quiz #4 Flashcards
What is the end result of all shock regardless of the type
inadequate tissue perfusion due to decreased cardiac output
Who are the people that are most at risk for developing shock
-Elderly
-Immunosuppressed or immuncomp
-Patients with multiple comorbidities
What are some conditions or diseases that affect preload
-hypovolemia
-pericarditis
-anemia
-MI
-Aortic stenosis
-Heart failure
What is the equation for cardiac output
Stroke volume x Heart rate
What is stroke volume
The amount of blood ejected from each ventricle with each cardiac cycle
what is preload
the amount of blood/stretch of the heart at the end of diastole
What are the 4 stages of shock
-Initial
-Compensated
-Progressive
-Refractory
what is the initial stage of shock
No clinical symptoms are apparent yet but lactic acid is starting to build up due to lack of tissue perfusion
what is the compensatory stage of shock and what is a classic clinical finding
-The body starts to use compensatory mechanisms to maintain tissue perfusion
-hypotension is a classic symptom late in this stage
What is the progressive stage of shock
Begins as the compensatory mechanisms of the body begin to fail
what is the refractory stage of shock
When compensatory mechanisms have failed and there is multiple organ failure
what are the three overarching ways that the body can compensate for shock
-Neural
-Biochemical
-Hormonal
how does the body compensate for shock neurally
By stimulating SNS activation
How does the body compensate for shock biochemically
by altering function of the body like RR and HR in response to increasing lactate levels and pH etc
which actions of the body do biochemical changes usually stimulate
usually stimulate increased HR and RR
How does the body compensate for shock hormonally
usually by stimulating the RAAS system which also releases ALDOSTERONE
If a client was having decreased urine output due to shock what order would you advocate for from the physician
an order for blood work especially ABG’s
What lab work is especially important in the MODS stage of shock
-LACTATE (especially important)
-ABG’s & Lytes (especially important)
-Liver enzymes
-renal panel
-Coags (INR/PT)
what dysfunction of the heart causes cardiogenic shock
it is either a dysfunction of systolic or diastolic function of the heart
what dysfunction of the heart causes obstructive shock
it is a dysfunction of the diastolic function of the heart
what is the difference between cardiogenic and obstructive shock
Cardiogenic is when there is a problem with the muscle of the heart and obstructive is when there is an obstruction that prevents blood from flowing through the heart properly
What is one of the most important medications for cardiogenic shock
Inotropes
What are the main inotropes used for cardiogenic shock
-Dobutamine
-Milrinone
-Levophed
what are two interventions to support the left ventricle
-Intra aortic balloon pump
-Left ventricle assist device
what are the normal ranges for blood pH CO2 and bicarb
-pH: 7.35-7.45
-CO2: 35-45
-Bicarb: 22-26
