Shock

Question 1

Shock

Answer 1

impaired tissue perfusion
imbalance between cellular oxygen supply and demand
can lead to multiple organ dysfunction system and death

tissues and cells need O2. want to recognize early signs of shock
- organs, tissues, systems all start to die off

Question 2

Initial Stage of Shock

Answer 2

decreased CO and threatened tissue perfusion
want to ID pts at risk!
if shock can be stopped here, failure will not happen

Question 3

Neural Compensation of Compensatory Stage of Shock

Answer 3

release of catecholamines

increase HR, contractility, vasoconstriction
Shunting of blood

“fight or flight”

Question 4

Endocrine compensation of compensatory stage of shock

Answer 4

glucocorticoid production

RAAs -body is trying to hold onto water; increasing volume in vascular space
ADH released - trying to hold onto more fluid in body

Question 5

Chemical compensation of compensatory stage of shock

Answer 5

works with baroreceptors

increased rate and depth of respiration, trying to blow off CO2 and get pH balance back

Question 6

Progressive Stage of Shock

Answer 6

failed compensatory mechanisms:

• cells begin anaerobic metabolism to produce energy
• lactic acid produced
• lactic acidemia
• increased vascular permeability-intravascular hypovolemia, tissue edema
• cellular death-inability to utilize oxygen

changes to tissue structure

Question 7

Refractory Stage of Shock

Answer 7

irreversible/unresponsive to therapy
multiple organ dysfunction symptom - 2 or more systems failed
death due to ineffective tissue perfusion

cannot respond to therapy; will usually die

Question 8

Hypovolemic Shock

Answer 8

inadequate fluid volume in the INTRAVASCULAR SPACE -> decreased tissue perfusion and initiation of shock states

decreased circulating volume, decreased stroke volume, decreased CO, decreased cellular oxygen supply, ineffective tissue perfusion, impaired cellular metabolism

Question 9

S/S of hypovolemic shock

Answer 9

Mild (less than 20% blood volume): cool extremities, increased capillary refill time, diaphoresis, anxiety

Moderate (20-40%): same as mild plus: tachycardia, tachypnea, oliguria, orthostatic changes

breathing faster to blow off CO2 or get in more O2

Severe (over 40%) same as moderate plus: hemodynamic instability (cannot maintain a BP), marked tachycardia, hypotension, mental status deterioration

Question 10

Cardiogenic Shock

Answer 10

failure of the heart to pump adequately causes decreased cardiac output, decreased tissue perfusion and circulatory failure

caused by anything the damages the heart muscle (MI, HF)

Question 11

S/S cardiogenic shock

Answer 11

signs of decreased CO:

SBP100, decreased MS, cool pale moist skin, UO

Question 12

Anaphylactic Shock (type of distributive shock)

Answer 12

immediate response to hypersensitivity; life threatening
SEVERE antibody-antigen response leads to decreased tissue perfusion and ultimately a shock response

an allergic rxn
body’s response: biochemical mediators released -> vasodilation, increased cap permeability, bronchoconstriction, mucus secretion, coronary vasoconstriction, inflammation, cutaneous rxn -> relative hypovolemia

give epi/steroids

Question 13

S/S anaphylactic shock

Answer 13

symptoms usually in mins/may take up to an hour
cutaneous effects may be seen first
cardiovascular: decreased BP, increased HR
respiratory: dysphagia, STRIDOR, wheezing, rales, rhonchi
neurologic: anxiety, decreased LOC
GI: N/V/D
GU: incontinence, vaginal bleeding

Question 14

Neurogenic Shock (type of distributive shock)

Answer 14

loss of sympathetic tone -> massive vasodilation, inhibition of baroreceptor response, impaired thermoregulation -> relative hypovolemia -> decreased CO -> inadequate tissue perfusion

volume doesn’t change; vascular space has gotten bigger

Question 15

S/S neurogenic shock

Answer 15

hypotension (from massive vasodilation)
bradycardia (lack of baroreceptor response)
warm dry skin (pooling of blood)
hypothermia (uncontrolled heat loss)

Question 16

Septic Shock (type of distributive shock)

Answer 16

microorganisms invade the body and initiate a systemic inflammatory response (SIR); perfusion abnormalities with organ dysfunction

microorganism-> SIRS-> toxins released, activate coag. cascade -> clotting, tissue perfusion, increased cap permeability -> cellular hypoxia/cellular death

Question 17

S/S septic shock

Answer 17

tachycardic, hypotensive, wide pulse pressures, full bounding pulses, skin pink/warm, tachypnea (early), decreased RR (late), crackles, decreased LOC, decreased UO, increased temp.

Question 18

Multiple Organ Dysfunction Syndrome (MODS)

Answer 18

failure of 2 or more organ systems
Pt outcomes r/t # of organs failed

high risk pts: trauma, infection, shock, acute pancreatitis, burns, multiple blood transfusions, surgical complications, age

Question 19

SIRS clinical conditions

Answer 19

infection, pancreatitis, ischemia, trauma, hemorrhagic shock, aspiration of gastric contents, massive transfusions, host defense abnormalities

Question 20

SIRS S/S

Answer 20

temp >86 or 90

RR >20 or PaCO2 12,000 or 10% bands

Question 21

Disseminated Intravascular Coagulation (DIC)

Answer 21

• abnormal clotting in the microcirculation
• uses up clotting factors
• results in the inability to form clots so hemorrhage occurs
• generates intravascular thrombin and fibrin, resulting in the thrombosis of small to medium sized vessels and ultimately organ dysfunction and severe bleeding