Shock Flashcards
What is shock?
a life-threatening response to alterations in circulation
What happens during shock?
inadequate tissue perfusion, which can lead to organ failure
What is one of the biggest signs that the body is in shock and why?
a build up of lactic acid because that means that the tissues aren’t being perfused probably and have resorted to using anaerobic metabolism which has a byproduct of lactic acid
What is stage 1 of shock?
hypoperfusion
not enough oxygen circulating
possible faint drop in CO
easily reversible stage
What is stage 2 of shock?
compensatory mechanisms kick in
still can be reversed without residual effects
What is stage 3 of shock?
increased hypoperfusion
build up of lactic acid present
progressive stage that can lead to respiratory acidosis, increased capillary hydrostatic pressure and edema
still reversible, but will have residual effects
What is stage 4 of shock?
refractory stage
prolonged inadequate tissue perfusion that can cause organ damage
acute respiratory distress or failure, severe hypotension, ARDS, DIC, MI, stroke
What is SIRS?
it is a systemic inflammatory response to sepsis that is treated with antibiotics and is a hard stage of shock to survive
What is an early CNS sign of shock?
anxiety and restlessness
What is a late CNS sign of shock?
coma
What body system is affected most by shock?
CNS
What are cardiovascular symptoms that occur with shock?
initially an increase in BP, but once the fluid volume deficit becomes too low, BP plummets
increased pulse to compensate for fluid volume deficit, but that will also plummet once the body can no longer compensate for it in later stages
What are early respiratory symptoms of shock?
rapid deep respirations
What are later respiratory symptoms?
rapid shallow breathes
What is the renal response to shock?
oliguria and Na+ retention to help keep a fluid volume
What happens to the GI system during shock?
decrease in bowel sounds, distention, constipation, nausea
all to help keep as much nutrients and fluid in the body as possible
What hepatic symptoms occur?
increased AST, ALT, LDH, bilirubin, ammonia,
decreased albumin
DIC
What happens hematologically during shock?
DIC
prolonged PT/PTT
INR > 1.5
What does the skin look like for a patient in shock?
cyanotic
starts off cool/moist and then becomes cold/clammy
Your patient is exhibiting a faint drop in CO. They seem to still be well orientated and don’t have much of a change in status other than their small drop in CO. What labs would you like to run to help determine if this patient is in shock?
CBC, BMP, coagulation, pH, serum lactate levels
How to you treat shock?
Treat the underlying cause first (ie: fluid loss treat with fluid replacement, stop bleeding, etc.)
Minimize oxygen consumption
IV fluids
What crystalloid IV fluids are used for shock patients?
lactated ringers
What colloid IV fluids are used for shock patients?
albumin
What are the types of shock?
Hypovolemic
Cardiogenic
Obstructive
Distributive
What type of shock is most common in patients?
hypovolemic
What is the cause of hypovolemic shock?
blood loss
How would you treat hypovolemic shock?
with fluid replacement, blood products, restore circulation (you want a 3:1 circulation ratio)
What are symptoms of hypovolemic shock?
increased HR, RR, SVR, HCT
decreased BP, urine output, mental status, CO, PAP, PAOP, RAP, SvO2
What is the cause of cardiogenic shock?
left ventricular MI (generally in the left main, left anterior descending, or the left circumflex)
How would you treat hypovolemic shock?
Pharmacologically: lasix, vasodilators, inotropes
Mechanically: IABP (increases coronary perfusion and decreases afterload) or VAD (used as a back up if the IABP doesn’t work and kept on this until the patient can receive a heart transplant)
How is the IABP inserted?
through the femoral artery
What is the type of care you provide to a patient with an IABP?
pulse checks distal to the insertion (pedal pulses)
skin temperature distal to insertion
HOB at a specific degree
Patient on bedrest (specific mattress to prevent pressure ulcers)
What is the cause of obstructive shock?
physical impairment to the blood flow
most commonly tamponade
What are some symptoms of obstructive shock?
chest pain, dyspnea, JVD, hypoxia
How do you treat obstructive shock?
you have to treat the underlying cause (tamponade: remove the blood out of the pericaridal sac to allow for heart movement)
What are the types of distributive shock?
neurogenic
hypothermic
anaphylatic
septic
What is neurogenic shock?
interruption of the SNS
What causes neurogenic shock?
spinal cord injury
spinal anesthesia
nerve damage
vasomotor depression
What are symptoms of neurogenic shock?
bradycardia, hypotension, warm/dry/flushed skin, hypothermia
What are some nursing implications for neurogenic shock?
put the patient on a telemetry monitor to watch for bradycardia
watch for immobliziation or progression of immobilization that could cause paralysis
IV fluid replacement, vasopressors, slow rewarming of a hypothermic patient, patient positioning to promote blood flow for nerve funtion
What is anaphylactic shock caused by?
a severe reaction to an allergen that can cause swelling, edema, and prevent proper circulation or respirations
How do you treat anaphylactic shock?
epinephrine, diphenhydramine
What is septic shock?
a progressive blood stream infection due to immunosuppression
What are some symptoms of septic shock?
extreme fatigue, weakness, elevated temperature, hyperglycemia
How you treat septic shock?
antibiotics are the most effective and work best if caught early
early goal directed therapy, ACTH, glycemic control, temperature control
What are some ways to prevent septic shock?
hand hygiene, aseptic technique, infection control
