shock Flashcards
hypovolemic shock description
significant decrease in intravascular volume by 15-30%
hypovolemic shock causes
traumatic blood loss
internal fluid shifts: edema, ascites, severe hydration
hypovolemic shock pathophysiology
decrease in intravascular volume which results in decreased venous blood return to heart and decreased ventricular filling.
hypovolemic shock s/s
impaired perfusion
thready pulses
decreased LOC
pale cool skin
hypovolemic shock hemodynamics
BP decreased
HR increased
CO decreased
SVR increased
hypovolemic shock treatment
finding causes
replace fluids or blood
vasoactive meds
O2
monitor for adverse effects of treatment
cardiogenic shcok description
the heart’s ability to contract and pump blood is impaired, and the supply of O2 is inadequate for heart and tissues
cardiogenic shock causes
direct damage to myocardium
hypoxemia or hyperglycemia causes damage
myocardial infarction
cardiogenic shock pathophysiology
decrease in SV and CO
cardiogenic shock s/s
decreased BP and tissue perfusion
chest pain
fatigue
pulmonary edema
dysrhythmias
cardiogenic shock hemodynamics
BP decreased
HR increased
CO decreased
SVR increased
cardiogenic shock treatment
treat cause
O2
pain control
lab and hemodynamic monitoring
cardiac meds
positive inotropes, vasopressors, antidysrhythmic meds
septic shock description
widespread infection in body. more than 31 million people impacted. more than 6 million people die annually
septic shock causes
any agent that causes infection
septic shock pathophysiology
inflammatory response is overwhelming. vessels vasodilated and increased capillary permeability. leak into interstitial tissues. cytokines cause clotting
septic shock s/s
tachycardia
HTN
increased lactic acid levels
hypoxic
hypo or hyperthermia
septic shock hemodynamics
BP decreased
HR increased
CO decreased
SVR decreased
septic shock treatment
measure lactate level
obtain blood cx X2 before abx
administer broad spectrum abx
administer 30 ml/kg crystalloid (NS and LR are crystalloids/isotonic fluids)
after 6 hrs apply vasopressors if needed. reassess.
early nutritional support
neurogenic shock description
a loss of balance between parasympathetic and sympathetic stimulation causes vasodilation, leading to relative hypovolemic state
neurogenic shock causes
spinal cord injury
anesthesia or other damage
meds, hyperglycemia
neurogenic shock pathophysiology
overriding parasympathetic nervous system stimulation causes drastic decrease in SVR and bradycardia
neurogenic shock s/s
bradycardia
dry warm skin
hypotension
neurogenic shock hemodynamics
BP decreased
HR decreased
CO decreased
SVR decreased
neurogenic shock treatment
restore sympathetic tone
cant do much to treat cause
support cardiovascular and neurologic function
prevent complications- dvts and internal bleeding (trauma)
anaphylactic shock description
caused by a severe allergic reaction when patients who have already produced antibodies to a foreign substance develop a systemic antigen-antibody reaction
anaphylactic shock causes
food, insects, meds that cause an allergy
anaphylactic shock pathophysiology and s/s
5-30 min after exposure
2 or more of:
respiratory compromise
reduced BP
GI distress
skin and mucosal irritation
anaphylactic shock hemodynamics
BP decreased
HR increased
CO decreased
SVR decreased
anaphylactic shock treatment
remove agent if present first
IV fluids
epinephrine IM or IV
histamine blockers or bronchodilators
compensatory stage of shock
normal BP
increased HR >100
increased RR >22
cold/clammy skin
decreased UOP
confusion or agitation
respiratory alkalosis
progressive stage of shock
low BP
increased HR >150
increased RR, rapid and shallow
mottled skin
decreased UOP <0.5 mL/kg/hr
lethargy
metabolic acidosis
irreversible stage of shock
low BP requires support
erratic HR
requires intubation
jaundice
anuric, requires dialysis
unconscious
profound metabolic and lactic acidosis
