Shock Flashcards
What are the 4 stages of shock?
Initial, nonprogressive, progressive, refractory.
Define shock.
It is the whole body response to poor tissue perfusion
During shock, what type of cellular respiration occurs and what builds up?
Anaerobic. Lactic acid
What are the 4 types of shock?
Hypovolemic, cardiogenic, distributive, obstructive
What causes distributive shock?
Loss of sympathetic stimulation, either through damage or chemicals
What causes obstructive shock?
In this case the heart muscle is OK, but other factors deter the pumping action.
What are the signs of early shock?
MAP falls 10mm or less, while BP stays the same due to the body’s ability to compensate
Describe non-progressive (compensatory) shock.
MAP falls 10-15 mm from baseline. Kidney and hormonal responses begin since the cardiovascular system can’t maintain balance by itself
Describe progressive (non-compensatory) shock.
MAP falls 20 mm or more. Compensatory mechanisms can’t keep up, vital organs become hypoxic, less vital organs become anoxic and ischemic
Describe the last stage of shock.
Refractory stage. It is irreversible. Too much damage has occured
What stage of shock is emergent?
Progressive (non-compensatory)
What is the primary intervention for any stage of shock?
Correct the condition that is causing the shock. Shock is not a disease, but a condition. It always has an underlying cause
Where does MODS begin?
In the brain, heart, liver, kidneys
What are some interventions for MODS?
Airway, IV fluids, O2, be gentle, HOB 30 deg, VS q5min until stable, heparin for phase 1, platelets/plasma/clotting factors for phase 2, do not leave client!
What nursing diagnosis is a major factor in MODS? What drug is given for this?
Potential for bleeding (DIC). Xigris (activated C protein), interlukin/cytokines (experimental)
What is the earliest manifestation of shock?
Increased heart rate
An O2 sat below _____% is considered a life threatening emergency and may signal irreversible shock.
70
Why is DIC a problem with severe sepsis/septic shock?
Because microthrombi formation is widespread
What happens to blood sugar when septic shock occurs?
It rises and must be controlled
Define cardiogenic shock.
The heart muscle is damaged and cannot pump enough blood. MI is the most common cause.
Define hypovolemic shock.
Lack of circulating blood volume. Most commonly caused by hemorrhage and dehydration.
What are the 2 types of distributive shock?
Neural-induced and chemical-induced.
Describe neural-induced distributive shock.
Sympathetic nerve impulses decrease to the extent that map falls, vessels relax, vasodilation occurs.
What are some causes of neural-induced distributive shock?
Pain, anesthesia, stress, spinal cord/head trauma.
What are some causes of chemical-induced distributive shock?
Anaphalaxis. sepsis, capillary leak from burns, trauma, liver impairment, hypoproteinuria.
