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critical care > shock > Flashcards

shock Flashcards

1
Q

what does cardiogenic shock result from?

A

decreased myocardial contractility

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2
Q

symptoms of cardiogenic shock?

A

cool/pale skin
altered mental status
thready pulse
crackles/dyspnea
dec. output!

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3
Q

heart rate in cardiogenic shock

A

high

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4
Q

BP/MAP in cardiogenic shock

A

low

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5
Q

CVP in in cardiogenic shock

A

high

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6
Q

wedge in cardiogenic shock

A

high

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7
Q

SVR in cardiogenic shock

A

high

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8
Q

CO in cardiogenic shock

A

low

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9
Q

reason for hemodynamic change in cardiogenic shock

A

sympathetic/RAAS response

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10
Q

medical management in cardiogenic shock

A

+ inotropes (dobutamine, dopamine, digoxin, milrinone)
diuretics
nitrates
opioids
vasopressors

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11
Q

nursing interventions in cardiogenic shock

A

afterload reducer
preload reducer
HOB elevated
intraaortic balloon pump

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12
Q

surgical intervention for cardiogenic shock

A

intraaortic balloon pump

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13
Q

complications in cardiogenic shock

A

dysrhythmias
med dependence (dobutamine)
acute tubular necrosis (kidney failure)

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14
Q

what is important to remmebr about intraaortic balloon pump for cardiogenic shock

A

goes through fem
bleeding/pulse concern
increases O2 supply and decreases demand

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15
Q

in terms of shock, which kinds of shock are “pool” “pump” and “pipe” problems

A

cardiogenic = pump problem
hypovolemic = pool
early septic = pipe

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16
Q

what does hypovolemic shock result from?

A

-dec. blood/intravascular volume
-internal & external fluid shifts

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17
Q

symptoms in hypovolemic shock

A

cool/pale! & diaphoretic!
dec. LOC!
tachycardia
hypoTN
postural vs
tachypnea
oliguria

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18
Q

heart rate in hypovolemic shock

A

high

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19
Q

BP/MAP in hypovolemic shock

A

low (no volume to pump)

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20
Q

CVP in hypovolemic shock

A

low

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21
Q

wedge in hypovolemic shock

A

low

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22
Q

SVR in hypovolemic shock

A

high (compensation)

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23
Q

CO in hypovolemic shock

A

low (no volume)

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24
Q

why are there hempdynamic changes in hypovolemic shock

A

vasoconstriction and compensation from sympathetic/RAAS

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25
Q

med treatment in hypovolemic shock

A

IV FLUID OR BLOOD TO REPLACE VOLUME
vasopressors??

26
Q

nursing interventions in hypovolemic shock

A

modified trendelenburg

27
Q

complications in hypovolemic shock

A

tubular necrosis
shock liver from dec. perfusion

28
Q

what is early septic shock from?

A

release of toxins from bacteria -> damage to vascular endothelium -> water leak
-altered vascular permeability

29
Q

s/sx of early septic shock

A

warm/dry/flushed skin!
fever
increased WBCs

30
Q

HR in early septic shock

A

high

31
Q

BP/MAP in early septic shock

A

slightly low

32
Q

CVP in early septic shock

A

low

33
Q

wedge in early septic shock

A

low

34
Q

SVR in early septic shock

A

low
(bacteria causes vasodilation)

35
Q

CO in early septic shock

A

normal
(or high)

36
Q

reasons for hemodynamic changes in early septic shock

A

altered vascular permeability, bacteria causes vasodilation
(protein leakage -> fluid follows)

37
Q

medical management of early septic shock

A

**fluids/antimicrobials
**vasopressors and low dose steroids after fluids

38
Q

nursing interventions for early septic shock

A

**cooling blanket/antipyretic
ventilation

39
Q

which forms of shock look similar symptomatically?

A

cardiogenic and late septic

40
Q

what does late septic shock come from?

A

progression of early shock, irreversible vascular issues
**contractility worsens

41
Q

s/sx of late spetic shock

A

**cold/clamy
diaphoretic
dec. LOC
dec. urine
signs of increased preload

42
Q

HR in late spetic shock

A

high

43
Q

BP/MAP in late spetic shock

A

severely low

44
Q

CVP in late spetic shock

A

high

45
Q

wedge in late spetic shock

A

high

46
Q

SVR in late spetic shock

A

high (from vasopressors and compensation)

47
Q

CO in late spetic shock

A

very low

48
Q

med management of late spetic shock

A

+ inotropes (dobutamine dopamine)
vasopressors
corticosteroids
antibiotics

49
Q

nursing interventions for late spetic shock

A

supportive care like DNR/CC

50
Q

complications of late septic shock

A

MODS
death

51
Q

which lab value is high in sepsis

A

lactate

52
Q

what are the 3 kinds of distributive shock?

A

septic, anaphylactic, neurogenic

53
Q

indicatord of shock

A

MAP < 60
high lactate
high bicarb (ABGs)

54
Q

what are the 3 stages of shock? (progression order)

A

compensatory, progressive, refractory

55
Q

what is a rare form of shock from massive dilation of blood vessels as a result of loss of sympathetic tone

A

neurogenic shock

56
Q

which form of shock has signs of hypotension, bradycardia, and hypothermia?

A

neurogenic

57
Q

treatment of neurogenic shock

A

treat cause
volume replacement
vasopressors

58
Q

pathways used to recognize sepsis

A

SIRS and qSOFA

59
Q

what are the 3 aspects of qSOFA

A

low bp
altered mentation
high resp rate

60
Q

what 4 aspects make up the SIRS criteria

A

temp >38
HR >90
RR >20 OR PaCO2 <32
WBC >12000

61
Q

when are blood products administered?

A

when hgb is 7.0-9.0 or lower

critical care (23 decks)

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