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Med Surg 3 > Shock > Flashcards

Shock Flashcards

1
Q

STROKE VOLUME

A

amount of blood ejected with each ventricular contraction

Three parts to:
afterload
preload
contractility

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2
Q

CARDIAC OUTPUT

A

amount of blood pumped per minute (CO=HRX SV)

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3
Q

MEAN ARTERIAL PRESSURE (MAP)

A

average pressure in the arterial circulation throughout the cardiac cycle

(systolic + 2diastolic)/3

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4
Q

PULSE PRESSURE

A

the difference between systolic and diastolic pressures

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5
Q

TYPES OF SHOCK

A
  • Low blood flow

- Misdistribution of blood flow

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6
Q

LOW BLOOD FLOW

A
  • hypovolemic

- cardiogenic

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7
Q

MALDISTRIBUTION OF BLOOD FLOW

A
  • septic
  • neurogenic
  • anaphylactic
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8
Q

HYPOVOLEMIC CAUSE

A
  • severe trauma with massive tissue injury

- hemorrhage

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9
Q

CARDIOGENIC CAUSE

A
  • acute MI
  • arrhythmias
  • cardiomyopathy
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10
Q

SEPTIC CAUSE

A
  • pancreatitis
  • infection
  • sepsis
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11
Q

NEUROGENIC CAUSE

A
  • spinal cord injury

- narcotic overdose

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12
Q

ANAPHYLACTIC CAUSE

A
  • multiple transfusion

- severe allergic reaction

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13
Q

SHOCK

A

-characterized by decreased tissue perfusion and decreased cellular metabolism

  • imbalance in supply /demand
  • not enough oxygen
  • aerobic to anaerobic

MAP less than or equal to 60= shock
MAP less than 50= death
MAP 70-90= normal

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14
Q

HYPOVOLEMIC SHOCK

A

most common
-severe blood and or fluid loss making the heart unable to pump enough blood to the body

  • emergency situation
  • loss of 1/5 the normal amount of intravascular volume in the body
  • AFFECTS NEURO STATUS 1ST
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15
Q

ABSOLUTE HYPOVOLEMIA

A

FLUID LOSS THROUGH

  • hemorrhage
  • gastrointestinal loss
  • fistula drainage
  • diabetes insipidus
  • rapid diuresis
  • severe dehydration
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16
Q

RELATIVE HYPOVOLEMIA

A

FLUID LOSS THROUGH

  • movement of fluid from intravascular space to extravascular space
  • burns
  • liver disease
  • third spacing
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17
Q

HYPOVOLEMIC SHOCK

A

-size of vascular compartment unchanged
- decreased venous return to heart
- decreased preload, SV and CO
- impaired cellular metabolism
- response to acute voulume loss depends upon
: age, injury, health

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18
Q

SIGNS AND SYMPTOMS OD HYPOVOLEMIC SHOCK

A
  • anxiety , confusion
  • agitation
  • tachycardia
  • hypotension
  • pallor
  • cold and clammy
  • decreased cap refill/pulses
  • decreased urine output
  • decreased or absent bowel sounds
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19
Q

HYPOVOLEMIC SHOCK IMMEDIATE TREATMENT

A
  • recognize before it happens
  • ABC’s and LOC
  • high flow O2 95% stat wanted
  • 2 large bolus IV
  • fluids / blood via warmer
  • medications as warranted
  • expose pt to find and stop bleeding
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20
Q

CARDIOGENIC SHOCK

A

LOW BLOOD FLOW SHOCK

  • failure of the heart to act as a pump moving blood forward
  • compromised CO and SV
  • right side - pulmonary circulation compromised
  • left side- impaired ability of the ventricle to fill during diastole
  • DECREASED STROKE VOLUME
21
Q

CAUSES OF CARDIOGENIC SHOCK

A
  • MI
  • cardiomyopathy
  • severe systemic /pulmonary hypertension
  • blunt cardiac injury
  • severe myocardial depression from sepsis
  • cardiac tamponade
  • dysrhythmias
22
Q

CARDIOGENIC SHOCK

A
  • decreased CO with resultant decreased MAP
  • tachycardia compensation stresses the heart
  • myocardial ischemia progresses to necrosis
  • cardiac failure leads to shock and pulmonary failure
23
Q

SIGNS AND SYMPTOMS OF CARDIOGENIC SHOCK

A
  • tachycardia, thread pulse, JVD
  • hypotension
  • narrowed pulse pressure
  • increased SVR
  • increased myocardial O2 consumption (angina)
  • pale , cold, moist skin
  • cyanosis
24
Q

signs and symptoms of peripheral hypoperfusion

A
  • RENAL BLOOD FLOW
  • DECREASED URINE OUTPUT
  • IMPAIRED CEREBRAL BLOOD FLOW
25
Q

CARDIOGENIC SHOCK TREATMENTS

A
  • cautious use of fluids
  • high flow O2
  • medications as indicated
  • vasoactives
  • beta 1 meds (act on the heart)
26
Q

DISTRIBUTIVE SHOCK

A
  • an increased in the size of the vascular bed due to massive vasodilation or peripheral pooling of blood
  • normal blood volume that can not adequately fill the increased size of the capillary bed

TYPES:
neurogenic
anaphylactic
septic

27
Q

NEUROGENIC SHOCK

A
  • occurs after spinal cord injury at T5 or above
  • results in massive vasodilation leading to pooling of blood in vessels
  • loss or suppression of sympathetic tone
  • the rarest of all shocks
28
Q

SIGNS AND SYMPTOMS OF NEURGENIC SHOCK

A

TRIAD

  • hypotension
  • bradycardia
  • dry, warm skin initially
  • with hypothalamic dysfunction there is temperature dysregulation
  • respiratory dysfunction based on level of cord injury
  • can begin 30 minutes after injury and last days to weeks
29
Q

TREATMENTS FOR NEUROGENIC SHOCK

A
  • treat the injury
  • corticosteroids
  • vasoactive agents
  • reduce parasympathetic stimulation
30
Q

ANAPHYLACTIC SHOCK PATHO

A
  • acute, life threatening hypersensitivity reaction
  • massive vasodilation
  • release of mediators , (histamine, serotonin, etc)
  • loss of intravascular volume
  • increased capillary permeadbility
  • impaired tissue perfusion
31
Q

CAUSES OF ANAPHYLACTIC SHOCK

A 
ANTIGENS: BINDS TO ANTIBODIES 
-foods
food additives 
diagnostic agents 
biologic agents 
environmental agents 
drugs 
venoms/insects 
blood reactions
32
Q

ANAPHYLACTIC SHOCK DEGREE OF REACTION

A

SUDDEN ONSET OF S AND S

CUTANEOUS MANIFESTATIONS
-utricaria, rash, erythema, angioedema, purirtis, flushing

RESPIRATORY COMPROMISE

  • swelling of lips and tongue
  • SOB, wheezing stridor, chest pain

NEUROLOGICAL COMPROMISE
-anxiety, confusion, impending doom, decreased LOC

33
Q

ANAPHYLACTIC SHCOK TREATMENTS

A
  • epinephrine
  • corticosteroids
  • high flow O2
  • artificial airways
34
Q

SEPTIC SHOCK

A
  • systemic inflammatory response to infection
  • presence of sepsis with hypotension despite fluid resuscitation with abnormal tissue perfusion
  • leading cause of death in non-coronary ICU’s

Primary causative organisms

  • gram negative and gram positive bacteria
  • endotoxins stimulate inflammatory response
35
Q

SIGNS AND SYMPTOMS OF SEPTIC SHOCK

A

early manifestations
-decreased LOC

cutaneous manifestations
-warm, dry , flushed skin only in beginning

Cardiovascular manifestations
- hypotension , hyperthermia, decreased SVR, compensatory CO, increased coagulation , decreased fibrinolytysis, decreased output

Tachypnea
-hyperventilation

36
Q

SEPTIC SHOCK WARM STAGE

A 
hypotension 
tachycardia
warm,flushed skin 
increased core temperature
chills
anxiousness
N/V/D

short stage rapid

37
Q

COLD STAGE SEPTIC SHOCK

A 
hypotension 
tachycardia and dysrthmias 
cool pale, edematous skin 
lethargy or coma 
oliguria/anuria
decreased core temperature
38
Q

SEPTIC SHOCK TREATMENTS

A
  • anitibiotic and IV fluids
  • possible ventilator support
  • support vital functions
    cultures to identify organism ( pan and urine)
39
Q

STAGES OF SHOCK : INITIAL STAGE

A
  • may not be clinically apparent
  • may be restless or anxious
  • metabolism changes from aerobic to anaerobic
  • lactic acid accumulates
  • must be removed by blood and broken doen by the liver
  • this requires O2
40
Q

INITIAL STAGE

A
  • baroreceptors detect a sustained decrease in the MAP
  • decreased circulating blood flow
  • natural physiologic responses are activated
  • vasoconstriction
  • increased cardiac contractions and HR
  • reversible at this point
41
Q

COMPENSATORY STAGE

A
  • attempted homeostaisis
  • MAP <10-15 and 25-35% volume loss
  • renin angiotensin system activated
  • impaired GI motility
  • cool skin clammy
  • except septic shock where skin is warm and flushed
42
Q

COMPENSATORY STAGE

A
  • shunting blood from lungs=physiologic dead space
  • SNS stimulation increses myocardial O2 demand
  • decreased blood to kidneys
43
Q

PROGRESSIVE STAGE

A

MAP <20
begins when compensatory mechnisms fail
lactic acid accumulation
requires aggressive interventions to prevent multiorgan dysfunction syndrome and death

-decreased cellular perfusion and altere capillary permeability

  • movement of fluid from intravasculature to interstitium
  • hyperkalemia due to cellular destruction
44
Q

PROGRESSIVE STAGE

A
  • fluid movement into alveoli
  • CO begins to fall
  • myocardial dysfunction
  • GI system becomes ischemic
  • liver fails to metabolize drugs and wastes
  • failure of one organ system affects others
45
Q

REFRACTORY STAGE

A
  • exacerbation of aneorobic metabolism
  • accumulation of lactic acid
  • increased capillary permeability
  • hypotension and tachycardia worsen
  • decreased coronary blood flow
  • cerebral ischemia
  • hypoxemia
  • recovery unlikely
46
Q

MEDICAL MANAGEMNT

A

supportive care
- ventilation and oxygenation

adequate intravascular volume

  • positioning
  • volume replacement

circulatory support

  • vasopressors and positive inotropes
  • vasodilators
  • circulatory assist devices (blood products , plasma, platelets)
47
Q

NURSING DIAGNOSIS

A
  • decreased cardiac output
  • impaired gas exchange
  • fluid volume deficit
  • altred tissue perfusion
  • hyperthermia/hypo
  • fear/anxiety
  • knowledge deficit
48
Q

COMPLICATIONS

A
  • MODS
  • ARDS
  • death
  • liver failure
  • DIC
  • myocardial failure
  • Gi bleeds

Med Surg 3 (5 decks)

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