Shock Flashcards
What the body needs:
Body organs and tissues require a regular consistent supply of oxygen and removal of metabolic waste
Sufficient cardiac output
Uncompromised vascular system – open vessels that are able to dilate and constrict
Sufficient blood volume
Healthy tissue – able to extract and use the O2 delivered by the capillaries
If one or more parts of this system is affected, a cascade of responses in the body….
Stroke volume (SV) Cardiac Output (CO) Mean Arterial Pressure (MAP) Systemic Vascular Resistance (SVR) Central Venous Pressure (CVP)
Shock - definition
Triggered by a sustained drop in mean arterial pressure
Clinical syndrome characterized by a systemic imbalance between oxygen supply and demand.
Inadequate blood flow to organs and tissues.
Life threatening cellular dysfunction.
Stage 1
Compensatory Mechanisms in the Early Stage of Shock
Body attempts to restore BP.
Sympathetic stimulation of the heart raises HR & CO.
-rapid responses via sympathetic nerve impulses, and the hormones epinephrine, ADH, and angiotensin.
Sympathetic vasoconstriction of arterioles of nonessential tissues (e.g. skin, GI tract).
Early, Reversible, Compensation
-sympathetic vasoconstriction of veins and venules in the abdomen increases venous retain
-Hormones ADH (vasopressin) and epinephrine
angiotensin causes further arteriolar constriction
-Activation of thirst mechanism, increasing fluid intake
-AHD and aldosterone causes fluid retention (decreased fluid output) by the kidneys – pg. 255
Stage 2 (progressive stage - interventions need to take place)
Body loss of compensatory mechanisms
Metabolic and respiratory acidosis. Cells switch from aerobic to anerobic = Lactic Levels (>4 mm/L life threatening) incr PH
Electrolyte imbalance (K, Na pumps in cells don’t work)
S & S
Severe hypotension, pallor, tachycardia, irregular rhythm, peripheral edema, cool and clammy extremties and altered LOC – restless.
(Pt restless, confusion, GI s/s, BP drops, pulse increases)
Hypovolemic Shock
type with the most varied sources of problems Intravascular volume decreased by 15% or more
Blood loss
Surgery
Trauma
GI Bleed
Fluid loss
Severe N,V,&D
Burns
Renal – Diuretics, diabetes insipidus
Fluid shift – intravascular to interstitial
“Third Spacing” –Liver disease-ascites, pleural effusion, intestinal obstruction
Blood Loss up to 750mL
Heart Rate 30 mL
Mental Status Anxious, mild confusion
Orthostatic Vitals
Blood Loss 750 to 2000mL
Heart Rate >100
BP Normal (especially if they are laying in bed)
Urine output > 20 - 30 mL
Mental Status Increased anxiety, agitated
Blood Loss > 2000mL
Heart Rate >140
BP Decreasing
Urine output >5 - 15 mL
Mental Status Lethargic – obtunded
Look at the chart on pg. 257
Cardiogenic Shock
Ineffective pump = tissue perfusion problems
Myocardial Infarction (most common)
Cardiac Tamponade
Restrictive pericarditis
Dysrhythmias
Valve damage
Electrolyte imbalances (potassium, sodium)
Drugs affecting cardiac muscle contractility
Cardiogenic Shock S/S
Pulse: rapid, thready, neck (JVD) and hand vein distension
Skin: pale, cyanotic, cold, moist
Oliguria to anuria
dependent edema
Elevated CVP, arrhythmias, cardiovascular collapse
Note: Vol has not changed, pump has
Obstructive Shock
Obstructive shock is a result of decreased cardiac output which causes reduced tissue perfusion.
- Pericardial tamponade
- Pulmonary Embolus
- Pneumothorax (pressure)
- Aortic stenosis
- Abdominal distention
Distributive Shock
Also called vasogenic Wide spread vasodilation = peripheral pooling Blood volume doesn’t change Types: Septic Shock Neurogenic Shock Anaphylactic Shock
Septic Shock (early-warm)
Fever, chills ,skin warm flushed, altered mental status, BP normal, tachycardia, UO normal, can have oliguria
Ex: elderly pt comes in, family says the pt was fine 2 days before, but all of the sudden they become confused and not responding like they usually do.
