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Nurs332 > Shock > Flashcards

Shock Flashcards

1
Q

what are the different types of compensation

A

neural
chemical
horomonal
cellular response

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2
Q

is this strictly RBC?

A

external losses
internal losses
blocked venous return

no it can be plasma, fluid volume or whole blood loss.

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3
Q

what is EBL of class one of shock? (hypovolemia)

S/S? (HR, PP, cap refill, RR, urine output, BP)

what do you need to do to intervene?

A 
40
cap refill brisk
RR 15-20
rine outpt >30
BP norma

crystalloid 2000-3000ml

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4
Q 
EBL of class 2 hypovolemia?
S/S

intervention?

A

750-1500ml. 15-30%
agitation
HR >100
PP

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5
Q

class 3
EBL
S/S

interventions?

A

1500-3000ml
30-40%
agitated & confused

HR >120
PP 20-30
cap refill delayed 
RR 30-40
urineo/p 5-15
BP decreased/varies

needs crysalloid 4500-
blood 2-4 units

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6
Q

class 4
EBL
S/S

interventions?

A 
>2000ml
>40%
confused and lethargic
HR >150
PP 10-20
cap refill no blanching
RR > varies and shallow
urine o/p negligable
BP BP decreased / varies

Needs…
crystalloid 4500 ml +
blood 2-4 units

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7
Q

what is the management of hypovolemic shock?

A

early recognition
stop the losses
replace losses if indicated

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8
Q

what are the causes of cariogenic shock?

A

coronary
-ami
post OHS ischemia

noncoronary
cardiomyopathy
tamponade
tension pneumothorax

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9
Q

what are the S/S of cariogenic shock?

A

forward flow
backward pressure
prgan hypoperfusion
stages of compensation

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10
Q

what is the management of cardiogenic shock?

A

early recognition
increase myocardial contractility (inotrope)
reduce moycardial oyxygen demands (dilate the coronary arteries)

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11
Q

what are the causes of distributive shock?

A

septic shock
anaphylactic shock
neurogenic shock

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12
Q

what are the S/S of septic shock?

A

evidence of infection
organ hypoperfusion
no alpha SNS compensation

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13
Q

what are the S/S of anaphylactic shock?

A

evidence of exposure
airway reactivity
organ hypoperfusion
no alpha SNS compensation

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14
Q

what are the S/S neurogenic shock?

A

evidence of injury
organ hypoperfusion
no SNS compensation

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15
Q

what is normal MAP?

A

70-105mmHg

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16
Q

what is the acid-base balance in each phase/class?

A

1: resp alkolsis
2: metb acidosis
3: profound acidosis

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17
Q

what is normal pulse pressure?

A

40mmHg

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18
Q

why does narrowing of pulse pressure occur in shock?

A

because diastolic will inc because the catecholamines inc the VR from vasoconstriction and the systolic will decrease because of the lack of flow

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19
Q

what is your skin like in class 1 or the compensatory phase of hypovolemic shock?

A

cold and clammy

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20
Q

what cardiovascular effects might occur from hypovolemic shock?

A

dysrhythmias and ischemia, chest pain. my have MI. inc cardiac enzymes, myocardial depression and ventricular dilation

21
Q

what hepatic damage occurs during shock?

A

dec blood flow dec metb of wastes and more sus. to infect.

ubc liver enzymes and bilirubin –> jaundice

22
Q

GI effects from shock?

A

ischemia causes stress ulcers in stomach (inc risk of GI bleed)
bloody diarrhea
bacteria toxins may enter circulation via lymph
enteral feeding in shock states is recommended

23
Q

would there be an inc in bleeding or clotting in shock?

A

bleeding due to DIC because all the clotting factors are consumed d/t over activation of inflm response.
might need platelets and clotting factor replacements

24
Q

why is there hyperglycaemia in shock?

A

bc the release of the catecholamines, cortisol, glucaogns and inflm cytokines and mediators are released and so there is hyperglycemia and insulin resistance to mobilize glucose for cellular metb

glyconeogensis occurs in the liver and gluconeogensis from proteins and fats cause hyperglycaemia

25
Q

what medical mgmt is there for shock?

A

early enteral support, aggressive hyperglycaemic control w IV insulin, antacids, histamine 2 blockers, DVT prophylaxis

26
Q

how does RL help with the acid-base problem?

A

it has lactate ion that converts to bicarbonate and buffers the acidosis

27
Q

whats a disadvantage of using an isotonic solution for fluid replacement?

A

some of it is lost in the interstitial compartment d/t cellular permeability from the shock

28
Q

why are colloids better choices for shock therapy?

A

contain molecules that are too large to pass through capillary membranes and they expand the intravascular volume by exerting oncotic pressure and pull fluid into the intravascular space (none is lost) also longer duration and less vol is required

29
Q

what are some risks of hypovolemic shock (think external and internal)

A

external: trauma, sx, diarrhea, vomiting, diabetes insipidus, diuresis
internal: ascites, hemorrhage, burns, peritonitis, dehydration

30
Q

what are some medications that you might give for hypovolemic shock?

A 
dobutamine
nitroglycerin
dopamine
antiarrthymic medications
mechanical assistive devices
31
Q

what does dobutamine do?

A

inotropic effects (inc HR, contractility)

32
Q

what does nitroglycerin do?

A

acts as a vasodilator and reduces preload and at high doses acts as an arterial vasodilator

33
Q

what does dopamine do?

A

sympathomimetic agent. vasoactive effects.. inc the HR and CO

34
Q

what are some risk factors for septic shock?

A

immunosuppression, extremes of ages, malnourishment, chronic illness, invasive procedures, pneumonia

35
Q

what is the patho behind septic shock?

A

immune response causes inflm response and inc cap perm and vasodilation

36
Q

what are some early signs of septic shock?

A

BP remains normal at first, tachycardia begins, hyperthemia, flushing, tachypnea, bounding pulses, possible GI upset, inc serum glucose and insulin resistance, confusion and agitation, inc lactate levels, WBC high or low

37
Q

what are some major signs of septic shock

A

BP drops, skin cool, pale and mottled, temp normal or low, Hr and rr remain high, oliguria, MODS and possible death

38
Q

how soon do u want to treat sepsis?

A

first hour

39
Q

what is neurogenic shock?

A

vasodilation resulting from loss of balance between parasympathetic and sympathetic stimulation-> predom parasympathetic causing bradycardia and drop in BP

40
Q

what are some causes of neurogenic shock?

A

spinal cord injury, spinal anesthesia, depressant action of meds, glucose deficiency

41
Q

medical mgmt for neurogenic shock?

A

restore sympathetic tone by stabilization of spinal cord injury

glucose if insulin shock

42
Q

what is some nursing mgmt for neurogenic shock?

A

prevention- fter spinal ro epi, important to elevate HOB to 30 degrees to prevent spread of anesthetic spinal cord

cardiovascular and neuralgic support, compression socks, elevate feet to prevent pooling

43
Q

what is anaphylactic shock?

A

mast cells release vasoactive substances (histamine, bradykinin)

44
Q

S&S of anaphylactic shock?

A

resp stress (wheezing, stridor), tachycardia, prolonged cap refill, neurlogical compromise and possible pruitis, abdominal cramping

45
Q

medical mgmt of anaphylactic shock?

A

epinephrine, benadryl, albuterol via neb, CPR, intubation, IV inert

46
Q

what is multiple organ dysfunction syndrome?

A

develops with cut illness that compromises perfusion

occurs at the end of septic shock

47
Q

which organ fails first in MODS?

A

lungs-> dyspnea, resp failure

48
Q

S&S of MODS?

A

hotn, hypoxemia, hypercapnia, adventitious breath sounds, inc creatinine, dec Burnie output, thrombocytopenia, coagulation abnormalities, lactic academy, metb acidosis, altered LOC, elevated LFTS, hyperbilirubenimia

Nurs332 (12 decks)

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