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Med Surg 3 Exam 3 > Shock > Flashcards

Shock Flashcards

1
Q

What is shock

A

inadequate tissue perfusion, starts to kill the cells then organs start to fail

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2
Q

what is hypovolemic shock

A

a decrease in intravascular volume - too little circulating blood - decreases preload, venous return, stroke volume

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3
Q

what is cardiogenic shock

A

failure of the heart to pump effectively due to a cardiac factor like MI or decreases cardiac output/MAP

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4
Q

what is obstructive shock

A

impairment of the heart to pump effectively as a result of a non cardiac factor like cardiac tamponade, tension pneumothorax, PE, pulmonary artery stenosis

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5
Q

what is disruptive shock

A

vasodilation and increased capillary permeability - blood is not distributed correctly so it cant perfuse organs

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6
Q

what are the stages of shock

A

initial, compensatory, progressive, refractory

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7
Q

what happens in the initial stage of shock

A

decrease MAP, vascular constriction (so increase HR)

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8
Q

what happens in the compensatory stage of shock

A

body compensates to increase CO to restore tissue perfusion (increase vitals - decrease output)

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9
Q

what happens in the progressive stage of shock

A

compensatory mechanisms start to fail (decrease in MAP over 20), rapid weak pulse, cool moist skin, decreased O2

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10
Q

what happens in the refractory stage of shock

A

irreversible shock with organ failure, then more organ failure – death (toxic metabolites, MODS, DIC) non palpable pulse, cold dusky extremities, shallow respirations, unmeasurable O2

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11
Q

what are some causes/risk factors for hypovolemic shock

A

hemorrhage, ulcer, inadequate clotting, dehydration, severe vomiting/diarrhea, diuretic therapy, elderly, NPO status,

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12
Q

how is hypovolemic shock managed

A

fluid and blood replacement to restore volume, with normal saline, LR, plasma, RBCs, meds that vasoconstrict, trendelenburg, O2

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13
Q

what do vasoactive agents (norepinephrine) do for hypovolemic shock

A

increase peripheral resistance, increase venous return, increase myocardial contractility

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14
Q

what do positive inotropic agents (dobutamine, epinephrine) do for hypovolemic shock

A

strengthen cardiac contraction and increase CO

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15
Q

what does vasopressin do for hypovolemic shock

A

cause vasoconstriction, increase systemic vascular resistance - increase BP

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16
Q

what is cardiogenic shock

A

direct pump failure

17
Q

what are some risk factors for cardiogenic shock

A

MI, dysrhythmias, cardiomyopathies, myocardial degeneration, valvular rupture or stensosis

18
Q

what are the ss of cardiogenic shock

A

increase HR/RR, decrease BP, cool clammy skin, oliguria, cyanosis, confusion , PE, PAP increases

19
Q

How is cardiogenic shock managed

A

O2, angioplasty/stenting, balloon pump, pulmonary artery catheter insertion, pain managed, vasodilator, diuretics

20
Q

what is septic shock

A

systemic inflammatory response from sepsis, endotoxins cause vasodilation, inflammation, and capillary permeability

21
Q

Patient is in septic shock if they require vasopressor therapy to maintain…..

A

MAP > 65 mmHg, and lactate is > 2mmol/L

22
Q

what are some risk factors for septic shock

A

immunosuppression, cancer, infants, elderly, malnourished, injury, chronic illness, central lines, foley catheters

23
Q

what are some ss of septic shock

A

ARDS, MODS evident, Poor clotting with uncontrolled bleeding, Low WBC count, Cold, clammy skin, Increased risk of death

24
Q

what is included in the septic bundle

A

within 1 hour, draw lactate level/blood cultures, broad spectrum antibiotics, fluids, vasopressors, urine cultures, ches x ray, sputum, and wound culture,

25
Q

what is anaphylactic shock

A

exposed to an antigen, IgE antibodies bine and create inflammatory response

26
Q

what are some ss of anaphylactic shock

A

hypotension, pruitits, rhinorrhea, tachycardia, bronchospasms (stridor), hives

27
Q

how is anaphylactic shock treated

A

remove antigen, o2, meds (epinephrine, diphenhydramine), albuterol, IV fluids

28
Q

what are some risk factors for neurogenic shock

A

head trauma, spinal cord injury, anesthesia, meds

29
Q

what are some ss of neurogenic shock

A

dry,warm skin, hypotension, bradycardia, impaired breathing

30
Q

what is the tx for neurogenic shock

A

immobilize, restore sympathetic tone, IV fluids

31
Q

what are the meds used to tx neurogenic shock

A

dopamine, atropine, norepinephrine, phenylephrine (increases BP not HR)

Med Surg 3 Exam 3 (6 decks)

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