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NUR 230 > Shock > Flashcards

Shock Flashcards

1
Q

shock

A

Life‐threatening condition in which tissue perfusion is inadequate to
deliver oxygen and nutrients to support cellular function
* Affects all body systems
* May develop rapidly or slowly
* Any patient with any disease state may be at risk for developing
shock
* Regardless of the initial cause of shock, certain physiologic responses
are common to all types of shock: hypoperfusion of tissues,
hypermetabolism, and activation of the inflammatory response
central perfusion problem

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2
Q

patho of shock

A

Decreased effective
tissue perfusion
(hypoperfusion, low
MAP)
Oxygen delivery less
than oxygen demand
Cells switch from
aerobic to anerobic
metabolism to make ATP
Leads to a buildup of
lactic acid and metabolic
acidosis
Acidosis and decreased
ATP causes cellular
dysfunction and cell
death
Without
treatment/intervention,
result is organ failure
and death

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3
Q

what is map

A

Average
blood pressure in a person’s blood vessels during a
single cardiac cycle (MAP= CO x SVR)

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4
Q

map goal

A

> or equal to 65 mm Hg

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5
Q

vasodilation makes map….

A

decrease

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6
Q

vasoconstriction makes map….

A

increase

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7
Q

factors affecting map

A

Total Blood Volume
* Cardiac Output Pump
* Size and Integrity of the vascular bed
(capillaries) Blood vessels

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8
Q

effects of low map

A

lack of perfusion
low 02 in blood
low bp

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9
Q

How does the
body sense and
respond to a low
MAP?

A

baroreceptors and chemoreceptors

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10
Q

what are the kidneys doing in shcok

A

fluid retention
retaining na
vasoconstriction…angiotensin

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11
Q

nsg assesment of shock

A

Head‐to‐Toe Assessment for Perfusion Status
* Mean Arterial Pressure (MAP)
* Pulse Pressure
* Passive Leg Raising (PLR)
* Invasive hemodynamic monitoring
* Central venous pressure (CVP)
* Central venous oximetry (ScvO2)
* Pulmonary artery (PA) monitoring
* Arterial line (A‐line)

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12
Q

what is pulse pressure

A

diastolic-systolic
diastolic increases
narrowed pulse pressure
<30-40
early stage of shock

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13
Q

compensatory stage

A

Switch from aerobic to anerobic metabolism
*Compensatory mechanisms effective to
maintain cardiac output
*Shunting of blood from non‐vital to vital
organs
*BP normal; pulse pressure may be narrow

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14
Q

progressive stage

A

Hypotension; MAP < 65 mm Hg
*Compensatory mechanisms fail
*Hypoperfusion to all organs
*Organ systems decompensate

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15
Q

irreversable (refractory) stage

A

Persistent hypotension and hypoperfusion
*Multiple Organ Dysfunction Syndrome
(MODS)
*Multiple Organ Failure
*Client will ultimately die

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16
Q

compensatory management

A

Treat underlying cause
* Fluid replacement
* Supplementation oxygen,
decrease patient anxiety
* Maintain BP and tissue perfusion
* Frequent assessment (subtle
changes)
* LOC, I&O, respiratory and heart
rate, BP (MAP of 65 mm Hg or
less, narrowing or decreased
pulse pressure)
* Promote safety (advanced
directives)

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17
Q

progressive management

A

Treat underlying cause
* Restore tissue perfusion with fluid
management
* Respiratory support
* Nutritional support for energy
* Assessment (subtle changes)
including ABGs, hemodynamic
monitoring, ECG monitoring,
mental status changes, and serum
electrolytes
* Oral care if on ventilator to
prevent VAP
* Promote rest and comfort to
reduce stress, decreased chance
of postintensive care syndrome

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18
Q

irreversable management

A

Treat underlying cause
* Respiratory support
* Circulatory support
* Nutritional support
* Experimental treatments
* Simple comfort measures
(palliative care)
* Support and education for the
friends and family
* Be honest regarding prognosis

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19
Q

what do inotropic meds do

A

improve contractility, increase stroke volume, increased co

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20
Q

disadvantages to inotropes

A

increase o2 demand of heart`

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21
Q

common inotrope

A

dobutamine

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22
Q

vasodilators

A

reduce preload and afterload
reduce o2 demand of heart

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23
Q

disadvantage to vasodilators

A

cause hypotension

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24
Q

common vasodilator used

A

nitroglycerin

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25
Q

vasopressor agents

A

increased bp by vasoconstriction

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26
Q

disadvantags to vasorpressors

A

increase afterload therby increasing cardiac workload: compromise perfusion to skin, kidneys, gi tract

27
Q

common vasopressor

A

norepi

28
Q

what is hypovolemic shock

A

lack of volume (due to volume lost)

29
Q

what is cardiogenic shock

A

heart itself not pumping effectively (pump failure)

30
Q

distributive shock

A

volume displaced (vasodilation)q

31
Q

neurogenic shock

A

loss of sympathetic response, volume pools in periphery

32
Q

anaphylactic shock

A

antigen‐antibody reaction, vasodilatation and increased
capillary permeability, volume pools in periphery

33
Q

septic shock

A

systemic infection, inflammatory response causes vasodilation and
capillary leakage, volume pools in periphery

34
Q

external risk factors hypovolemic shock

A

Trauma, surgery, vomiting, diarrhea,
diuresis, DKA, diabetes insipidus

35
Q

internal risk factors hypovolemic shock

A

Hemorrhage, burns, ascites, peritonitis,
dehydration

36
Q

initial s/s hypovolemic shock

A

 HR
*  diastolic BP
*  pulse pressure
*  pulses

37
Q

s/s progressive hypovolemic shock

A

Orthostatic changes
* decreased UO
* decreased BP; SBP, pp & increased DBP
* decreased pulse ox
* Pale, cool skin
* Delayed capillary refill
* increased RR
* Thirst
* ∆ LOC

38
Q

diagnostic tests for hypovolmeic shock

A

decreased HCT, HGB if caused by
hemorrhage
* increased HCT, HGB if caused by
dehydration or fluid shift
* increased K+, Na+, Cr, BUN
* increased lactic acid
* ABG
* Radiology/x-rays/scans
to identify source of
bleeding (if hemorrhage)
* Hemoccult, gastroccult
* decreased CO, decreased preload

39
Q

treatment hypovolemic shock

A

Control bleeding
* Possible surgery
* Fluid resuscitation
* Large bore IVs/Central line
* Crystalloids & Colloids
* Transfusions PRBCs, FFP, platelets
* Use warmer/warm fluids
* Prevent complications of ischemia
* Supplemental Oxygen
* Mechanical Ventilation
* Drug therapy
* Vasoconstrictors (vasopressors)
* Treat underlying cause- (ex: insulin for DKA;
antidiarrheals/antiemetics for N/V/D)

40
Q

what to monitor during hypovolemic shock treatment

A

LOC
* VS
* Hemodynamics
* Pulses, cap refill, skin
* I&O
* Labs
* Watch for S&S of fluid overload

41
Q

causes of cardiogenic shock

A

Coronary
* Acute MI
* Noncoronary
* Stress on myocardium
* Ineffective myocardial
function

42
Q

s/s of cardiogenic shock

A

increased HR
* Narrowed pulse pressure
* Orthostatic Hypotension
* decreased O2 sat
* Pale, cool, clammy skin
* Cyanosis
* Delayed cap refill
* increased RR, dyspnea, rales
* decreased UO
* ∆ LOC

43
Q

diagnostic tests for cadiogenic shock

A

EKG
* Cardiac enzymes
* CXR
* Hemodynamic monitoring
* Electrolytes, BUN/Cr, liver enzymes
* CBC, coagulation tests
* ABG, lactic acid
* Echo
* Cardiac cath

44
Q

cardiogenic shock treatment

A

Oxygen or ventilation support
* Depends on overall client condition/signs & symptoms
* Cautious administration of small fluid boluses
* Monitor for fluid overload
* Positive Inotropes (dobutamine)
* Vasodilators (nitroglycerin)
* Vasopressors (epi/norepi, vasopressin)
* Diuretics (furosemide)
* PTCA/Revascularization
* IABP
* LVAD

45
Q

nsg management of cardiogenic shock

A

identify at risk pts
promote adequate perfusion of heart muscle
conserve to energy
promptly relieve chest pain
administer o2
monitor hemodynamics
anticipate meds, iv fluids, and equipment
report abnormal labs quickly
assess cardiac and resp status often
assess cardiac rhythm often
report changes immediatly

46
Q

patho of distributive shock

A

precipitating event
vasodilation
active inflammatory resonse
maldistribution of intravascular volume
decreased venous return
decreased co
decreased tissue perfuison

47
Q

risk factors for sepsis and septic shock

A

Immunosuppression
* Extremes of age (<1 y and >65 y)
* Malnourishment
* Chronic illness
* Invasive procedures
* Emergent and/or multiple surgeries
* Medical devices

48
Q

sirs criteria

A

Temperature >38.3°C or 101°F, < 36°C or 96.8°F
* Tachycardia
* Tachypnea
* WBC’s >12 00/mm3 or <4000/mm3 or >10% immature
bands
* Short duration of this phase, may be missed

49
Q

initial clinical manifestations of septic shock

A

Hyperthermia, warm flushed skin
* Tachycardia
* Bounding pulses
* Hypotension with decreased urine output
* Nausea, vomiting, decreased GI motility
* Hepatic dysfunction‐ increased bilirubin, decreased platelets
* Hypercoagulability‐ DIC
* Hypermetabolism‐ increased glucose and insulin resistance
* Subtle changes in mental status

50
Q

later clinical manifestations in septic shock

A

BP continues to drop; cool, mottled skin; no urine output; multiple organ dysfunction with no
response to treatment; bleeding due to DIC

51
Q

septic shcok treatment

A

SEPSIS RESUSCITATION BUNDLE
* AFTER CULTURES DRAWN- blood
cultures + urine/sputum cultures
* Broad Spectrum IV Antibiotics
* Serum Lactate levels (increased)
* Procalcitonin level (increased)
* IV crystalloids- 30mL/kg bolus
* Hypotension
* IV vasopressors (norepinephrine)
* Colloids
* Clotting problems
* (increase)D-dimer, FSP, PT/PTT
* (decrease )fibrinogen, platelets
* Heparin
* Blood replacement
* PRBCs, FFP, clotting factors, platelets
* Nutritional support
* Stress ulcer prevention
* SEPSIS MANAGEMENT
BUNDLE
* Low dose steroids
* Insulin drip
* Mechanical ventilation
* SEPSIS is a rapidly progressing
emergency!

52
Q

neuogenic shock risk factors

A

Spinal Cord Injury
* Spinal Anesthesia
* Depressant action
of medications

53
Q

neurogenic shock patho

A

disruption of sns
loss of sympathetic tone…pns response
venous and arterial vasodilation
decreased venous return
decreased stroke volumne
decreased co….decreased hr
decreased cellular o2 supply
dedcreased tissue perfusion
impaired cellular metabolism

54
Q

neurogenic shock

A

Cardiovascular effect due to loss of autonomic function
* Peripheral vasodilation and venous pooling
* Bradycardia
* Hypotension
* Decreased CO
* Core Hypothermia (with warm, dry skin below level of injury)

55
Q

treatment for neurogenic shock

A

Spinal immobilization
* C‐ Spine Precautions
* Surgery
* Hypotension
* IV volume replacement
* IV vasoconstrictors
* Oxygen therapy
* Ventilatory Support
* Bradycardia
* IV Atropine
* Pacer
* DVT Prevention
* Warm blankets
* Monitor for hypo/hyperthermia

56
Q

risk factors for anaphylactic shock

A

History of medication sensitivity
* Prescription of new medication
* Transfusion reaction
* History of reaction to insect
bites/stings
* Food allergies
* Latex sensitivity

57
Q

patho of anaphylactic shcok

A

antigen
antibiody
compliment, histamine, kinins, prostaglandins
increased cap refill, peripheral vasodilation, constriction of extravascular smooth muscle
extravascular fluids, decreased svr
edema, relative hypovolemia
decreased co
decreased tissue perfusion
impaired cellular metabolism

58
Q

anaphylactic shock s/s

A

Itchy, urticaria, skin rash
* Swelling lips & tongue
* Wheezing or stridor
* Tightness in chest – SOB
* Bronchospasm
* GI distress- pain, N/V
* Headache, lightheadedness, feeling of impending doom, decreased LOC
* Hypotension
* Tachycardia & arrhythmia; can progress to cardiac arrest

59
Q

treamtnet anaphylactic shock

A

Airway/Breathing
* High flow O2 via NRB mask
* High Fowler’s position
* Intubation & mechanical ventilation
* Epinephrine IM- 1:1000 concentration
* Diphenhydramine (Benadryl) IV
* H2 receptor antagonist (famotidine) IV
* Steroids IV
* Hydrocortisone
* Methylprednisolone
* Albuterol nebulizer
* Cardiac arrest- CPR

60
Q

invasive hemodynamic monitoring

A

Indicated for critically ill clients
* Requires informed consent
* Nurse prepares pressure monitoring system
* Catheter with infusion system
* Transducer
* Monitor

61
Q

nsg considerations central lines

A

Post‐insertion‐ CXR, auscultate lung sounds
Record and trend values; Observe waveforms
Assess that sutures are intact

62
Q

complications with central lines

A

Infection
* Cover with sterile, occlusive dressing
* Assess for redness, swelling, drainage, firmness
(induration)
* Ventricular Arrythmias
* Thrombus/ embolus at catheter site
* Bleeding to site
* Pulmonary Infarction/ rupture
* Air emboli‐ position client on L side + head down

63
Q

arterial catheter complications

A

Bleeding
* Infection
* Pain
* Arterial spasms
* Obstruction
* Distal infarct
* Air emboli

64
Q
A

NUR 230 (16 decks)

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