Shock Flashcards
How can hypovolemic shock can be identified?
Has normal ‘shock’ vitals: high HR/RR, low BP/UO, cold/clammy/pale, weak pulses, delayed cap refill. Must look at history for following:
-absolute loss: blood loss, diarrhea, diuresis, vomiting
-relative loss: third spacing–burns, edema/ascites
Patho and causes of cardiogenic shock:
direct damage to heart –> impaired pumping –> decreased CO –> perfusion impaired
-cardiomyopathy
-MI
-cardiac tamponade
How can cardiogenic shock can be identified?
-recent hx of heart damage, surgery
-CARDIAC WORKUP: EKG, draw troponins, CXR
-classic hypoperfusion s/s
-crackles (pulmonary congestion)
-earlier tachypnea
Patho and causes of obstructive shock:
Perfusion is mechanically obstructed:
-pneumothorax
-tumor
-pulmonary embolism
-compartment syndrome
-aortic dissection
How can obstructive shock can be identified?
-classic hypoperfusion s/s
-JVD
-systolic BP drop during inhalation (pulsus paradoxus)
Patho of septic shock:
severe blood infection –> inflammation –> vasodilation and increased capillary permeability –> massive hypoperfusion
How can septic shock can be identified? And, name 3 serious complications.
-classic hypoperfusion s/s
-‘rigors’ (shaking)
-elevated WBCs
-fever, malaise
-ARDs
-microthrombi formation, DIC
-myocardial depression –> low ejection fraction
List the manifestions specific to anaphylactic shock.
along with classic s/s hypoperfusion:
-airway swelling (laryngeal edema, facial edema)
-wheezing and stridor
-bronchospasm and chest pain
-flushing (early on), pruritus, urticaria
-impending doom
-incontinence
Patho and causes of neurogenic shock:
SNS disruption –> PNS takeover –> MASSIVE VASODILATION
-spinal cord injury (trauma) mostly
-opioids
-epidural damage
List the manifestions specific to neurogenic shock.
-LOW HR (other than this, classic s/s hypoperfusion)
-temp dysregulation: initial hyperthermia, then hypothermia (d/t progressive vasodilation)
-flaccid paralysis below lesion
‘Classic’ s/s hypoperfusion in shock
-high HR
-high RR
-low BP
-low UO
-cold/clammy/pale
-weak pulses
-delayed cap refill.
What irregular lab values would you expect for a person in shock (general)
-elevated lactic d/t anaerobic metabolism (lack of O2)
-ABGs: early alkalosis, later metabolic acidosis
-elevated BG early, then drops as liver fails
-elevated BUN/creatinine d/t renal failure
-elevated D-dimer, thrombocytopenia d/t DIC
List the stages of shock and what occurs:
1) sneaky: elevated lactate
2) compensatory
-high HR
-anxiety
-early S/S poor organ perfusion (decreased UO, increased RR)
3) progressive
-low CO
-low BP
-S/S organ damage: GI bleed, AKI/ATN, liver failure, DIC, ARDs, delirium
4) refractory–MODS
-ischemic gut
-anuria
-SEVERE DIC
-respiratory failure
-SIRS
-unresponsiveness
–> death
Every ____-___ patient is at risk for shock.
post-op
List the steps for general management of shock by the nurse:
- ABCs
-apply 100% non-rebreather, intubate PRN
-q15 vitals
-place ART, IV, central line, pulmonary-arterial catheter - Assess perfusion
-place foley and monitor I/Os closely
-look for: weak pulses, pale, cool, clammy, anxiety and LOC change - Support nutrition
-start feeding w/in 24 hours (enteral feed or TPN PRN)
Describe the nursing management of hypovolemic shock
-FLUID BOLUS (999mL/hr)
-give blood if d/t blood loss
-treat cause: stop bleeding, give albumin for ascites, etc.
Describe the nursing management of cardiogenic shock
-treat cause (ex: shock a dysrhythmia)
-place PULMONARY CATHETER and monitor hemodynamics
-IV MEDS:
-diuretics to rid fluid from lungs
-vasodilators for cardiac issue (nitroglycerin,
nitroprusside)
-vasopressors to raise BP (dopamine, norepi)
-inotropics to raise contractility (dobutamine)
Dobutamine–when would this be given, considerations for administration:
-to increase contractility in cardiogenic, septic shock
-pt will probably be intubated. Give w/ O2 as it can impair gas exchange.
Describe the nursing management of obstructive shock
-treat cause
Describe the nursing management of septic shock–including ‘in the first hour’, and what is done every hour?
1st hour: draw lactate and cultures, then start broad spectrum antibiotics IV, LOTS OF IV FLUIDS (NS/LR)
Meds:
-vasopressors to raise BP (norepi, dopamine)
-inotrope (dobutamine) to increase contractility
-corticosteroids (IV hydrocortisone)
-anticoagulants (heparin, lovenox) and VTE
prophylaxis
-PPIs (‘-prazoles’) for stress ulcer prophylaxis
-Monitor BG q1 hour!, insulin infusion PRN
Describe the nursing management of anaphylactic shock
- priority is AIRWAY!
- administer epinephrine
- GIVE FLUIDS!!!
Describe the nursing management of neurogenic shock
-spinal cord precautions: C-collar, log roll
-prevent hypothermia w/ warm blankets/room temp
-Meds
-atropine to increase HR
-vasopressors (dopamine, norepi) to raise BP
In shock management, our goal is to have a MAP greater than ____.
65
Explain the general pathophysiology of shock (applies to all types but neurogenic).
trauma/event –> decreased stroke volume –> vasoconstriction –> decreased tissue perfusion and organ failure
Define Systemic Inflammatory Response Syndrome (SIRS).
SIRS is systemic inflammation in response to severe physical stress/trauma.
Define Multiple Organ Dysfunction Syndrome (MODS).
MODS is a progression of SIRS that occurs when 2+ organ systems fail.
List the 4 main nursing priorities when caring for a patient with MODS, along with at least one example of how you would demonstrate this.
1) maintain tissue perfusion/oxygenation
-sedation and pain management, rest (pt prob intubated)
-treat fever, chills ASAP
2) prevent infection
-strict aseptic technique
-debride necrotic tissue
-early mobilization
3) support nutrition/electrolyte balance
-manage enteral nutrition or TPN
-monitor BG
4) treat failing organ systems
-ex: intubation, dialysis
