Shock Flashcards
Shock
Inability to perfuse the tissues for any reason with a MAP of less than 60
Hypovolemic shock
Total body fluids decreased Hemorrhage Dehydration Diabetes insipidus Vomiting Diarrhea
Cardiogenic shock
Direct pump failure
Fluid volume not affected
Distributive shock
Fluid shift
Neural-induced
Chemical induced
Neural induced
Pain Anesthesia Stress Spinal Cory injury Head trauma
Chemical induced
Anaphalyxsis
Sepsis
Capillary leak
Obstructive shock
Cardiac function by noncardiac factor Cardiac tamponade Arterial stenosis PE Pulmonary HTN Tumor Tension pneumothorax Constructive pericarditis
Cardio manifestations
Decrease output Increase pulse Threats pulse Decreased BP Narrowed pulse pressure Postural hypotension Low central venous pressure Flat hand and neck veins Slow cap refill Diminished peripheral pulses
Respiratory manifestations
Increased respirations Shallow respirations Increased CO2 Decreased O2 Cyanosis
GI manifestations
Decreased motility
Diminished or absent bowel sounds
N&V
Constipation
Neuromuscular manifestations
Early
Anxiety
Restlessness
Increased thirst
Neuromuscular manifestations
Late
Lethargy Coma Muscle weakness No DTR Sluggish pupils
Kidney manifestations
Decreased output
Increased gravity
Sugar and acetone present in urine
Skin manifestations
Cold
Pale, mottled, cyanotic
Moist, clammy
Mouth dry, paste like coating present
Anaphylaxis
Widespread loss of muscle tone
Chemical induced distributive
Initial stage
MAP 5-10 below baseline Metabolism is still aerobic Increase HR, BP, RR Difficult to detect Some lactic acid
Non-progressive
Compensatory stage
MAP 10-15 below baseline Kidney and hormonal activation Decrease urine Fluid shift to vital organs Acidosis and lactic acid start Hyperkalemia Reversible if caught early
Signs and symptoms of non-progressive stage
Anxiety Thirst Tachycardia Tachypnea O2 90-95% Low urine Cool and clammy
Labs for non-compensatory
Acidosis Hyperkalemia Hypernatremia Hyperglycemia Lactic acid
Progressive stage
MAP 20 over baseline
Vital organs hypoxic
Ischemia of non-vital organs
Can recover if reverse within one hour
Signs and symptoms of progressive stage
Severe thirst Impending doom Confusion Thready, tachy O2 75-80 Hypotension Cyanosis Cool and clammy Anuria
Refractory stage
Irreversible
Ischemia
Body cannot respond
Rapid progression to MODs
MODS
Rapid loss of consciousness
Non-palpable pulse
Unmeasurable O2
Shallow, slow respirations
Multiple organ dysfunction syndrome
Loss of vital organ due to microemboli
Occurs first in liver, heart, kidney
Irreversible even if MAP restored
Early neuromuscular assessment
Anxious
Restlessness
Increased thirst
Late neuromuscular assessment
Lethargy Coma Muscle weakness Pain Absent DTR Sluggish pupils
GU assessment
Oliguria or anuria
Sugar and acetone present
Increased SP gravity
Integumentary assessment
Cool and clammy Pale Cyanotic Mottled Dry mouth
GI assessment
N&V
Decreased or absent bowel sounds
Constipation
Nursing actions for hypovolemic shock
Oxygen!!! Trendelenburg Look for bleeding IV Vasopressors Monitor urine
Cardiogenic shock signs symptoms
Cold, clammy Poor pulses. Agitation Pulmonary congestion Tachypnea Continuing chest discomfort!!!!
Cardiogenic shock
Heart muscle or valve damage MI most common Tachycardia Hypotension BP systolic <90 MAP 30 less than baseline Low urine output
Medical management of cardiogenic shock
Pain relief Preload and after load reduction Nitro Intra-aortic balloon pump Heart cath CABG
Distributive shock
Fluid in interstitial spaces
Loss of sympathetic tone
Blood vessel dilation
Capillary leak
Obstructive shock
Outside the heart Pericarditis Tamponade PE Pneumothorax Aortic dissection Surgical emergency!!!
Vasoconstrictors
Dopamine
Epinephrine
Norepinephrine
Phenylephrine
Heart contractility
Doubutamine
Milrinone
Myocardial perfusion
Nitro
