Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Med Surg > Shock > Flashcards

Shock Flashcards

1
Q

What is shock?

A

Shock is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cardiogenic shock

A

systolic or diastolic dysfunction of the heart’s pumping action results in reduced CO, Stroke Volume, and BP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What side of the heart does systolic dysfunction occurs?

A

It mainly occurs in the L. ventricle b/c pressure is greater on L. side of the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of systolic dysfunction?

A

ACUTE MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of Cardiogenic shock?

A

Dysrythmias, (Bradydysrthmias, Tachydystryhtmia) strucutral factors(Valvular stenosis), Systolic Dysfunction (MI), Diastolic Dysfunction( Cardiac tamponade)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the patho of Systolic Dysfunction?

A

1) Ineffective forward movement of blood
2) Decreased Stroke Volume
3) Decreased CO
4) Decreased Cellular Supply
5) Decreased tissue !!perfusion
6) Impaired cellular metabolism!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are EARLY presentations of Cardiogenic shock?

A

similar to Acute Demcompensated HF.

Tachycardia with hypotension, pulse pressure is narrowed.
Upon assessment: -Tachypneic
-crackles on auscultation , increased
-Pulmonary artery wedge pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are signs of peripheral hypo-perfusion?

A

-cyanosis
-pallor
-diaphoresis
-weak peripheral pulses
-cool and clammy skin
-Delayed cap refill
-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hypovolemic shock?

A

occurs from inadequate fluid in the intravascular space to support adequate perfusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the differences between hypovolemic shock and cardiogenic shock?

A

Cardiogenic shock has to do with filling and pumping dysfunction of the heart that decreases perfusion and hypovolemic shock is inadequate fluid in the intravascular space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the two types of hypovolemic shock?

A

-Absolute: Loss of fluid from (hemorrhage, GI(vomiting and diarrhea, diabetes insipidus, and urination.

  • Relative: Movement of fluid from intravascular space to the extravascular space (third spacing)
  • Burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the consequences of absolute and relative fluid loss?

A

1) Decreased venous return
2) Decreased SV
4) Decreased CO
5) Impaired cellular metabolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the compensatory mechanism for fluid loss?

A

1) Patient can compensate for (15%) of total blood volume (750mL)
2) 15-30% blood loss results in SNS response(Increased HR, CO, RR. )
- Crystalloid can be given
3) Greater than 30% loss is immediate replacement of blood products
4) Greater than 40% irreversible tissue destruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is neurogenic shock?

A

happens within 30 minutes of a spinal cord injury. Loss of SNS vasoconstrictor tone that leads to massive vasodilation causing pooling of blood in blood vessels, hypo-perfusion, and impaired cellular metabolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the classical manifestations of neurogenic shock?

A

-Bradycardia(classical)
-Hypotension(classical)
Other Manifestations:
-Not regulate temperature
-1st skin: warm –> then cold
(poikilothermia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is spinal shock?

A

Absence of voluntary and reflex below the level of injury.

17
Q

What is septic shock?

A

characterized by persistent hypotension, despite fluid resuscitation and inadequate tissue perfusion that results in tissue hypoxia.

18
Q

What are the main organisms that causes sepsis?

A

Gram -negative and gram positive bacteria

19
Q

What are the 3 pathophysiologic effects?

A

1) vasodilation
2) Maldistribution of of BF
3) myocardial depression

20
Q

What clinical presentation is common in shock?

A

Respiratory failure is common.

-Hyperventilation: leads to respiratory alkalosis then respiratory acidosis

21
Q

What is obstructive shock?

A

physical obstruction to blood flow with a decreased CO

22
Q

What causes obstructive shock?

A

1) restricted diastolic filling of the right ventricle from compression.
2) abdominal compartment syndrome
3) pulmonary embolism

23
Q

What is the initial stage of shock?

A
  • occurs at cellular level.
  • S/S usually not apparent
  • Metabolism: aerobic to anaerobic –> LACTIC BUILDUP
  • Liver metabolizes it, but not enough 02 because of decrease in tissue perfusion
24
Q

What is the compensatory Stage?

A
  • Classic sign is DROP in B/P
  • SNS is activated due to drop and maintains BF
  • BF to nonvital organs is diverted
25
Q

What happens when blood is shunted from the lungs?

A
  • V/Q mismatch as not enough air is being perfused to lungs

- Rate and depth of RR is increased

26
Q

What occurs to nonvital organs when blood flow is decreased?

A

1) GI: impaired motility and slowing of peristalsis (risk for paralytic ileus)
2) Skin: cool and clammy
3) Kidneys: RAAS is activited to increase BF and aldosterone is released to absorb water and sodium

27
Q

What are the important findings in Progressive Stage? (irreversible)

A

Patient’s MENTAL STATUS

28
Q

What happens to Cardio, Respiratory, GI, and Renal system in progressive?

A

C: Decrease in BP, edema, weak peripheral pulses, myocardial dysfunction
R: ARDS
G: erosive ulcers, GI bleeding, impaired absorption of nutrients
K: Renal tubular ischemia.. May lead to AKI, Decreased urine, increased BUN and creatine, Metabolic acidosis

29
Q

What is refractory stage?

A
  • Profound hypotension and hypoxemia
  • Cerebral ischemia
  • Recovery is unlikely
30
Q

What is given if patient does not respond to adequate fluid resuscitation?

A

-Vasopressor (NE, dopamine) and/or inotrope (dobutamine)

31
Q

What is the goal of vasopressor?

A

Achieve and maintain MAP greater than 65 mmHg

32
Q

What are drug therapies for Cardiogenic shock?

A

1) Decreased workload of heart (nitrates)
2) Reducing preload (Diurectics)
3) Reducing afterload (vasodilators)
4) HR and contractility (Beta adrenergic blockers)

33
Q

How to manage Septic shock?

A
  • Isotonic crystalloid solution
  • Passive leg raise
  • Vasopressors (NE)are given if no longer fluid responsive
  • antibiotics
  • Glucose
  • PPI and VTE prophylaxis
34
Q

TX for neurogenic shock

A
  • Atropine

- Vasopressors

35
Q

Which assessment to tell the effectivness of pantoprozole?

A

Check for occult blood in stool

36
Q

What 3 things do you give with a patient with septic shock?

A

1) Oxygen
2) Fluids
3) Antibiotics

Advanced Med Surg (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions