Shock Flashcards
what type of shock has inadequate circulating volume?
hypovolemic shock
Causes of hypovolemic shock
sudden blood loss from trauma, severe dehydration, significant fluid shifts from burns
decreased blood volume, causes decreased venous return, causes decreased SV, causes decreased C.O. which causes decreased perfusion, is what type of shock?
hypovolemic shock
increased HR, decreased BP, decreased C.O., increased SVR, decreased wedge, and decreased CVP are for what type of shock?
hypovolemic shock
Treatment for hypovolemic shock
fluid (crystalloids and isotonic- for burn pt give LR, for N/V/D give saline- then move to blood products if necessary like albumin and ptls), warm fluids, observe for a response to therapy and fluid overload
what position to place a patient in hypovolemic shock in?
modified trendelenburg position
what type of shock is extreme congestive heart failure
cardiogenic shock
causes of cardiogenic shock
Left ventricular MI, valvular disease, dysrhythmias, cardiomyopathy, and sort of heart issue
decreased cardiac contractility leads to decreased SV and C.O., which leads to pulmonary congestion, decreased systemic tissue perfusion, and decreased coronary artery perfusion is indicative of what type of shock?
cardiogenic shock
thready, rapid pulse; narrow pulse pressure; distended neck veins; arrhythmias; chest pain; cool, pale, moist skin; oliguria; decreased mentation; enlarged heart, pulmonary congestion; dyspnea; increased RR; insp rales, and wheezing; decreased PaO2; respiratory alkalosis are all S/S of what type of shock?
Cardiogenic shock
increased HR, decreased BP, decreased C.O, increased SVR; increased wedge and CVP are for what type of shock?
cardiogenic shock
goals of treatment for cardiogenic shock?
increase myocardial oxygen delivery, maximize C.O by management of fluids, monitor and replace elctroolytes, avoid arrhythmias/treat them, positive inotropes and decreased left ventricular work load, give vasoconstrictors
what medications do you give a patient in cardiogenic shock?
vasoconstrictors (nerepi, phenylephrin, vasopressin), inotropes (amrinone, milrinone, dobutamine, dopamine), vasodilators (nitroprusside, nitroglycerin, ACE inhibitors)
What type of shock is an allergic reaction to a specific antigen?
anaphylactic shock
penicillin, sulfa drugs, NSAIDS, narcotics, blood products, dies, eggs, milk, nuts, fish, bees, wasps, latex are all common antigens for what type of shock?
anaphylactic shock
puffy face or hands, itching/hives, anxiety, restlessness, dyspnea, wheezing, stridor, flushing, diaphoresis, tachycardia, weakening pulses, poor cap refill, increased RR, laryngeal edema, hypotension, bronchospasms are S/S of what type of shock?
anaphylactic shock
increased HR, decreased BP, decreased C.O., decreased SVR, decreased wedge and CVP are for what type of shock?
anaphylactic shock
management of anaphylactic shock
oxygen, benadryll, possilby sup-Q epinephrine to bronchodilate and vasoconstrict, corticosteroids, bronchodilators, vasoconstrictors, positive inotropes
Nursing management of anaphylactic shock
maintain airway, provide supplemental oxygen, intubate or trach if necessary, monitor response to treatment, patient education on avoidance of antigen and use of epi-pen
loss or disruption of sympathetic tone causing peripheral vasodilation and decresed tissue perfusion, loss or disruption of the autonomic nervous system causes bradycardia, dysrhythmias is what type of shock?
neurogenic shock
most common cause of neurogenic shock?
spinal cord injury above T6
vasodilation, maldistribution of blood volume leads to decreased venous return which leads to decreased SV and C.O., and decreased perfusion. this is indicative of what type of shock?
neurogenic shock
decreased HR, decreased BP, decreased C.O., decreased SVR, decreased wedge and CVP are indicative of what type of shock?
neurogenic shock
management of neurogenic shock
fluid administration to support BP, vasopressors, atropine for bradycardia, pacemaker if bradycardia persists
Shock that initiated by an infection?
Septic Shock
presence of viable bacteria in the blood
bacteremia
presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention
Multiple Organ dysfunction syndrome (MODS)
systemic response to infection, characterized by 2 or more of the following:
- T> 38c or < 36c
- HR >90
- RR>20 or PaCO2 12,000 or 10% bands (immature RBC)
Sepsis
Sepsis with hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include all of the above
Septic Shock
the systemic inflammatory response to a variety of severe clinical insults. has 2 or more of the following:
- T> 38c or 90
- RR>20 or PaCO2 12,000 or 10% bands (immature RBC)
SIRS- Systemic Inflammatory Response Syndrome
Inflammatory response to infection:
- cytokines are released form WBC- they produce vasodilation, hypotension, increased cap permeability, fever, and decreased myocardial contractility
- Neutrophils are released- they adhere to vessel walls and travel to site of infection, Cytokines released increase inflammatory response and destroy organisms. The same cytokines damage endothelium, which releases more cytokines.
- bacteria and neutophils release inflammatory factors such as tissue factor
- Tissue factor stimulates a procoagulant state and formation of fibrin clots.
- Microcirculatory clots form that inhibit tissue perfusion. this is pivitol for progression from sepsis to SIRS, MODS, and death
What shock
Septic shock
mental status change, increased RR, edematous but intravascularly depleted, spontaneous bleeding, C.O. unusually high, SVR unusually low are S/S of what type of shock
Septic Shock
HR increased, BP decreased; C.O. increased/decreased, SVR decreased, wedge and CVP decreased are indicative of what type of shock?
Septic Shock
Treatment goals for Septic shock
maximize O2 delivery; halt the exaggerated inflammatory response; prevention (handwashing aseptic technique); early identification and tx of infection; aggressive restoration of intravascular volume; maintenance of adequate C.O., maintenance of adequate ventilation and oxygenation; restoration of coagulation balance, maintenance of appropriate metabolic environment
hypoperfusion, hypercoagulability, activation of the inflammatory response, shock is an acute widespread process of impaired tissue perfusion are common features of what?
Shock
