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
