Sepsis and Shock Flashcards
Exam 3
1
Q
How does shock impact all body systems?
A
- Can lead to organ failure and death
and it is influenced by compensatory mechanisms and successful interventions
2
Q
Life-threatening response to alterations in circulation
Inadequate tissue perfusion
Imbalance between cellular oxygen supply and demand
A
Shock is a clinical syndrome
3
Q
What is shock?
A
Hypovolemic
Cardiogenic
Obstructive
Distributive
Septic, anaphylactic, or neurogenic
4
Q
What is the cardiovascular system composed of?
A
Heart, blood, vascular bed (bed: arteries, arterioles, capillaries, venules, and veins)
5
Q
What is the microcirculatory system?
A
Portion between arterioles and venules
6
Q
What are the four components involved in shock?
A
Blood volume, myocardial contractility, blood flow, vascular resistance
7
Q
What is the initial failure in shock?
A
Cardiovascular system failure
8
Q
What are the causes of hypovolemic shock?
A
Dehydration, Trauma, Bleeding/Hemorrhaging
9
Q
What is cardiogenic shock characterized by?
A
Inadequate myocardial contractility
10
Q
What is obstructive shock caused by?
A
Obstruction of blood flow
11
Q
What are the types of distributive shock?
A
Anaphylactic, Neurogenic, Septic
12
Q
What is the first stage of shock?
A
Stage I: Initiation
13
Q
What happens during hypoperfusion?
A
Inadequate delivery or extraction of oxygen
14
Q
What are the clinical signs in stage I of shock?
A
No obvious clinical signs
↓ CO may be assessed with invasive hemodynamic monitoring
15
Q
What are the stages of shock?
A
Stage II: Compensatory
16
Q
What happens in the compensatory stage of shock?
A
Sustained reduction in tissue perfusion; initiation of compensatory mechanisms
17
Q
What are the initiation of compensatory mechanisms for stage II: compensatory?
A
Initiation of compensatory mechanisms
Neural: baroreceptors and chemoreceptors
Endocrine: ACTH and ADH
Chemical: Low oxygen tension; Hyperventilation and respiratory alkalosis
18
Q
What happens in Stage III (Progressive) of shock?
A
Failure of compensatory mechanisms
19
Q
What are the cardiovascular effects of Stage III shock?
A
Hypoperfusion and vasoconstriction
20
Q
What happens to the extremities in Stage III shock?
A
Extremity ischemia
21
Q
What happens at the cellular level in Stage III shock?
A
Cellular hypoxia and anaerobic metabolism
22
Q
What metabolic process increases in Stage III shock?
A
Lactic acid production
23
Q
What type of acidosis occurs in Stage III shock?
A
Metabolic acidosis
24
Q
What pump fails in Stage III shock?
A
Na+/K+ pump
25
What can the failure of the Na+/K+ pump affect in Stage III shock?
Rhythm and conductivity
26
What are the effects of Stage III of shock?
Interstitial edema, decreased circulating intravascular volume, decreased coronary perfusion, decreased myocardial contractility, and Increased capillary hydrostatic pressure
27
What is the stage IV of shock called?
Refractory
28
What happens in stage IV of shock?
Prolonged inadequate tissue perfusion
29
What is the response to therapy in stage IV of shock?
Unresponsive
30
What are some complications in stage IV of shock?
Dysrhythmias, pulmonary edema, respiratory distress syndrome, cerebral changes, renal decreased GFR
31
What can stage IV of shock lead to?
Multiple organ dysfunction and death
32
What is Systemic Inflammatory Response Syndrome (SIRS)?
Widespread systemic inflammatory response
33
What disorders are associated with SIRS?
Infection, trauma, shock, pancreatitis, ischemia
34
What is SIRS most frequently associated with?
Sepsis
35
What happens to intravascular volume in SIRS?
Increased permeability of endothelial wall, Fluid shifts into intravascular spaces, depletion of intravascular volume = relative hypovolemia
36
What is the central nervous system most sensitive to?
Early changes
37
What are the initial stage symptoms of shock in the central nervous system?
Anxiety/restlessness
38
What are the late stage symptoms of shock in the central nervous system?
Coma
39
In what stage of shock does blood pressure initially show compensatory changes?
Initial stages
40
What are the blood pressure changes in the early stages of shock?
Slightly elevated
Narrow pulse pressure
41
What lab values should be focused on?
cbc, cmp
42
What can happen to the heart rate?
tachycardia (early), brady (late)
43
What compensation mechanism does the body use?
ABGs
44
What is a sign that things are going wrong?
<0.5 mL/kg/hr
45
What are the early stage symptoms of shock in the pulmonary system?
Rapid, deep respirations
46
What are the late stage symptoms of shock in the pulmonary system?
Shallow respirations and poor gas exchange
47
What is the effect of shock on the renal system?
Decreased glomerular filtration
48
What system is activated in response to shock in the renal system?
Renin-angiotensin-aldosterone system
49
What is the result of sodium retention in the renal system during shock?
Water reabsorption
50
What is a possible symptom of shock in the renal system?
Oliguria
51
What are some signs of slowing intestinal activity in shock?
Decreased bowel sounds, distension, nausea, and constipation
52
What are some signs of altered liver function in shock?
Altered liver enzymes, clotting disorders
53
What is a potential consequence of hepatic dysfunction in shock?
Increased susceptibility to infection
54
What are common symptoms of issues with bacteria from the gut in the blood supply?
Decreased bowel sounds, nausea, distention
55
What are some signs of consumptive coagulopathy (DIC)?
Enhanced clotting/inhibited fibrinolysis, depletion of clotting factors
56
What is the significance of skin color, temperature, texture, and turgor in shock assessment?
Evaluation of integumentary system
57
What is a late and unreliable sign of shock?
Cyanosis
58
What happens when the body does not have enough clotting factor?
Compensate with platelet count but this does not occur in shock therefore leading to DIC
59
What are some examples of laboratory studies?
Hemogram, serum chemistry, coagulation studies, serum lactate level
60
What does serum chemistry measure?
Function of various organs and electrolyte balance
61
What do coagulation studies measure?
Ability of blood to clot
62
What does serum lactate level indicate?
- Overall state of shock and adequacy of resuscitation
- Indicator of decreased oxygen to cells
63
What does an increased serum lactate level indicate?
Lack of perfusion and sepsis
64
What are interventions for shock management?
include increasing the cardiac output and cardiac index, increasing the hemoglobin level, increasing the arterial oxygen saturation, and minimizing oxygen consumption.
two IV catheters: one in a peripheral vein (16 gauge) and ideally one in a central vein
65
What is the general management of shock?
- Treat underlying cause
- Maintain circulatory volume
66
What are the components of combination therapy for shock?
Fluid, pharmacotherapy, mechanical therapy
67
What should be minimized in shock management?
Oxygen consumption
68
What are the two IV catheter insertion sites you want for a shock patient?
Peripheral and Central line
69
What gauge is commonly used for peripheral IV catheters?
14- or 16-gauge
70
What is a fluid challenge?
Rapid infusion of a crystalloid solution
71
What are the two common crystalloid solutions used for fluid challenge?
Lactated Ringer’s or normal saline
72
What is the recommended volume for a fluid challenge?
250 mL up to 2 liters
73
What is a potential complication of fluid challenge related to plasma protein?
Hemodilution of plasma protein
74
What type of access is recommended for fluid challenge?
IV access of a 20-gauge and higher
75
What should be done to prevent transfusion reactions during the fluid challenge?
Keep vein open with normal saline solution
76
What are two potential complications of fluid challenge?
Pulmonary edema, transfusion reaction
77
What is the recommended administration for d5 or ns 45?
Do not give want to use isotonic solution
78
What is the importance of oxygenation?
Maintaining adequate oxygen levels in the body
79
Why is it important to maintain the airway?
To ensure proper oxygenation and ventilation
80
What is the purpose of mechanical ventilation?
To assist with oxygenation and ventilation
81
Why is sedation used in the context of oxygenation and mechanical ventilation?
To keep the patient calm and comfortable during the process
82
When is neuromuscular blockade utilized in the context of oxygenation and mechanical ventilation?
To temporarily paralyze the patient's muscles for better control of ventilation and reduce oxygen demand
83
What would you do to decrease afterload?
Decrease afterload
- arterial vasodilators
- ace or arbs inhibitors
To decrease RV afterload specifically
- oxygen
84
What would you use to decrease contractility?
- beta blockers
- calcium channel blockers
85
What would you do to increase contractility?
- cardiac glycosides
86
What would you do to decrease preload?
- venous vasodilators
- diuretics
- ace or inhibitors
87
What would you do to increase preload
- fluids
- blood and blood products
- decrease vasodilator dosage
88
What do you do to increase HR?
- tx the cause
- atropine
- epinephrine
- pacemaker
89
What decrease HR
- antidysrhythmic
- vagal maneuvers
90
What is the role of pharmacological support in patient management?
Manage symptoms and improve outcomes
91
What factors affect cardiac output?
Heart rate, preload, afterload, contractility
92
What does heart rate refer to?
Number of times the heart beats in one minute
93
What is preload?
Volume of blood in the heart before contraction
94
What is afterload?
Resistance that the heart must overcome to pump blood out of the left ventricle
95
What is contractility?
Ability of the heart muscle to contract and pump blood
96
Why is central venous access important?
To monitor central venous pressure and administer medications/fluids
97
What is the purpose of hemodynamic monitoring?
Assess cardiovascular function and response to treatment
98
What should you watch for?
Tissue necrosis
99
When should you leave the IV in?
When inflating
100
What is the role of chronotropic drugs?
Increase heart rate
101
What is the role of dysrhythmia agents?
Manage irregular heart rhythms
102
What medication is used to treat bradycardia in neurogenic shock?
Atropine
103
What is the purpose of an IV fluid challenge in hypovolemic and distributive shock?
Assess and improve fluid status
104
What type of medication is used for to change preload in cardiogenic shock?
Venous vasodilators
105
What is the purpose of vasoconstriction in distributive shock?
Increase systemic vascular resistance to change the afterload
106
What type of medication is used to change afterload in cardiogenic shock?
Arterial vasodilators
107
What type of medication is used to increase contractility in cardiogenic shock?
Dobutamine
108
What is the role of beta blockers?
Decrease heart rate and workload on the heart
109
What are some med classes you would tx shock with?
Sedatives
Analgesics
Insulin (two consecutive glucose readings are above 180 mg/dL) – will implement the high bg management
Corticosteroids
Antibiotics
Low–molecular-weight heparin to prevent DVTs
H2-receptor antagonist or protein pump inhibitor to prevent gastric stress ulceration
110
When would insulin be implemented for high blood glucose management?
Two consecutive glucose readings above 180 mg/dL
111
What medications are commonly used to prevent DVTs?
Low-molecular-weight heparin
112
What type of medication is used to prevent gastric stress ulceration?
H2-receptor antagonist or protein pump inhibitor
113
What is one way to regulate body temperature?
Rapid administration of IV fluids
114
What effect does hypothermia have on cardiac function?
- Depresses cardiac contractility
- Impairs cardiac output
- Impairs oxygenation
115
Rapid administration of IV fluids may reduce temperature are you should use what to compensate?
Anticipate hypothermia, and proactively use warming methods (e.g., fluid warmer, heated forced air blankets, blankets around the patient’s head).
116
What can be used to keep the patient warm?
Warm blankets
117
What is enteral nutrition?
Preferred route of nutritional support
118
When should enteral nutrition be initiated?
Within 24 to 48 hours of admission
119
What condition hinders enteral nutrition?
Paralytic ileus cannot do enteral nutrition if they have one
120
What is an alternative to enteral nutrition?
Parenteral nutrition
121
When is parenteral nutrition given?
If enteral nutrition is not tolerated
122
Should you worry about overfeeding a patient?
Yes
123
What are some important considerations for maintaining skin integrity?
Turn every 2 hours, use protective barrier cream, use pressure-relieving devices, elevate heels off the bed surface, foley catheter if indicated
124
What is psychological support?
Emotional assistance for patients
125
Who should psychological support be provided to?
Patients and their families
126
What are advance directive discussions?
Planning for future medical decisions
127
What is hypovolemic shock?
Inadequate intravascular blood volume
128
What happens in cardiogenic shock?
The heart fails to act as an effective pump
129
What causes obstructive shock?
Physical impairment to adequate circulating blood flow
130
What is distributive shock characterized by?
Widespread vasodilation and decreased vascular tone resulting in a relative hypovolemia
131
Name three types of distributive shock.
Neurogenic, Anaphylactic, Septic
132
Why is a warmer needed when giving a lot of blood?
To prevent hypothermia
133
What factors should be considered when determining fluid replacement?
Blood pressure, urine output, and hematocrit level
134
What is the target MAP range?
65-70 mmHg
