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Shock Flashcards

1
Q

What is stroke volume (SV)?

A

The amount of blood ejected from the left ventricle with each contraction

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2
Q

What is Cardiac Output (CO)?

A

The amount of blood ejected from the left ventricle in 1 minute
Stroke Volume X HR = CO

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3
Q

Preload

A

The amount of blood in the ventricle during diastole, which is prior to systole.
The amount of blood in venous return and refers to filling pressure.

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4
Q

Afterload

A

Systemic Vascular Resistance (SVR)
Blood volume ejected from the left ventricle during systole along with the peripheral (extremities) resistance experienced at the same time.
SVR also reflects pressure or workload in the heart.

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5
Q

Would an increased SVR increase or decrease cardiac workload?

A

Increase

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6
Q

Vasopressors with SVR

A

Vasopressors can increase SVR and cause fingers to fall off.

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7
Q

What can cause an increase in SVR with peripheral resistance?

A

It could be from an increased blood pressure or from the cold

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8
Q

What does high SVR do?

A

puts more pressure on the heart and more workload on the heart

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9
Q

Define Shock

A

A life threatening condition that develops when there is inadequate tissue perfusion to deliver oxygen and nutrients needed to maintain cellular function.

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10
Q

Shock Pathophysiology

A

Inadequate tissue perfusion results in tissue hypoxia which can lead to organ failure if not treated.

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11
Q

The nurse understands that which of these increase as the delivery of oxygen to the tissues falls below the tissues’ requirements? (Select all that apply.)
A. VO2
B. Oxygen debt
C. SvO2
D. Pa02
E. Preload

A

A and B

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12
Q

Oxygen delivery

A

The amount of oxygen delivered to the tissues.

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13
Q

Oxygen consumption (VO2)

A

Reflects the amount of oxygen extracted from the blood at the tissue level

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14
Q

Oxygen debt

A

The difference between normal VO2 and VO2 during the low-DO2 state.

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15
Q

Normal SvO2

A

60-75%

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16
Q

SvO2 value below normal

A

The tissues are extracting more oxygen than normal

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17
Q

What causes a low SvO2?

A

A decrease of DO2 which may be a decrease in oxygen, hemoglobin, or cardiac output.

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18
Q

Classifications of shock

A

Hypovolemic
Cardiogenic
Distributive
Obstructive

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19
Q

Hypovolemic shock

A

An intravascular content issue resulting from rapid fluid loss resulting in inadequate circulating volume.

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20
Q

Cardiogenic shock

A

Heart pump issue
Inadequate pumping ability of the heart muscle, most typically a result of acute MI

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21
Q

Distributive shock

A

Due to massive vasodilation caused by poor vascular tone.
Relative hypovolemia
Warm extremities

22
Q

Obstructive Shock

A

Blockage
Caused by a mechanical barrier to ventricular filing or ventricle emptying causing decreased cardiac output.

23
Q

The nurse understands that which patient is at risk of developing hypovolemic shock?
A. A patient with severe valvular disease
B. A patient receiving spinal anesthesia
C. A patient with severe diarrhea
D. A patient with a large pneumothorax

24
Q

Types of distributive shock

A

Anaphylactic
Neurogenic
Early septic
Late septic

25
Neurogenic Shock causes
Brain injury Spinal injury Spinal anesthesia Decreased sympathetic tone
26
Anaphylactic shock causes
Severe allergic reaction
27
Septic shock cause
Overwhelming systemic infection
28
Goal for all shock types
To restore circulating blood volume and increase tissue perfusion
29
Causes of Hypovolemic shock
Blood loss from: Hemorrhage (can be postpartum) Penetrating or blunt trauma Severe GI bleeds Penetrating: GSW/knife injuries Blunt: damage to the liver, trauma to the thoracic cavity, ruptured aorta, long bone/femur fractures. Severe Vomiting/diarrhea Extensive burns Surgery
30
Stages of shock
Initial Compensatory Progressive Refractory
31
Causes of obstructive shock
Tension pneumothorax Cardiac tamponade Severe vascular disease
32
Initial stage of shock
Hypoxia Decrease cardiac output Subtle
33
Compensatory stage of shock
Increase in heart rate Increase in blood pressure Vasoconstriction Hyper-dynamic VS due to working hard to keep a semi normal BP
34
Progressive shock stage
Failure of compensatory mechanisms to maintain BP and fluid volume
35
Refractory stage of shock
Cell death Multisystem organ failure Irreversible Coma
36
What are the signs and symptoms of decreased cardiac output?
Weak pulses Cool extremities Organs start to have dysfunction Decreased urine output
37
What happens in shock
An event occurs causing a shock state Cells are deprived of oxygen and nutrients Decrease cellular function resulting in cell death Body responds through compensatory mechanisms Most shock types cause decreased blood pressure and and increase in heart rate and respiratory rate Distributive neurogenic shock causes bradycardia
38
How does neurogenic shock present?
With bradycardia due to activation of the parasympathetic nervous system
39
Other causes of hypovolemic shock
Diabetes insipidus Excessive diuresis, urination
40
Signs and symptoms of hypovolemic shock
Hypotension, tachycardia, tachypnea, altered/decreased level of consciousness, anxiety/restlessness, decreased urine output, delayed capillary refill, pale/cool/clammy skin, decrease cardiac output, decreased central venous pressure (cvs), increased systemic valvular resistance (SVR)
41
What is CVP
Central Venous Pressure Pressure in the right atrium measured with the use of a pulmonary artery catheter
42
SVR refers to…
Increased pressure in the extremities which put pressure back in the heart and then decreases cardiac output
43
4 likens of a Pulmonary Artery Catheter
Proximal (CVP) Distal (pulmonary artery wedge pressure) Thermistor (measure temp) Inflator (port used to inflate the balloon within the end of the pulmonary catheter)
44
Hypovolemic Shock Labs
CBC, HMG/HCT, Lactate and BMP Occult Blood (GI bleed)
45
Lactate levels
Increased lactate levels indicates the body is in anaerobic metabolism due to tissue hypoperfusion. Body is not receiving enough oxygen
46
Hypovolemic Shock Diagnostics
Labs CT scan Endoscopic- EGD and Colonoscopy Hemodynamic monitoring Decreased BP
47
Hypovolemic Shock Nursing interventions
Identify and treat cause Volume replacement before IV Vasopressors meds Monitor- VS, oxygenation, labs Promote venous return- elevate legs 10-12”, head slightly elevated, no transdelenburg positioning
48
Why does volume replacement come before Vasopressors?
You need to refill the vascular system before “squeezing” it with Vasopressors.
49
Why is transdelenburg contraindicated?
Increased the workload on the heart Increased ICP Increases pressure in the legs
50
Cardiogenic Shock
Pump issue- inadequate tissue perfusion due to impairment of ventricular contraction
51
Cardiogenic Shock most often due to
Inadequate systole (contracting) Usually adequate volume with inadequate ventricular contraction

Shock (8 decks)

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