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PRNU 131 > Shock > Flashcards

Shock Flashcards

1
Q

what is shock?

A

circulatory failure causes tissues to be hypoperfused. when the organs are not perfused, multiple organ dysfunction syndrome occurs and can lead to death

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2
Q

what are the types of shock?

A

hypovolemic
distributive
cardiogenic
obstructive

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3
Q

what is hypovolemic shock?

A

hypoperfusion occurs because overall body fluid is decreased

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4
Q

what can cause hypovolemic shock? (fluid loss)

A

hemorrhage
trauma
surgery
clotting issues
dehydration
vomiting, diarrhea, NG suction

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5
Q

what is distributive shock?

A

hypoperfusion occurs because of extreme vasodilation that makes it more difficult for vital organs to be properly perfused

blood pools in peripheral vascular system, causes pseudo hypovolemia

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6
Q

what can cause distributive shock?

A

sepsis
anaphylaxis
spinal cord injury (neurogenic)

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7
Q

what is cardiogenic shock?

A

hypoperfusion occurs because the heart fails to pump blood

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8
Q

what can cause cardiogenic shock?

A

MI
cardiac arrest
ventricular dysrhythmias
cardiomyopathy

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9
Q

what is obstructive shock?

A

hypoperfusion occurs because the heart’s ability to pump is impaired by a factor outside of the heart itself.

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10
Q

what can cause obstructive shock?

A

pulmonary embolism
cardiac tamponade
tension pneumothorax

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11
Q

what are cardiovascular symptoms of shock?

A

tachycardia, hypotension, flat neck veins
thready pulse, diminished peripheral pulse
slow cap refill

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12
Q

what are respiratory symptoms of shock?

A

increased respiratory rate, rapid and shallow
decreased O2 sat
cyanosis

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13
Q

what are GI symptoms of shock?

A

decreased motility and diminished bowel sounds
N/V
constipation

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14
Q

what are neuro symptoms of shock?

A

early shock has anxiety and restlessness
late shock has generalized weakness, coma

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15
Q

what are urinary symptoms of shock?

A

decreased UOP
increased specific gravity
increased BUN and creatinine

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16
Q

what are integumentary symptoms of shock?

A

cool, pale, mottled skin, cyanosis
moist, clammy
dry mouth

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17
Q

what is good MAP?

A

MAP should be >65 for proper perfusion

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18
Q

what ABG is characteristic of early shock?

A

respiratory alkilosis

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19
Q

what ABG is characteristic of late shock?

A

metabolic acidosis

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20
Q

why are lactate levels elevated with shock?

A

anaerobic metabolism is taking over because oxygen supply is not meeting demands of the body due to poor perfusion

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21
Q

what should urine output be?

22
Q

when are hemoglobin and hematocrit increased?

A

hypovolemia - less diluted in fluid

23
Q

when are hemoglobin and hematocrit decreased?

A

hemorrhage - lost with blood loss

24
Q

what are the stages of shock?

A

compensatory
progressive
irreversible

25
what are the findings of compensated shock?
normal BP tachycardia tachypnea/hyperventilation (cause of respiratory alkalosis) cold clammy skin decreased UOP confusion and anxiety
26
what are the findings of progressive shock?
systolic BP <90 with MAP <65 tachycardia >150 BPM with thready pulse rapid shallow respirations with crackles mottled skin with petechiae decreased UOP lethargy
27
what does progressive shock do in the body?
inflammatory response occurs capillaries leak increased need for mechanical ventilation AKI from decreased kidney perfusion clotting cascade activates hypermetabolic state
28
how is BP treated in shock?
fluid resuscitation vasoactive medications
29
what are the findings of irreversible shock?
systolic BP <90 with MAP <65 erratic heart rate cyanosis, requires intubation jaundice no UOP unresponsive
30
how to recognize shock early from BP?
systolic <90 MAP <65 systolic drops by 40 from baseline
31
when are vasoactive medications used?
when fluid therapy doesn't keep MAP above 65
32
what must be done when vasoactive medications are administered?
continuous VS monitoring doses titrated based on pt response do not stop abruptly best to give through central line
33
what side effect can come from using vasoactive medications?
necrosis of extremities - vasoconstriction decreases perfusion around capillaries
34
name vasoactive medications
epi, norepi, phenylephrine vasopressin dopamine dobutamine milrinone
35
what is the most common type of shock?
hypovolemic shock
36
what are external vs internal fluid losses?
external - trauma (shot or stabbed), surgical blood loss, vomiting internal - internal hemorrhage, ascites, third spacing
37
how is hypovolemic shock treated?
albumin for ascites and third-spacing blood products for hemorrhage treat underlying cause - stop fluid loss
38
assessing cardiogenic shock
monitor ECG look at lab work for electrolytes and troponin
39
how is cardiogenic shock treated?
correct underlying cause - stent, valve replacement, or fix electrolyte imbalances fluid therapy should never be a bolus vasoactive medications oxygenation pain control
40
signs of obstructive shock
hypotension tachycardia chest pain tachypnea, dyspnea hypoxia
41
how is obstructive shock treated?
pericardiocentesis used to relieve tamponade thrombolytics used to treat PE needle decompression used to treat tension pneumothorax
42
what is beck's triad (signs of cardiac tamponade)
hypotension JVD muffled heart sounds
43
what are the signature signs of tension pneumothorax?
chest pain, SOB absent lung sounds tracheal deviation
44
what is neurogenic distributive shock?
damage to nervous system impairs sympathetic tone body doesn't get message to vasoconstrict as needed, vascular system stays dilated
45
what are the signs of neurogenic shock?
BRADYCARDIA (unlike everything else) and hypotension dry, warm skin nausea confusion
46
what can cause neurogenic shock?
spinal cord injury spinal anesthesia
47
how to treat neurogenic shock
atropine for bradycardia large bore IV for rapid fluid infusion C-spine stabilization if pt has spinal cord injury elevate legs if it it caused by anesthesia vasoactive meds
48
what causes anaphylactic shock?
histamines and cytokine release causes systemic vasodilation
49
signs and symptoms of anaphylactic shock
can occur rapidly or hours after allergen exposure erythema, flushing, itching stridor, bronchospasm, dyspnea angioedema hypotension
50
managing anaphylactic shock
remove allergen remove items from swollen extremities elevate legs, but elevate HOB if airway is compromised IV epi, diphenhydramine, nebulizer IV fluids administer O2 via NRB, intubate if respiratory arrest CPR for cardiac arrest

PRNU 131 (18 decks)

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