Shock Flashcards
What type of shock is described as when the heart fails to pump normally?
Cardiogenic shock
What is the most common cause of cardiogenic shock?
Extensive left ventricular MI
What is the mortality rate of cardiogenic shock?
50 - 80 %
Describe the pathophysiology of cardiogenic shock.
- MI produces necrotic heart tissue that cannot contract adequately causing impairedcardiac contractility and cardiac output
- Damaged ventricle cannot pump blood (O2)into circulation causing worse ischemia
- SV decreases equaling decreased CO and BP
- Decreased BP further compromises perfusion to the coronary arteries which leads tofurther myocardial ischemia
- Blood backs up into the pulmonary system causingpulmonary congestion
**Increasing pulmonary congestion leads to pulmonary edemaand increased afterload of the right ventricle. These events can trigger SIRS and lacticacidosis.
What is the goal of nursing care in cardiogenic shock?
Optimize cardiac output
What are some interventions for cardiogenic shock?
Optimize 02 delivery
Decrease 02 consumption
Administer related drug therapy
Usually intubated and placed on mechanical ventilation
Other treatment options include things like thrombolytic therapy an intra-aortic balloon pump percutaneous left ventricular assist device or revascularization
Actions to support circulation: IV drug therapies such as vasopressors, line atrophic agents, and diuretics, invasive or noninvasive hemodynamic monitoring, aortic counterpulsation
What type of shock is described as severe damage to the central nervous system?
neurogenic shock
What is the most common cause of neurogenic shock?
Most often associated with acute spinal cord injury (SCI) but can also be associated with nontraumatic causes (tumors, disc degeneration, inflammation/infection)
What are clinical manifestations of neurogenic shock?
Hypotension
Bradycardia
Hypothermia
(known as the triad of expected signs)
What type of shock is described as a severe allergic reaction?
Anaphylactic shock
What type of shock is described as reduced circulating blood volume?
Hypovolemic shock
What type of shock is defined as a severe immune response to an infection?
Septic shock
What are clinical manifestations of cardiogenic shock?
- Sustained hypotension or systolic blood pressure less than 90 mm of mercury for 30 minutes or longer
- An elevated pulmonary artery wedge pressure greater than 15 mmHg
PAWP: pressure within the pulmonary arterial system when catheter tip ‘wedged’ in the tapering branch of one of the pulmonary arteries - A low cardiac index less than 2.2 L per minute per metre squared
- Common clinical findings include continuing chest pain and pulmonary congestion including dyspnea, bilateral crackles, and hypoxemia
- Other general signs of shock are usually present including reduced mentation, mottled and cool skin, diaphoresis, weak peripheral pulses, and tachycardia
What treatments are involved in neurogenic shock?
- maintaining stability of the spine
- optimizing oxygen delivery
- restoring intravascular volume
- Continuous cardiac monitoring
- Airway support
What diagnostic tests are completed to diagnose cardiogenic shock?
- ECG
- cardiac echocardiogram
- serial cardiac enzymes
- Chest x-ray
- arterial blood gases
- electrolytes
What medical and nursing management approaches are used to manage cardiogenic shock?
- Patient usually intubated and placed on mechanical ventilation
- Thrombolytic therapy
- intra-aortic balloon pump
- percutaneous left ventricular assist devices
- revascularization
- Circulation support through use of IV drug therapies such as vasopressors, inotrpic agents, diuretics
What is spinal shock (as differentiated from neurogenic shock)?
Spinal shock is the temporary loss of spinal reflex activity that develops below the level of cord injury. Neurogenic shock is when the spinal cord is injured above T6. Impulses from the sympathetic nervous system cannot reach the arterioles, resulting in unopposed vagal stimulation and loss of vasomotor tone. Blood vessels still receive parasympathetic innervation, causing vasodilation and blood pooling. creates relative hypovolemia; results in hypoperfusion to the spinal cord, further damaging the cord.
How is neurogenic shock treated?
- Goals are to maintain stability of the spine, optimize oxygen delivery, and restore intravascular volume
What is the cause of anaphylactic shock?
Severe allergic
reaction
What is the cause of cardiogenic shock?
Heart fails to pump
normally
What are the signs and symptoms of anaphylactic shock?
- Hypotension
- Tachycardia
- ↓ Cardiac Output
- ↓ Systemic Vascular
Resistance - Cough
- Dyspnea
- Pruritus
- Urticaria
- Restlessness
- ↓ level of consciousness
What are the signs and symptoms of cardiogenic shock?
- Hypotension
- Weak, thready pulse
- ↑Systemic Vascular
Resistance - ↓Cardiac Output
- Crackles, tachypnea
- Cool, pale, clammy skin
- Urine output <30 mL/hr
What is hypovolemic shock?
Reduced circulating
blood volume
What are the signs and symptoms of hypovolemic shock?
- Hypotension
- Weak, thready pulse
- ↓ Cardiac Output
- ↑Systemic Vascular
Resistance - Tachycardia
- Cool, pale, clammy skin
- ↓ Urine output
What are signs and symptoms of neurogenic shock?
*Hypotension
* ↓Cardiac Output
* Bradycardia
* Warm, dry skin
* Venous & arterial
vasodilation
* Loss of bladder control
What is obstructive shock?
Heart or great blood
vessels are blocked
by a physical
obstruction
What are signs and symptoms of obstructive shock?
- Hypotension
- Muffled heart sounds
- ↓ Cardiac Output
- ↓ level of consciousness
- Signs of poor perfusion
- Pale, cool skin
- ↓ Urine output
- Temperature
What is septic shock?
Severe immune
response to an
infection
What are signs and symptoms of septic shock?
- Hypotension
- Full bounding pulse
- ↓ Systemic Vascular
Resistance - ↓ Cardiac Output
- Tachycardia
- Warm, flushed skin
- Tachypnea
- ↓ Urine output
- Fever
What are signs of left-sided heart failure?
L - left L - lung
Constant coughing.
Shortness of breath with walking or bending over.
Waking up short of breath or unable to lie flat at night.
Weight gain.
Fatigue
What are signs of right-sided heart failure?
- Peripheral edema
- Ascites
- JVD
- Increased peripheral venous pressure
- Enlarged liver and spleen
