygen delivery to the cell
- Has many causes and clinical manifestations; all types of shock begin with the same cascade of events
- Inability to correct and reverse shock results in increasing oxygen debt, tissue acidosis, organ system dysfunction and eventual death
- Key to prevention is rapid recognition and intervention before a refractory shock state is established
- Second leading cause of death among pediatric patients
What are the cascade of events that can lead to shock?
- Decreased BP, decreased CO, decreased blood flow
- Blood shunted to brain and heart
- Periphery cold and clammy, cells convert to anaerobic metabolism
- Decreased urine output, increased lactic acid, leads to metabolic acidosis, increased RR
What are the different types of shock?
1) Hypovolemic
2) Distributive
- Septic
- Anaphylactic
- Neurogenic
3) Cardiogenic
What is hypovolemic shock? Signs and symptoms?
Results from fluid loss
Blood loss
Plasma loss
Extracellular fluid loss
Clinical S & S:
high SVR, poor skin turgor, thirst, oliguria, increased HR, falling BP, increased cap. refill time
What is distributive shock?
- The different types have significantly different etiologies; however, all cause a similar physiologic response
- Results from a misdistribution of blood flow and altered organ perfusion
- Intravascular volume remains normal, a functional or relative hypovolemia occurs
What is septic shock? Signs and symptoms?
- Is the result of infection that overwhelms the host defenses
- Invading organism migrates into bloodstream, releases toxins triggering a massive inflammatory response which causes vasodilation and damage to the capillaries
- Permeability of the capillaries is increased and results in fluid leaking out of the vascular space (3rd spacing)
Clinical S & S:
persistently low BP, low SVR, tachycardia, temperature instability, decreased LOC, tachypnea, altered WBC levels, nausea/vomiting/diarrhea, increased cap. refill time
What is anaphylactic shock? Signs and symptoms?
- Outcome of a widespread hypersensitivity reaction
anaphylaxis = allergic reaction; anaphylactic shock = allergic reaction + hemodynamic instability - The invading allergen causes an extensive immune and inflammatory response resulting in vasodilation and increased vascular permeability
- Extravascular effects include constriction of the extravascular smooth muscle
- Onset of anaphylactic shock is usually sudden and progression to death can occur within minutes
Clinical S & S:
anxiety, difficulty breathing, gastrointestinal cramps, edema, hives, sensations of burning or itching, decreased LOC, decreased SVR, hypotension, tachycardia, oliguria
What is neurogenic shock? Signs and symptoms?
- Extreme, persistent vasodilation
- Blood volume has not changed but the amount of space containing the blood has increased, the SVR decreases dramatically
- Neurogenic shock can be caused by any factor that stimulates parasympathetic activity or inhibits sympathetic activity
trauma to the spinal chord or medulla - Certain depressive drugs, anesthetic agents, opioids, antihypertensive agents
Clinical S & S:
low SVR, bradycardia, warm skin temperature, flushed skin, hypotension
What is cardiogenic shock? Signs and symptoms?
- Occurs when the heart is unable to pump enough blood to meet the body’s demand for oxygen
- Defined as persistent hypotension and tissue hypoperfusion caused by cardiac dysfunction in the presence of adequate vascular volume
- Cardiogenic shock in the pediatric population might occur:
After surgery for congenital heart disease, primary pump failure (myocarditis, myocardial trauma, heart failure), dysrhythmias (supraventricular tachycardia-SVT)
Clinical S & S:
tachycardia, tachypnea, hypotension, jugular venous distension, low CO, cyanosis, skin mottling, rapid/faint/irregular pulses, low urine output occasional peripheral edema
What are the three phases of shock?
Compensated
Decompensated
Irreversible
What is compensated shock? What are the clinical manifestations?
The overall purpose of this response is to improve tissue perfusion and support cellular metabolism through 4 mechanisms:
1) CO is improved by the increase in HR and contractility
2) Blood flow is increased to central, essential organs
3) Plasma volume is increased by retention of sodium and water
4) Glyconeogenesis provides increased substrate availability to the cells for metabolism
Clinical manifestations are subtle and easily missed:
anxiety, restlessness, pallor and decrease in peripheral skin temperature, increased cap. refill time, slight increase in HR progressing to tachycardia, normal BP can be maintained for some time, thirst, decreased u/o
What is decompensated shock? What are the clinical manifestations?
- Hypotension is the hallmark clinical finding of transition from the compensated to decompensated phase
- Metabolic acidosis is clinically detectable
- In the decompensated phase perfusion to the core organs are now significantly compromised
Clinical manifestations:
altered LOC, hypotension, metabolic acidosis, tachypnea, oliguria, cool/very pale extremities, decreased skin turgor, markedly increased cap. refill
What is irreversible shock? What are the clinical manifestations?
- Ongoing hypoperfusion results in irreversible cellular and organ damage
- The patient is now very acidotic
- Hallmark of this phase is the predictable progression of organ system dysfunction and eventually death
Clinical manifestations:
thready/weak pulse, severe hypotension, irregular breathing/apnea, anuria, very altered LOC/coma
Describe what to look for in a nursing assessment
General Appearance Airway Breathing Circulation Vital signs, O2 sats Urine output Glucose check
What is the primary nursing diagnosis?
Inadequate tissue perfusion
