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NURS 428: Evolution > Shock > Flashcards

Shock Flashcards

Exam 3

1
Q

ShockIntroduction:

What is it an activation of?

A

Activation of the sympathetic nervous system, inflammatory response, and the immune system

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2
Q

ShockIntroduction:

What is it a state of?

A

State of hypoperfusion

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3
Q

ShockIntroduction:

What does it result in?

A

Derangement of compensatory mechanisms that results in further circulatory and respiratory dysfunction with subsequent multiple organ damage

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4
Q

ShockIntroduction:

What happens to oxygen levels?

A

Oxygen is consumed at a much greater rate than it is delivered.

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5
Q

ShockIntroduction:

Compensatory mechanisms result in what?

A

Compensatory mechanisms result in increases in heart rate, systemic vascular resistance (SVR), preload, and cardiac contractility.

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6
Q

Compensatory mechanisms used to maintain circulatory function and blood volume in hypovolemic shock.

Include what?

A

Include what?

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7
Q

Systemic Inflammatory Response Syndrome (SIRS)

A

Local inflammatory response becomes a systemic response (overwhelming)

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8
Q

Systemic Inflammatory Response Syndrome (SIRS)

What is activated and leads to a response?

A

Endothelial cells are activated in many vessels throughout the body, causing widespread interstitial extravasation of fluid into the interstitial compartment

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9
Q

Systemic Inflammatory Response Syndrome (SIRS)

What is it associated with?

A

Associated with any type of shock or insult

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10
Q

Systemic Inflammatory Response Syndrome (SIRS)

Associated with any type of shock or insult such as?

A

Massive blood transfusion

Infection

Trauma/brain injury

Surgery

Burns

Pancreatitis

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11
Q

Systemic Inflammatory Response Syndrome (SIRS)

What does it typically precede?

A

Typically precedes septic shock

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12
Q

SIRS criteria

How is temperature?

A

Temperature less than 36o C or greater than 38o C

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13
Q

SIRS criteria

How is HR?

A

HR >90 bpm

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14
Q

SIRS criteria

How is RR?

A

RR > 20 BPM

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15
Q

SIRS criteria

How is PaCO2?

A

PaCO2<32mmHg

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16
Q

SIRS criteria

How is WBC levels?

A

WBC </= 4000cells/mm3 or > 12000cell/mm3 or >10% immature bands

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17
Q

Stages of Shock:

What are they?

A

Stage I: non progressive

Stage II: progressive

Stage III: irreversible

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18
Q

Stages of ShockStage I: non progressive

How are compensatory mechanisms?

A

Compensatory mechanism are effective in maintaining normal vital signs and tissue perfusion

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19
Q

Stages of ShockStage I: non progressive

What are the clinical signs and symptoms?

A

No obvious clinical signs and goes unrecognized

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20
Q

Stages of ShockStage I: non progressive

How is it?

A

Early, reversible

If SIRS criteria are recognized

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21
Q

Stages of ShockStage II: progressive

What occurs?

A

Compensatory mechanisms begin to fail

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22
Q

Stages of ShockStage II: progressive

Compensatory mechanisms begin to fail: What occurs?

A

One or more organ systems begin to fail

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23
Q

Stages of ShockStage II: progressive

What else occurs?

A

Metabolic and circulatory derangements become more pronounced.

24
Q

Stages of ShockStage III: irreversible

What happens to compensatory mechanisms?

A

Failure of compensatory mechanisms

25
Q

Stages of ShockStage III: irreversible

What kind of injury occurs?

A

Cellular and tissue injury is severe- cannot correct the following derangements:

26
Q

Stages of ShockStage III: irreversible

Cellular and tissue injury is severe- cannot correct the following derangements:

A

metabolic

circulatory

inflammatory derangements

27
Q

Stages of ShockStage III: irreversible

What ensues?

A

MODS develops/death ensues

28
Q

Classifications of Shock

Hypovolemic shock

A

Inadequate circulating blood volume

29
Q

Classifications of Shock

Cardiogenic shock

A

Heart fails to act as an effective pump

30
Q

Classifications of Shock

Neurogenic shock

A

Imbalance between sympathetic and parasympathetic system

31
Q

Classifications of Shock

Anaphylactic shock

A

Allergic response to a specific antigen

32
Q

Hypovolemic Shock:

What is it?

A

Inadequate circulating volume

33
Q

Hypovolemic Shock:

What is it caused by?

A

Caused by sudden blood loss or severe dehydration, burns

34
Q

Hypovolemic Shock:

If left untreated, what can it lead to?

A

If left untreated, hypovolemia may lead to a variety of secondary complications, such as hypotension, electrolyte and acid–base disturbances, and organ dysfunction resulting from hypoperfusion.

35
Q

Hypovolemic Shock:

What causes the mycocardium to fatigue?

A

Failed compensatory mechanisms, which were initiated to restore cardiac output, eventually cause the myocardium to fatigue.

36
Q

Hypovolemic Shock Assessment & Management

Assessment: What is altered? What does it range?

A

Altered mentation

Range from Lethargy-unresponsiveness

37
Q

Hypovolemic Shock Assessment & Management

Assessment: How are respirations?

A

Rapid deep respirations

38
Q

Hypovolemic Shock Assessment & Management

Assessment: Rapid deep respirations- what eventually happens?

A

Gradually become labored and shallow as patient condition deteriorates

39
Q

Hypovolemic Shock Assessment & Management

Assessment: What happens to urine output? Urine?

A

Decreased urine output

Dark & concentrated urine

40
Q

Hypovolemic Shock Assessment & Management

Assessment: What else?

A

Cool and clammy skin-weak thread pulses

Tachycardia from activation of SNS

Hypotension

41
Q

Hypovolemic Shock Assessment & Management

Labs

A

Lactate, ABG, CBC, electrolytes, H&H, coagulation panels

42
Q

Hypovolemic Shock Assessment & Management

Management: What is given?

A

Blood products

43
Q

Hypovolemic Shock Assessment & Management

Management: What is monitored?

A

Oxygen, monitor VS, Labs, respiratory status, mentation, urine output

44
Q

Hypovolemic Shock Assessment & Management

Management: What is restored? How?

A

Restore circulating volume with crystalloids first (isotonic preferred over hypotonic)

eg; lactated ringers

45
Q

Neurogenic shock:

What is it?

A

Interruption of sympathetic nervous system impulse transmission

46
Q

Neurogenic shock:

What is the most common cause?

A

The most common cause of neurogenic shock is a spinal cord injury above the level of T6, because sympathetic innervation occurs above this level.

47
Q

Neurogenic shock:

What are causes of this?

A

Causes subsequent decreased tissue perfusion.

SCI above T6

Spinal anesthesia

Emotional stress, pain

CNS problems

Venous pooling- decreased circulatory volume

48
Q

Neurogenic shock:

Manifestations:

A

Manifestations: Hypotension, bradycardia and hypothermia, skin may feel warm due to massive vasodilation

49
Q

Neurogenic Shock management

A

Management: IV Fluids and vasopressors following fluid replacement, slow rewarming

50
Q

Neurogenic Shock management

How should SBP be?

A

Keep SBP> 90

51
Q

Neurogenic Shock management

Keep SBP> 90: how?

A

Norepinephrine

Dopamine

52
Q

Anaphylactic Shock

What is it caused by?

A

Allergic response to a specific antigen that evokes a life-threatening hypersensitivity

53
Q

Anaphylactic Shock

Allergic response to a specific antigen that evokes a life-threatening hypersensitivity

What are examples?

A

Food

insect stings

medications

54
Q

Anaphylactic Shock

Clinical manifestations

A

Erythema,

urticaria,

pruitus,

anxiety restlessness,

dyspnea,

wheezing,

chest tightness,

warm feeling,

N&V,

angioedema,

abdominal pain,

laryngeal edema,

severe bronchoconstriction

55
Q

Anaphylactic Shock

Managementincludes:

A

Preserve airway

Early recognition

Remove the offending antigen

Pharmacology

56
Q

Anaphylactic Shock

Managementincludes: Pharmacology

For mild symptoms, what is used?

A

Mild symptoms:

oxygen,

subcutaneous or IV diphenhydramine

57
Q

Anaphylactic Shock

Managementincludes: Pharmacology

For life-threatening symptoms, what is used?

A

Life-threatening: epinephrine, fluids, steroids, bronchodilators, vasopressors

NURS 428: Evolution (17 decks)

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