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nur 112 > Shock > Flashcards

Shock Flashcards

1
Q

Shock

A
  • Life threatening- results in death if untreated
  • Caused by inadequate tissue perfusion
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2
Q

Pt. presents in shock with hypotension. What would you expect
the body to do in attempt to maintain homeostasis? Select all
1. Decrease heart rate

  1. Increase heart rate
  2. Decrease resp. rate
  3. Increase resp. rate
A

2 & 4

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3
Q

Adequate Tissue Perfusion (B4)
Requires:

When 1 component is impaired,

A

1.Adequate cardiac pump (heart)
2.Intact circulatory system
3.Sufficient blood volume

inadequate blood flow to tissues result
in impaired O2 & nutrient delivery to cells
Cellular ischemia leads to cellular death and organ failure

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4
Q

Who is at increased risk of shock?

A
  • Older adults
  • Patients with chronic illness ex: diabetes, CKD, HF
  • Patients who are receiving immunosuppressive therapy
  • Malnourished patients
  • Debilitated individuals
  • Malnourished patients
  • Debilitated individuals
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5
Q

Classification of Shock
*1. Maldistribution of blood flow ( 3)

  1. Low blood flow (3)
A

Classification of Shock (B4)
* Maldistribution of blood flow
–Septic
–Anaphylactic
–Neurogenic

  • Low blood flow
    –Cardiogenic
    –Hypovolemic
    –Obstructive
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6
Q

Maldistribution of blood flow-

A

loss of blood vessel tone. Leads to
massive pooling in venous and capillary beds and decreases
venous return.

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7
Q

____________ fluid moves out of vascular space
and is unavailable to maintain blood flow

A

relative fluid loss

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8
Q

Obstructive shock

A

physical obstruction restricting the filling of the
heart

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9
Q

shock is basically

A

VASODILATION OF VESSEL

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10
Q

Septic Shock

DEFINE:

  • Myocardial depression =

NURSING INTERVENTIONS

A
  • Vasodilation
    *May be normovolemic
    *Acute hypotension
    *Inflammatory response-capillary dilatation and permeability,
    platelet aggregation (exaggerated effect)

*Inflammatory response-capillary dilatation and permeability,
platelet aggregation (exaggerated effect)
* Maldistribution of blood flow
* Myocardial depression
*Decreased E/F
*Respiratory Failure, organ shutdown

culture ( broad -spectrum antibiotics ) WE GOTTA START SOMEWHERE.

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11
Q

Cardiogenic Shock

NURSING interventionS

A

–Severe heart failure seen with massive damage to left ventricle with
an MI

Angioplasty /stents/bypass/medication ( b2/calcium)/ valve replacement

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12
Q

Hypovolemic Shock = define

Absolute hypovolemia-

vs

Relative hypovolemia-

A

Decreased intravascular volume due to external fluid loss or
internal fluid shift

Absolute hypovolemia-fluid loss from body (blood or other body fluid)
Hemorrhage, Diarrhea, Vomiting, Excessive sweating,
GI bleed, Excessive diuresis

Relative hypovolemia- fluid loss from the vascular space
Ascites, Anasarca, Internal bleeding, vasodilation

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13
Q

The patient suffers a massive MI. Which type of shock should the
nurse be aware of?
1. Hypovolemic
2. Neurogenic
3. Cardiogenic
4. Septic

A

3

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14
Q

Tissue & organ perfusion depend upon mean arterial pressure (MAP). MAP should exceed _______ mm Hg for cellular oxygenation and ATP
metabolism ( state equation)

A

70-100 mm

MAP= SBP plus 2(DBP)

3

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15
Q

Cardiac Output equation

A

SV * HR

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16
Q

4 Stages of Shock (B7)

A
  1. Initial
  2. Compensatory
  3. Progressive
  4. Refractory (Irreversible)
17
Q

Initial stage of Shock

approx. ____blood loss (750 ml)

______ Liter

A

Initial stage S&S
–VS WNL
–approx. 10-15% blood loss (750 ml)
–5-6 Liter= normal blood volume
–very subtle changes
–urinary output WNL

–skin pink in color
–normal cap refill

18
Q

Compensatory Stage
* Fight or Flight response-

  • ________ blood loss, ________ ml
A

SNS stimulated to produce epinephrine and
norepinephrine, HR increases, vasoconstriction occurs so BP is
maintained, then decreasing.

  • 20-30% blood loss, 1500ml or 1.5L
19
Q

Compensatory Stage (B7)

  • ________ not a good indicator; may be WNL
  • Changes in LOC and narrowing pulse pressure (<_____) is an earlier
    indicator of shock than BP
  • Increased _______
  • ___________ skin
  • Decreased ____________ sounds
  • ____________ increase
A
  • BP- not a good indicator; may be WNL
  • Changes in LOC and narrowing pulse pressure (<30) is an earlier
    indicator of shock than BP
  • Orthostatic hypotension
  • Blood shunted from GI tract, kidneys, skin to heart and brain
  • Increased thirst
  • Cold clammy skin
    **except early sepsis
  • Decreased bowel sounds
  • Respirations increase
  • Urine output decreased d/t ADH (retention aids in increase in fluid
    volume) foley & hrly output
  • Confused, restlessness, anxious, agitated, combative, do not sedate
    (masks deterioration)
  • Prognosis good if detected now
  • Must look for S&S other than BP as indicator of early shock
20
Q

Progressive Stage (B8)

A
  • Mechanisms that regulate BP can no longer compensate- system
    exhausted
  • Noticeable clinical deterioration
  • MAP<60
  • Hypotensive- systolic below 90mmHg or a decrease in systolic of 40
    mmHg
  • Unable to get BP, need automatic cuff or arterial line with con’t BP
    monitoring
  • Unable to get BP, need automatic cuff or arterial line with con’t BP
    monitoring
  • Pulse pressure<20
  • 40% blood loss; 2000ml or 2L
    Progressive Stage (B8)
  • Decreased cardiac output- leads to anaerobic metabolism- lactic acid
    builds up- metabolic acidosis occurs
  • HR> 150, chest pain, MI, arrhythmias, EKG changes, elevated
    cardiac enzymes
  • Rapid shallow respirations, crackles, alveoli collapse, CO2 retention
  • Decreased perfusion to brain- leads to confusion- lethargy or listless
    and agitated, dec responsiveness to stimuli
    Progressive Stage (B8)
  • Output 5-15ml/hr, increased BUN, serum creatinine, AKI
  • Decreased liver perfusion leads to decreased ability to metabolize
    meds and waste. Lactic acid, ammonia, bilirubin and liver enzymes
    increase, bacteria not filtered from blood
    Progressive Stage (B8)
  • Dry Mucus membranes
  • Skin mottled, cold, petechiae, ecchymosis, jaundiced
  • Capillary refill >2 sec
  • GI ischemia leads to stress ulcers, GI bleeding, gut bacteria may
    enter blood stream
  • Bowel sounds hypoactive or decreased
  • Disseminated Intravascular coagulation (DIC)
21
Q

Refractory (Irreversible) Stage (B9)

A
  • Vasoconstriction cuts off blood supply long enough that ischemia
    turns to infarction, multiple organ dysfunction or failure. The more
    organs involved the worse the prognosis.
    –Pulse pressure 0-10
    –BP is very low and needs pharmacological support
    –>40% blood loss, 2000 or 2L
    –Unconscious
    –Dilated pupils with minimal or absent response to light
    –Sepsis
    –Cap refill > 3 sec
22
Q

Refractory (Irreversible) Stage

A
  • Intubation & mechanical ventilation
  • Renal failure- dialysis
  • DIC
  • Organ Failure
  • Death
23
Q

Treatment of Shock

A
  1. Treat underlying cause- stop the bleeding, vomiting, diarrhea etc
  2. Restore intravascular volume/Fluid Resuscitation
    * Administer Normal Saline (change in packet)
  • Administer blood or blood products
    Treatment of Shock (B9)
  • Whole Blood- restores blood volume and O2 carrying capacity of
    blood
  • Whole Blood- restores blood volume and O2 carrying capacity of
    blood
  • Packed RBC- contains RBC and 20% plasma, no clotting factors,
    restore O2 carrying ability, decreased risk of fluid volume overload
  • Fresh frozen plasma- liquid part of blood separated from cells.
    Expands circulating volume
24
Q

Administer blood or blood products/ Treatment of Shock

A
  • Whole Blood- restores blood volume and O2 carrying capacity of
    blood
  • Whole Blood- restores blood volume and O2 carrying capacity of
    blood
  • Packed RBC- contains RBC and 20% plasma, no clotting factors,
    restore O2 carrying ability, decreased risk of fluid volume overload
  • Fresh frozen plasma- liquid part of blood separated from cells.
    Expands circulating volume
25
Q

Crystalloids

A

such as Lactated Ringers, Hypertonic Saline, and 0.9% Normal Saline are administered for treating shock and to restore intravascular volume.

26
Q

Redistribution of Fluid-

A

position in Modified Trendelenburg position.
Lower extremities elevated to 45 degrees, knees straight, trunk
horizontal, head on flat pillow.

27
Q

Septic Shock Treatment

A

In treating Septic Shock, massive fluids, cultures, antibiotics, and hemodynamic pharmacologic support with vasopressors and vasopressin are recommended.

28
Q

Administer IV vasoactive medications:

A

–Inotropic
–Vasoconstrictors
–Antiarrhythemias
–Vasodilators

nur 112 (23 decks)

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