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CCM > Shock > Flashcards

Shock Flashcards

1
Q

**what is shock

A

inadequate tissue perfusion resulting in cellular, metabolic and hemodynamic derangement’s

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2
Q

shock begins with

A

cardiovascular system failure

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3
Q

alterations in 1 of 4 components in shock, what are they

A

blood volume
myocardial contractility
blood flow
vascular resistance

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4
Q

shock is a life-threatening response to alterations in circulation, t or f

A

true

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5
Q

in shock there is an imbalance of

A

oxygen supply and demand

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6
Q

Shock results from

A

ineffective cardiac function, inadequate blood volume and vascular tone

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7
Q

what lab value will you always check with shock

A

lactate levels

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8
Q

impaired cellular metabolism leads to

A

impaired O2 use - anaerobic metabolism - increased lactate metabolic acidosis

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9
Q

stages of shock - stage 1

A

initiation

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10
Q

stages of shock - stage 2

A

compensatory

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11
Q

stages of shock - stage 3

A

progressive

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12
Q

stages of shock - stage 4

A

refractory

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13
Q

which stage of shock will be difficult to recognize

A

stage 1 (initiation)

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14
Q

clinical presentations in stage 1 of shock (initiation)

A

*decreased tissue oxygenation, hypo-perfusion,

may not see obvious clinical signs*

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15
Q

clinical presentations in stage 2 of shock (compensatory)

A 
neural, endocrine, and chemical compensation*
rapid, deep respiration's*
narrowed pulse pressure*
restlessness leading to confusion*
oliguria (small amt of urine)*
cool, moist skin
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16
Q

clinical presentations in stage 3 of shock (progressive)

A

anaerobic metabolism with lactic acidosis*
progressive tissue hypo-perfusion*
decreased BP*
lethargy to coma*
anuria (no urine output)
increased BUN, creatinine and potassium (kidneys aren’t working well)
absent bowel sounds

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17
Q

clinical presentations in stage 4 of shock (refractory)

A 
severe tissue hypoxia w/necrosis and ischemia*
worsening acidosis*
severe hypotension despite vasopressors*
multiple organ failure*
acute respiratory failure
SIRS/MODS
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18
Q

what is a first sign/clinical indicator that something might be going wrong

A

change in respiration’s

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19
Q

how does a nurse assess for adequate tissue perfusion

A

BP, urine output, pulse ox, skin temperature

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20
Q

nursing mgmt for shock

A

Nutritional support - early enteral feeding, increased metabolic needs
Skin integrity - increased risk for pressure ulcers, skin care
psychological support - end of life decision making, communication

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21
Q

4 categories of shock

A

hypovolemic
cardiogenic
obstructive
distributive

22
Q

all 4 categories of shock have issues with

A

perfusion - reason/cause differs

23
Q

in hypovolemic shock there is

A

inadequate intravascular blood volume

24
Q

in cardiogenic shock the

A

heart fails to act an an effective pump

25
Q

in obstructive shock there is

A

physical impairment to adequate circulating blood flow

26
Q

in distributive shock there is (septic)

A

widespread vasodilation and decreased vascular tone resulting in relative hypovolemia

27
Q

all categories of shock have how many stages

A

4

28
Q

cause of hypovolemic shock

A 
external loss (car accident, trauma, hemorrhage)
Internal sequestrations (hemorrhage, ascites, pelvic fxr)
29
Q

presentation of hypovolemic shock

A

decreased cardiac output, right arterial pressure

increased systemic vascular resistance

30
Q

mgmt of hypovolemic shock

A

treat cause
fluid resuscitate
check BP
monitor Pulmonary Artery Occlusion Pressure (PAOP)

31
Q

what labs will be drawn for hypovolemic shock

A

CBC, type and screen

BUN and Creat

32
Q

cause of cardiogenic shock

A

Acute MI
Dysrhythmias
Valvular Disease
HF Exacerbation

33
Q

presentation of cardiogenic shock

A 
decreased cardiac output
decreased venous oxygen saturation
increased vascular resistance
increased right arterial pressure
*chest pain
*dysrhythmia
low urine output
tachycardia
tachypnea (rapid breathing)
34
Q

mgmt of cardiogenic shock

A 
promote myocardial contractility
decrease myocardial oxygen demand
increase oxygen supply*
treat cause
improve contractility
reduce preload and after-load
mechanical support
give diuretics
35
Q

If HF Exacerbation Caridiogenic Shock manage this way

A

lasix
transplant
lvad
end of life decision making

36
Q

if acute MI cardiogenic shock manage this way

A

MONAB

revascularization therapy

37
Q

if dysrhythmias cardiogenic shock manage this way

A

cardio-version

pacemaker

38
Q

if vulvular disease cardiogenic shock manage this way

A

valve replacement

39
Q

what does MONAB stand for

A

morphine, oxygen, nitrogen, aspirin, beta-blocker

40
Q

cause of obstructive shock

A

cardiac tamponade
pulmonary embolism
aortic dissection

41
Q

presentation of obstructive shock

A 
*decreased cardiac output
systemic vascular resistance
norm or increased right arterial pressure
increased after-load
decreased ventricular filling
42
Q

mgmt of obstructive shock

A

treat the cause of obstruction (pericardiocentesis)

decompression

43
Q

with a tension pneumothorax pt will present with

A 
deviated trachea
severe chest pain
JVD
hypoxia
dyspnea
increased HR
44
Q

cause of distributive shock

A

widespread vasodilation

decreased systemic vascular resistance

45
Q

presentation of distributive shock

A

DECREASED: cardiac output, systemic vascular resistance, right arterial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure

46
Q

3 types of distributive shock

A

neurogenic
anaphylactic
septic

47
Q

in neurogenic (distributive) shock there is an

A

imbalance between sympathetic and parasympathetic stimulation causing massive vasodilation - impaired thermoregulation

48
Q

causes of neurogenic shock

A

spinal cord injury
spinal/general anesthesia
nervous system damage

49
Q

presentation of neurogenic shock**

A

bradycardia

hypotension

50
Q

mgmt of neurogenic shock

A

treat the cause

maintain tissue perfusion - avoid fluid overload

51
Q

the nurse is developing a care plan for the patient in cardiogenic shock, the goals for therapy include

A

decrease after-load

52
Q

most common cause of cardiogenic shock

A

acute MI

CCM (13 decks)

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