Shock Flashcards
Shock definition?
- Circulatory system abnormality resulting in:
- inadequate tissue perfusion
- decreased cellular metabolism
Classification of Shock
Cardiogenic
Hypovolemic
Distributive
Obstructive
Types of Distributive Shock?
Neurogenic
Anaphylactic
Septic
Cardiogenic Shock process?
Heart with decreased ability to pump blood
↓
↓ stroke volume
↓
↓ Cardiac Output
↓
↓ tissue perfusion and cellular metabolism
CV manifestations Cardiogenic Shock?
- Early: Tachycardia, Hypotension, Narrowed pulse pressure
- ↓ perfusion-peripheral, renal
manifestations of Cardiogenic Shock?
1) Resp
2) Integument
3) Neurological
1) pulmonary congestion
2) cool, clammy skin
3 confusion
Hypovolemic Shock process?
Loss of intravascular fluid volume
↓
↓ preload
↓
↓ stroke volume
↓
↓Cardiac Output
↓
↓ tissue perfusion and cellular metabolismWhat are 2 types of hypovolemia?
Absolute and Relative
Absolute hypovolemia?
due to fluid loss
Relative hypovolemia?
due to fluid shift
Results when fluid volume moves out of the vascular space into extravascular space (e.g., interstitial or intracavitary space)
Relative hypovolemia
Causes of Absolute hypovolemia?
- Hemorrhage
- GI loss (e.g., vomiting, diarrhea)
- Fistula drainage
- Diabetes insipidus
- Hyperglycemia (water follows glucose)
- Diuresis
Clinical manifestations of Hypovolemic Shock?
- ↓ stroke volume, CVP
- ↓urine output
- ↑ RR and depth
- anxiousness
When does the SNS mediated response occur in hypovolemic shock?
- when the fluid loss is > 15% of TBV (750mL)
- causes ↑ HR, RR and depth
Neurogenic Shock process?
Massive vasodilation = ↓ preload = ↓ stroke volume = ↓CO = ↓ tissue perfusion and cellular metabolism
Causes of Neurogenic Shock?
- spinal cord injury (T5 or higher)
- spinal anesthesia
- Vasomotor center depression (drugs)
Poikilothermia
Temperature dysregulation where the body assumes the same temp as the environment
S/S of Neurogenic Shock?
Hypotension, bradycardia, poikilothermia
Anaphylactic Shock physiology?
- massive vasodilation
- release of vasoactive mediators
- increased capillary permeability
Symptoms of Anaphylactic Shock appear within what timeframe?
< 20 mins
Systemic inflammatory response to infection
Sepsis
S/S of Septic shock ?
- ↓bp despite fluids
- resp failure
- vasodilation
- myocardial depression
- Hypo or Hyperthermia
- ↑ Coagulation and inflammation
- ↓ Fibrinolysis
Generalized inflammation in organs remote from the initial insult?
Systemic Inflammatory Response Syndrome (SIRS)
Multiple Organ Dysfunction Syndrome (MODS)
- failure of > 2 organ systems
- homeostasis cannot be maintained without intervention
- results from SIRS
Obstructive Shock manifestations?
- ↓ CO
- ↑ afterload
Causes of Obstructive Shock?
- Pulmonary embolism
- Pericardial tamponade
3 clinically apparent stages of Shock?
compensatory, progressive, irreversible
S/S of the progressive stage of Shock?
- ↓ BP, MAP < 60, mental status changes, agitation
- lungs are 1st to show critical dysfunction
What are the most reliable signs of shock during the compensatory stage?
anxious and slight ↓ in BP, other signs are very subtle and may be missed
What is another name for the irreversible stage of shock?
the refractory stage
What is the purpose of administering Isotonic crystalloids solutions?
- to increase volume and BP
- convenient, inexpensive, few side effects
Fluid Resuscitation: Colloid
- expensive, hold volume in vessels
- Osmotic pressure draws water from interstitial spaces
Fluid Resuscitation: Blood Products
If non-responsive to 2 to 3 L of crystalloids
Pharmacotherapy for shock?
- Achieve/maintain MAP ›65 mm Hg
- Vasopressor drugs
- NE (levophed)
- Vasodilator therapy
- nitroglycerin [cardiogenic shock]
- nitroprusside [noncardiogenic shock]
Why is nitroglycerin used in the treatment of a patient in cardiogenic shock?
nitroglycerin is a potent vasodilator. It will cause vasodilation of the coronary arteries, resulting an increased oxygen delivery to the myocardium.
Vasodilator therapy for noncardiogenic shock?
nitroprusside
Nutrition: Shock
- Goal is to feed within 8-12 hours after sx/trauma
- Initiate enteral nutrition within the first 24 hours
- Initiate parenteral nutrition if enteral feedings contraindicated or fail to meet at least 80% of the caloric requirements
- Monitor protein,albumin, BUN, glucose, electrolytes
Goal of care for cardiogenic shock?
restore blood flow to the myocardium by tx the cause and through hemodynamic management
Fluid Therapy for Hypovolemic Shock?
- Crystalloids
- Blood
- Fluid Challenge-250-500 NS bolus
- 1cc/kg/hr = adequate fluid replacement
How do you calculate fluid replacement for hypovolemic shock?
give 3 mL for q 1mL lost
Care for Neurogenic Shock?
- Fluids used cautiously– Hypotension generally not from fluid loss - Treat hypotension and bradycardia - Vasopressors - Atropine - Monitor for hypothermia
Drugs to treat hypotension and bradycardia during neurogenic shock?
Vasopressors and atropine
Care-Specific for Anaphylactic Shock?
- Remove source of reaction
- Epinephrine IM; repeat q 5–15 min
- Antihistamines (diphenhydramine)
- Maintain a patent airway
- Aggressive fluid replacement
Care-Specific Septic Shock?
- Hemodynamic monitoring
- Fluid replacement
- If fluid resuscitation is inadequate:
- Vasopressor drug therapy
- IV corticosteroids
- Antibiotics
- Glucose levels 180 mg/dl
- Stress ulcer prophylaxis with histamine (H2)-receptor blockers
- DVT prophylaxis
Shock Nursing Assessments?
A, B, C’s
D- Disability (AVPU)
E - Exposure (exam and assess pain)
Pt positioning for Neurologic/Cardiac shock?
flat or slightly elevated for venous return
Nursing ManagementFluids/Electrolytes
- I&O
- UO q 1-2 hrs
- Monitor electrolytes
- Respiratory alkalosis: sedate to slow respiration, conserve CO2 or slow ventilator
- Metabolic acidosis: sodium bicarb to increase pH
