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Nursing and Complex Care > Shock > Flashcards

Shock Flashcards

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1
Q

Define Shock

A
  1. Shock is a clinical syndrome characterised by inadequate supply of O2 meeting its demand.
  2. Inadequate blood supply to the organs and tissues will result in cellular dysfunction.
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2
Q

Classification of Shock

A
  1. Septic shock
  2. Cardiogenic shock
  3. Hypovalaemic shock
  4. Anaphylactic shock
  5. Neurogenic shock
  6. Distribution shock
  7. Obstructive shock
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3
Q

What is the cause of Neurogenic, Anaphylactic and Septic shock?

A
  1. Caused by decreased in peripheral resistance
    a) Neurogenic shock:
    - Inadequate autonomic nerve activity to arterioles.

b) Anaphylactic shock:
- Release of vasodilators by excessive immune responses.

c) Septic shock:
- Presence of vasodilatory bacterial toxins

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4
Q

What is the cause of Hypovalaemic and Cardiogenic shock?

A
  1. Caused my decreased cardiac output
    a) Hypovalaemic shock: Reduction of blood volume
    b) Cardiogenic shock: Failure of the cardiac pump
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5
Q

Simple pathology of Hypovalaemic shock

A
  1. Inadequate myocardial contractility
  2. Sympathetic overactivity causes vasoconstriction in order to maintain the blood pressure
  3. BP remains normal however organs are poorly perfused due to decreased blood volume.
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6
Q

Simple pathology of Cardiogenic shock

A
  1. Poor myocardial contractility
  2. Increased venous pressure results in fluid to shift out of the vascular compartment causing oedema.
  3. SNS overactivity causes vasoconstriction in order to maintain BP
  4. BP remains high or normal however organs are poorly perfused.
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7
Q

Simple pathology of Distributive shock

A
  1. With adequate fluid replacement, heart compensates by increasing HR.
  2. Vessels dilate resulting in SVR (systemic vascular resistance)
  3. Capillaries continue to leak fluid; worsens hypovalaemia causes oedema (pulmonary oedema)
  4. Changes in BP and organ perfusion
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8
Q

Simple pathology of Obstructive shock

A
  1. Myocardial contracts against high after-load
  2. Back pressure leads of venous congestion.
  3. SNS over activity causes vasoconstriction in order to maintain BP
  4. BP remains normal however organs are poorly perfused.
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9
Q

Factors that induce Triad of death in shock

A
  1. Hypovalaemia
  2. Coagulopathy
  3. Hyper-perfusion metabolic acidosis
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10
Q

Paediactic shock

A
  1. Acute illness demands increased CO(HRxSV)
  2. Infants have a fixed SV; dependant on increased (CO/HR)
  3. Myocardial compliance decreases affecting the preload to increase SV
  4. loss of >25% fluid circulation volume -> signs of shock
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11
Q

Signs/symptoms of Paediatric Shock

A
  1. Tachycardia
  2. Tachypnoea (rapid breathing)
  3. Vasoconstriction
  4. Decreased consciousness
  5. Pallor & mottled peripheries (delayed capillary refills)
  6. Hypotension
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12
Q

Signs/symptoms of shock in Elderly

A
  1. Shock progress is rapid
  2. Reduced compensatory mechanisms in place
  3. Predisposed hypothermia
  4. Co- morbidities present
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13
Q

What are principals of shock management?

A
  1. ABC
  2. Oxygenation
  3. Fluid resuscitation
  4. Medications
  5. Symptom support
  6. Surgery
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14
Q

What are your intra-collaborative care?

A
  1. FBE: Hb, Hemocrit, WCC
  2. ABGs: O2, CO2, PH: 7.4
  3. U&E: Renal function
  4. F&E: glucose, Na, K, lactate lvls: metabolic acidosis.
    5 Cardiac enzymes: CK, troponin, LH, CKMB
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15
Q

What are your airway management care?

A
  1. Ensure, clear & patent

Simple -> Advanced measures

  1. High flow O2 Mask
  2. Intubation
  3. Circothyrotomy
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16
Q

What are your breathing management care?

A
  1. Maintain & assess breathing
  2. Remove the obstruction
  3. High- flow O2
  4. Intubated: CPAP;
    SpO2: >93%
    O2 >60
17
Q

What are your circulation management care?

A
  1. Positioning
  2. 2 large bore IVC/ CVC
  3. Bloods; Lactate lvls
  4. 12 lead ECG
  5. ABGs
  6. Vitals
  7. Intubated: ETCO2

Assess/control: Bleeding
Assess/control: Internal bleeding

18
Q

Altering cardiac output

A

Preload: Fluid-loading &resuscitation
Afterload: Vasoconstriction/vasodilation
Contractility: Medications

19
Q

Fluid loading

A
  1. Recom. 2/3 Cystalloid- 1/3-1/5 Colloid (10-20mls/kgs x2)

2. Hb & haemocrit are decreased after fluid loading

20
Q

What are the differences with crystalloids vs colloids?

A
  1. Crystalloids:
    a) Synthetic (Hartmans, 4% Dextrose, NS)
    b) Inexpensive
    c) No allergic reactions
  2. Colloids: Blood expanders
    a) 20x more expensive
    b) Improves CO, O2 consumption/delievery
    c) Increases allergic reactions
21
Q

Why are blood replacements used?

A
  1. RBC needed for O2 carrying capacity

2. Platelet for homeostatic & coagulation properties

22
Q

What are your blood replacement considerations?

A
  1. Need to be typed and crossed matched
  2. Time limited use O negative
  3. > 2units of blood need to be warmed
  4. Lines should be primed with NS or blood
  5. Must be used 4hrs after removal from fridge
23
Q

Guide to fluid replacement

A
  1. Volume replacement with crystalloids
    - 3mls for every 1ml lost
  2. Fluid challenges/options:
    - Bolus 20mls/kg 4% & 1/5 NS in children
    - IV bolus 200-300mls Hartmans/NS in adults (medical & surgical)
  3. Volume replacement for measured losses; (GIT loss 1ml for each ml lost every 4hrs)
  4. Volume replacement with colloids:
    1ml for every 1ml lost
24
Q

How would you minimise O2 consumption?

A
  1. WOB/Shivering
  2. Reduce cardiac work
  3. Neural Stress Response
  4. Treatment of Sepsis
25
Q

How would you minimise WOB/Shivering?

A
  1. Ventilation
  2. Body positioning
  3. Environmental control
  4. Bed rest
26
Q

How would you reduce cardiac work?

A
  1. Pericardiocentesis (tamponade)
  2. Interventional cardiology
  3. Thrombolysis
  4. Rest in bed
27
Q

How would you manage neural stress response?

A
  1. Analgesia
  2. Sedation
  3. Calm, quiet environment
  4. Support patient & family
28
Q

How would you treat sepsis?

A
  1. Operative treatment
  2. Anti-biotic
  3. Nutrition
29
Q

What are your nursing considerations of SHOCK?

A
  1. Oxygenation
  2. Haemodynamic monitoring
  3. Fluid Management
  4. Medication management
  5. Pain management
  6. Nutritional support
  7. Patient education
  8. Rehabilitation
  9. End of life decision

Nursing and Complex Care (8 decks)

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