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Nursing Theory IV A- Cindy'S Class > Shock > Flashcards

Shock Flashcards

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1
Q

What is shock?

A

decreased tissue perfusion and impaired cellular metabolism that affects ALL body systems

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2
Q

What are the two classifications of shock and what does it consist of?

A
  1. Low blood flow
    - cardiogenic, hypovolemia
  2. maldistribution (circulatory/distributive)
    - neurogenic, anaphylactic, septic
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3
Q

What is cardiogenic shock?

A

Ineffective cardiac pump
Caused by coronary(MI) or non coronary (hypoxemia)

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4
Q

What are the signs and symptoms of cardiogenic shock?

A

Tachycardia, hypotension, pallor; cool, pale, clammy skin, decrease cap refill, anxiety, agitation , decreased renal perfusion

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5
Q

How do you treat cardiogenic shock?

A

Restore blood flow to the myocardium by restoring the balance between O2 supply and demand
- Oxygen therapy, control chest pain, IV therapy…

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6
Q

What is hypovolemic shock?

A

Blood volume deficit
Caused by loss of intravascular fluid

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7
Q

What are the signs and symptoms of hypovolemic shock?

A

anxiety, tachypnea, increased heart rate, decrease urinary volume

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8
Q

How do you treat hypovolemic shock?

A

Stopping the loss of fluid and restoring the circulating volume. Administering prescribed fluids, drugs, and oxygen if needed

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9
Q

Why would you put someone who is in hypovolemic shock into modified trendelenburg?

A

increase cardiac output and circulation to the heart as well as to improve blood flow to the vital organs

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10
Q

What is neurogenic shock?

A

Shock due to a spinal cord injury at the fifth thoracic (T5) vertebra or above leading to massive vasodilation

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11
Q

What are the signs and symptoms of neurogenic shock?

A

Bradycardia, dry skin, hypotension, temperature dysreguation

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12
Q

What is the treatment of neurogenic shock?

A

Spinal stability
- treatment for hypotension and bradycardia
- monitor for hypothermia

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13
Q

What is an anaphylactic shock?

A

life threatening, allergic reaction

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14
Q

What are the signs and symptoms of anaphylactic shock?

A

chest pain, wheezing, swelling, anxiety, incontinence, flushing, respiratory distress, hives(urticaria)

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15
Q

What is the treatment of anaphylactic shock?

A

Medication: epinephrine, diphenhydramine, corticosteroids
Maintain a patent airway: bronchodilators, endotracheal intubation
Fluid replacement

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16
Q

What is septic shock?

A

Serious, caused by widespread infection. Presence of sepsis

17
Q

What is sepsis?

A

systemic inflammatory response to documented or suspected infection

18
Q

What are the signs and symptoms of septic shock?

A

tachypnea/hyperventilation, temperature regulation, decrease urine output and fibrinolysis, GI dysfunction, increased coagulation and inflammation

19
Q

What is the treatment of septic shock?

A

Medication: Antibiotics AFTER cultures are obtained
–> Drotrecogin alfa(Xigris): Major side effect is bleeding
Fluid replacement: Restore perfusion
Vasopressor drug therapy
IV corticosteroids: Maintain adequate BP

20
Q

How does multiple organ dysfunction system connect to septic shock?

A

Phase of progression of shock

21
Q

What are the four stages of shock?

A
  1. Initial Stage
  2. Compensatory stage
  3. Progression stage
  4. Refractory (irreversible) stage
22
Q

What is the initial stage of shock?

A
  • Usually not clinically apparent
  • Metabolism changes from aerobic to anaerobic
    –> lactic acid accumulates and must be removed by blood and broken down may liver
23
Q

What is the compensatory stage of shock?

A
  • Clinically apparent
  • Body activates neutral, hormonal, and biochemical compensatory mechanisms
24
Q

What are the signs and symptoms of the compensatory stage of shock?

A
  • Fight or flight response
    –> body starts to shut down, blood goes to heart and brain. Decrease urine output, hypoactive bowel sounds
  • cool clammy skin
  • decreased BP, increase HR
  • can be corrected, pt recovers with no residual affects
25
Q

What is the progressive stage of shock?

A
  • If compensatory mechanisms fail
  • aggressive interventions to prevent multiple organ dysfunction syndrome
  • decreased cellular perfusion and altered cap permeability
    -anasarca happens
26
Q

What is anasarca?

A
  • Fluid leakage affects solid organs and peripheral tissues and decreased blood flow to pulmonary capillaries
27
Q

What are the sign and symptoms of progressive stage of shock?

A
  • Fluid moves from pulmonary vasculature to interstitial, alveoli (pulmonary edema, bronchoconstriction, decrease residual capacity)
  • CO begins to fail causing hypotension, weak pulses, schema, and decreased peripheral perfusion
  • myocardial dysfunction (end result of complete deterioration of cardiovascular system)
  • Mucosal barrier of GI system becomes ischemic (ulcer, bleeding)
  • Liver fails to metabolize drugs and waste (Jaundice, elevated enzymes, loss of immune function, risk for DIC and significant bleeding)
28
Q

What is irreversible stage of shock?

A
  • Organ damage is so severe that the patient does not respond to treatment and cannot survive
  • Recovery unlikely
  • Failure of one organ affecting others
29
Q

What are the diagnostic studies of shock?

A
  • No SINGLE study to determine shock
  • Thorough hx and physical examination
  • Blood studies (elevated lactate, base deficit)
  • 12-lead ECG
  • Chest x-ray
  • Hemodynamic monitoring
30
Q

What are management strategies in shock?

A
  • Early identification and timely treatment is KEY
  • Management and care of the pt will vary
31
Q

Treatment for shock?

A

Correction of decreased tissue perfusion and nutrition
- Must focus on ABC (airways, breathings, and circulation)

32
Q

How do you prevent a patient into septic shock?

A

hand hygiene
antibiotics

33
Q

If someone has low blood pressure, how would you get it back to normal?

A

trendelenburg position
Increase IV bolus

34
Q

What is circulatory shock?

A
35
Q

What is the sighs and symptoms of circulatory shock?

A
36
Q

What is the treatment of circulatory shock?

A

Nursing Theory IV A- Cindy'S Class (17 decks)

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