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Med Surg 2 > shock > Flashcards

shock Flashcards

1
Q

what is shock

A
  • A state of inadequate tissue perfusion
  • Impairs cellular function/leads to organ failure
  • Any condition that compromises oxygen delivery to organs and tissues can lead to shock
  • Shock is a life-threatening, rapidly progressing process
  • Early detection with rapid response is necessary to improve outcomes!
  • focus on bp
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2
Q

types of shock

A

cardiogenic
hypovolemic
distributive: neurogenic, septic, anaphylactic

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3
Q

cardiogenic

A

Failure of the heart to pump effectively due to a cardiac factor

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4
Q

hypovolemic

A

A decrease in intravascular volume

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5
Q

distributive

A

Widespread vasodilation and increased capillary permeability

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6
Q

stages of shock

A

compensatory
progressive
refractory

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7
Q

compensatory

A

Measures to increase cardiac output to restore tissue perfusion and oxygenation

  • start to realize something wrong
  • tachycardia and normal bp, kidney retain water
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8
Q

progressive

A

Compensatory mechanisms fail
- bp drops, need 02 and fluid

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9
Q

refractory

A

Irreversible shock and total body failure
- organ failure
- hard to survive
- very low bp

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10
Q

expected findings of shock

A

Chest pain
Lethargy
Somnolence
Restlessness
Anxiousness
Dyspnea
Diaphoresis
Thirst
Muscle weakness
Nausea
Constipation

*loc worse in progressive stage not compensatory

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11
Q

cardiogenic shock cause

A

Caused by cardiac pump failure due to a direct cardiac cause:
- MI (most common)
- Heart failure
- Cardiomyopathy
- Dysrhythmias
- Heart valve rupture or stenosis

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12
Q

cardiogenic shock and fluid

A

DO NOT TREAT WITH FLUID

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13
Q

s/s of cardiogenic shock

A

tachypnea
sob
tachycardia
loss of loc
syncope
weak thready pulse
hypertensive
diaphoretic
pale
cold
cyanotic
urine output decreases

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14
Q

hypovolemic shock

A

A decrease in intravascular volume of at least 15%-30%
Excessive fluid loss:

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15
Q

areas to loose excessive fluid loss

A

Diuresis
Vomiting
Diarrhea
Blood loss
- Surgery
- Trauma
- Gynecologic
- Burns
- DKA

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16
Q

s/s of hypovolemic shock

A

thready pulse
letharguc
low bp
urine decreases
specific gravity increases

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17
Q

distributive shock 3 types

A

neurogenic
septic
anaphylactic shock

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18
Q

nurogenic shock and cause

A

Loss of sympathetic tone causing massive vasodilation:
- Head trauma
- Spinal cord injury
- Epidural anesthesia

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19
Q

neurogenic shock s/s

A

bp low
bladder full
tachkycardia

needs a lot of urine

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20
Q

septic shock

A

Exotoxins and other mediators causing massive vasodilation:

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21
Q

septic shock nursing care

A
  • Check blood cultures on patients at risk for sepsis
  • Low BP, elevated temp/fever, risk of infection
  • Gram negative bacteria is most common cause
  • Urosepsis is more frequent in older adults because of increased use of catheters in long term care facilities and late detection of UTIs.
  • Advise the client to complete the entire course of antibiotics!!!
22
Q

evidence of infection sepsis

A

Localized redness
Swelling
Drainage
Fever (hallmark)
Urinary frequency and burning

23
Q

anaphylactic shock and cause

A

: Allergen exposure that results in an antigen-antibody reaction causing massive vasodilation
- Antibiotics
- Foods (peanuts, tree nuts)
- Latex
- Bee stings

24
Q

anaphylactic shock nursing care

A
  • Advise the client to wear medical alert identification
  • Carry epinephrine pen at all time
  • Teach client and family how to use epi pen
  • Know early manifestations of anaphylactic shock:
    Itchy mouth, feeling of swelling in throat, redness, rash
  • Anticipate giving antihistamines: Diphenhydramine
    Blocks histamine at receptor sites
    Can cause drowsiness, hypotension, and tachycardia
25
Q

skin of shock

A
  • pale, mottled, dusky, cool, diaphoretic (cardiogenic, hypovolemic)
  • Warm, flushed with fever (distributive)
  • Rash (anaphylactic and septic)
26
Q

Physical Assessment Findings

A
  • Hypoxia (anaphylactic)
  • Tachypnea: RR greater than 40
  • Wheezing
  • Decreased Blood Pressure with narrowed pulse pressure
  • Postural hypotension
  • Tachycardia
  • Pulse that is weak, thread, or bounding (distributive)
  • Decreased cardiac output
  • Decreased CVP (hypovolemic shock)
  • Increase CVP (cardiogenic shock)
  • Decreased urine output
  • Seizures
27
Q

Diagnostic Procedures for Shock

A

Hemodynamic Monitoring:
- Arterial line insertion
- Pulmonary artery catheter insertion (assess right side and can be used as a central line)

  • The nurse will monitor ECG during procedures
  • Have resuscitation meds and emergency equipment ready
  • Catheter placement must be confirmed by X-ray before use!
28
Q

ecg used for

A

Assess for changes associated with MI and dysrhythmias

29
Q

echo used for

A

Used for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, ejection fraction, and valve function

30
Q

ct used for

A

Used for cardiac tamponade, PE, cardiomyopathy, aortic dissection, aneurysm, pericardial effusion

31
Q

cardiac cath used for

A

Identify coronary artery blockage

32
Q

chest xray used for

A

Diagnose cardiomegaly and pneumothorax, evaluate lungs

33
Q

other things to look at for shock

A
  • Investigate possible sources of bleeding
    NG tube
    Abdomen
    Stools
  • Continuously monitor airway! fluid resucciate
  • Provide hemodynamic support with fluid and medications. normal saline resembles blood plasma
  • Have resuscitation equipment available when transporting client, and during procedures
34
Q

nursing management of shock

A

What is the priority?
1) Oxygenation First!!!!
- Vital signs: attach your patient to a monitor
Assess rhythm
- Urine output
Check hourly, report less than 30 mls!
2) LOC
3) Skin assessment
- Color
- Temperature
- Capillary refill
- Turgor

35
Q

managing respiratory

A

Place the client on high-flow oxygen (100%)
- Consider using a non-rebreather
- If patient has COPD, what can you do? GIVE 2L NOT 100%

  • Be prepared for intubation
  • Maintain IV access
  • If hypotensive:
    Place client flat with legs elevated to increase venous return
36
Q

hemodynamic moniotring

A

Prepare and perform other hemodynamic monitoring
- CVP (right ventricle monitoring)
- PAWP (left ventricle monitor
- Cardiac output: intropes
Titrate continuous IV drips to maintain hemodynamic parameters as prescribed

37
Q

intropes

A

Inotropic Agents: Strengthen cardiac contraction and increase cardiac output
- Milrinone
- Dobutamine

increase bp
increase hr side effect

38
Q

intropes nursing care

A
  • Given by IV continuous infusion with constant hemodynamic monitoring (arterial line)
  • Some patients get more vasodilated (make sure they can handle that)
  • Often given with a vasopressor (helps with vasoconstriction)
39
Q

vasopressors

A
  • Strengthen cardiac contraction and increase cardiac output Increases client’s BP
  • Increase kidney perfusion at low doses
  • Decrease kidney perfusion at high doses…why? (b/c bp goes up)

Dopamine
Norepinephrine

40
Q

nursing actions for vasopressors

A
  • Given by IV continuous infusion with constant hemodynamic monitoring
  • Can titrate to maintain prescribed hemodynamic parameters
  • Monitor urine output
  • Give through a central line to prevent extravasation
  • Rapid onset occurs in 5 min, short duration, lasts 10 min
41
Q

vasopressin

A

Vasopressin causes vasoconstriction, increases systemic vascular resistance, increases blood pressure

42
Q

nursing actions for vasopressin

A
  • Put patient on a monitor
  • Monitor urine output closely…what should happen? (improvement in urine)
  • Give through a central line
43
Q

epinephrine

A

Rapid acting bronchodialator
Increases heart rate and cardiac output

44
Q

nipride

A
  • Vasodilator: Sodium nitroprusside
  • Used to treat cardiogenic shock
  • Reduces afterload and preload
  • Causes vasodilation
  • Decreases cardiac output: decrease bp
  • Assess patient’s BP
45
Q

hydrocortisone, methylprednisolone

A
  • Reduces WBC migration and decreases inflammation

Things to consider:
- May cause hypertension
- Should be discontinued slowly
- Give with antiulcer medication
- Monitor weight and BP
- Monitor glucose and electrolytes: can make hyperglycemic

46
Q

antibitoics

A
  • Because septic shock is most commonly caused by gram-negative bacteria
  • the Joint Commission’s national patient safety goals recommends the administration of IV antibiotics that are effective against gram negative bacteria within:
  • 30min to 1 hour of a septic shock diagnosis
  • Antibiotics sensitive to cultured organisms must be administered!
  • fever decifers that it is sepsis
  • vanco most commonly used
47
Q

vancomycin

A

Used to treat septic shock
Inhibits cell growth or reproduction of causative organism

48
Q

nursing actions for vanco

A
  • Monitor for hypersensitivity of the antibiotics
  • Administer slowly to prevent Red Mans (90min-2hr)
  • Obtain blood/body cultures before administering the first dose
  • Monitor IV site for infiltration
  • Consider kidney function…how? Why? NEPHROTOXIC
  • Do not give in same line as other medications: Usually incompatible
49
Q

Volume Replacement For Shock

A

Fluid Fluid Fluid!
- For every type of shock, the patient will get fluid replacement, except which one? CARDIOGENIC
Includes Blood Products
- Give 0.9% sodium chloride or Lactated Ringers
- During hypovolemic shock, give volume first!
What about cardiogenic shock?
fluid sparing, 1 fluid blous than inotropes and vasopressors

50
Q

To correct hypotension, give

A

vasopressor drugs if BP stays low after volume

51
Q

Multiple Organ Dysfunction Syndrome (MODS)

A
  • Can develop from severe hypotension and reperfusion of ischemic cells, causing further tissue injury.
  • Inadequate tissue perfusion can cause organ failure in lungs (ARDS), kidneys, heart (decreased coronary artery perfusion), and GI tract (necrosis)
52
Q

Multiple Organ Dysfunction Syndrome (MODS) nursing action

A
  • Assess organ function
  • Provide support measures that can increase tissue perfusion and improve organ function
    • Ventilatory support
    • Inotropic medication
      Implement measures to compensate for dysfunction
    • Administer clotting factors (for liver)
    • Put patient on dialysis (for kidney)

Med Surg 2 (35 decks)

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