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Complex > Shock 2 > Flashcards

Shock 2 Flashcards

1
Q

stages of shock

A

1) initial
2) compensatory
3) intermediate
4) irreversible

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2
Q

describe Initial stage of shock

A
  • slight decrease in MAP (<10)
  • flow to vital organs is maintained
  • loose 1 L of fluid, body can compensate
  • increased RR and diastolic BP
  • vascular constriction and increased HR to maintain C.O.
  • C.O and MAP are relatively maintained
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3
Q

how does initial stage of shock appear

A

-little cold and clammy

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4
Q

why is diastolic BP increased in initial stage

A

d/t shunting blood

more blood is going to the heart so diastolic increases about 10

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5
Q

describe compensatory stage of shock

A
  • nonprogressive
  • MAP decreases 10-15 mmHg
  • body does everything it can to save you
  • kidneys and hormones activated
  • heart rate is still elevated
  • **ACIDIC and hyperkalemia
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6
Q

once K reaches ______ the heart stops working

A

8

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7
Q

can compensatory be reversed

A

yes, if stabilized

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8
Q

during compensatory what are the kidneys doing

A

activate renin, angiotensin, aldosterone to conserve salt which conserves H2O and increases BP
RAAS, epi/norepi is also released

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9
Q

describe why the environment is acidodic and hyperkalemic during compensatory

A
  • build up of lactic acid d/t kidney not functioning
  • RR attempting to blow off CO2 but cant
  • the more acidodic, less Na pump can work , this increases K
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10
Q

describe intermediate stage of shock

A 
*progressive
less vital organs become anoxic
ischemia occurs
life threatening
sustained decrease in MAP (>20 mmHg)
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11
Q

if nothing is done w/in _____ of intermediate shock, pt will die

A

1 hr

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12
Q

what to do for pt in intermediate shock

A

1) start 2 large IV lines (1 L of NSS)
can hang blood w/ NSS, any drug is compatible with NSS, eventually give O negative blood
2) give oxygen (8-10 L high flow rate)
*oxygenation, protect airway: facemask, nonrebreather, intubate if gets worse
3) put them on monitor/EKG
4) put Foley in them

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13
Q

additional things to do for pt in intermediate shock

A

start CKGs of abdomen, labs, ABGs (do them often, done by resp. therapist in artery)
eventually give meds

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14
Q

describe irreversible shock

A
  • refractory
  • too much cell death/tissue damage has occurred
  • therapy is not effective even if MAP returns to normal
  • nothing can be done to fix/prevent death
  • warm pt up to see if dead, check for brain wave activity, check ECHO to see if heart is moving
  • if coded and started rigor mortus, stop attempting to revive
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15
Q

if renal is affected then it is ______

A

MODS

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16
Q

if in shock then change in _____

A

MAPS and decrease in BP

17
Q

process of how MODS occurs

A

1) injury
2) release toxins into plasma/bloodstream to fix area of damage
3) cytokines to stop bleeding in area and identify infection (cells fighting infection causes dilation)
4) vasodilaltion, decrease in BP
5) kidney, liver, lungs, brain
6) shock
7) MODS and death

18
Q

describe hypovolemic shock

A

too little circulation blood volume
decrease in MAP and O2
**low volume

19
Q

what to do for hypovolemic shock

A

1) start two large IV with saline
2) oxygen 8-10 L
3) blood if necessary
4) EKG
5) Foley
6) draw ABGs, labs, electrolytes
7) protect airway
8) start line (EJ or IJ)

20
Q

what does flail chest indicate

A

multiple ribs broken (>2)
lungs and chest collapse
**need chest tube

21
Q

what labs do you draw

A

4 tubes:

  • red/jungle (red/green) are chemistry (K, Cl, CO2, glucose)
  • purple: CBC, H & H, platelets, WBC
    green: lactate or ammonia
    blue: platelets, clotting factors (fluid will be in the tube for clotting)
22
Q

what tubes do you fill first

A

blue and purple to prevent clotting

23
Q

how do you draw up tubes

A

with 20 mL of fluid

24
Q

describe cardiogenic shock

A
  • heart muscle is unhealthy and pump is impaired
  • heart not working
  • MI can be cause
25
Q

why is open heart surgery done

A

performed for CABG, valve replace, tumors, cardiogenic shock requiring revascularization, VAD placement

26
Q

what do you need to tell pt before OHS is done

A
  • it WILL be PAINFUL after surgery
  • chest tubes following surgery (medial stinal)
  • may come back from surgery intubated (depends on stability)
  • get them UP ASAP after surgery, just wait until VS are stable
  • recovery time is ICU for two days
27
Q

what is the process of CABG procedure

A

1) heart stopped with K solution and then grafting begins
2) heart is rewarmed and observed for patency
3) epidcardial wires are placed and attached to an external pacemaker/pacer boxes
4) medistinal chest tubes placed, usually 4

28
Q

describe coronary artery bypass surgery

A

CABG

  • very common in pts >65 yrs
  • blockage is removed and the pts own venous or arterial blood vessel is used
  • before vessels are typically occluded >70%, cannot shunt to all vessels)
29
Q

what is the ejection fraction for effectiveness

A

> 40%

30
Q

_____ % of pts remain pain free 5 yrs post CABG

A

70 %

31
Q

what is an internal mammary artery

A

artery used in CABG
preferred artery
if only 1 or 2 grafts are present

32
Q

what is a saphenous vein

A

in the leg
thinner than artery
swelling in the leg is typically after CABG

33
Q

want OHS to be ____, why?

A

<4 hrs long

longer bypass, greater risk for clots

34
Q

thick muscle tissue is scraped

heart will not beat effectively if occluded here

A

miectomy

35
Q

what is final product of CABG

A

take blood from aorta directly to arteries

Complex (38 decks)

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