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6200 Adult /Older Adult II > Shock > Flashcards

Shock Flashcards

1
Q

Shock definition?

A
  • Circulatory system abnormality resulting in:
  • inadequate tissue perfusion
  • decreased cellular metabolism
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2
Q

Classification of Shock

A

Cardiogenic
Hypovolemic
Distributive
Obstructive

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3
Q

Types of Distributive Shock?

A

Neurogenic
Anaphylactic
Septic

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4
Q

Cardiogenic Shock process?

A

Heart with decreased ability to pump blood
↓
↓ stroke volume
↓
↓ Cardiac Output
↓
↓ tissue perfusion and cellular metabolism

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5
Q

CV manifestations Cardiogenic Shock?

A
  • Early: Tachycardia, Hypotension, Narrowed pulse pressure

- ↓ perfusion-peripheral, renal

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6
Q

manifestations of Cardiogenic Shock?

1) Resp
2) Integument
3) Neurological

A

1) pulmonary congestion
2) cool, clammy skin
3 confusion

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7
Q

Hypovolemic Shock process?

A 
Loss of intravascular fluid volume
                ↓
          ↓ preload
                ↓
      ↓ stroke volume
                ↓
      ↓Cardiac Output
                ↓
↓ tissue perfusion and cellular metabolism
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8
Q

What are 2 types of hypovolemia?

A

Absolute and Relative

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9
Q

Absolute hypovolemia?

A

due to fluid loss

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10
Q

Relative hypovolemia?

A

due to fluid shift

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11
Q

Results when fluid volume moves out of the vascular space into extravascular space (e.g., interstitial or intracavitary space)

A

Relative hypovolemia

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12
Q

Causes of Absolute hypovolemia?

A
  • Hemorrhage
  • GI loss (e.g., vomiting, diarrhea)
  • Fistula drainage
  • Diabetes insipidus
  • Hyperglycemia (water follows glucose)
  • Diuresis
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13
Q

Clinical manifestations of Hypovolemic Shock?

A
  • ↓ stroke volume, CVP
  • ↓urine output
  • ↑ RR and depth
  • anxiousness
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14
Q

When does the SNS mediated response occur in hypovolemic shock?

A
  • when the fluid loss is > 15% of TBV (750mL)

- causes ↑ HR, RR and depth

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15
Q

Neurogenic Shock process?

A

Massive vasodilation = ↓ preload = ↓ stroke volume = ↓CO = ↓ tissue perfusion and cellular metabolism

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16
Q

Causes of Neurogenic Shock?

A
  • spinal cord injury (T5 or higher)
  • spinal anesthesia
  • Vasomotor center depression (drugs)
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17
Q

Poikilothermia

A

Temperature dysregulation where the body assumes the same temp as the environment

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18
Q

S/S of Neurogenic Shock?

A

Hypotension, bradycardia, poikilothermia

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19
Q

Anaphylactic Shock physiology?

A
  • massive vasodilation
  • release of vasoactive mediators
  • increased capillary permeability
20
Q

Symptoms of Anaphylactic Shock appear within what timeframe?

A

< 20 mins

21
Q

Systemic inflammatory response to infection

A

Sepsis

22
Q

S/S of Septic shock ?

A
  • ↓bp despite fluids
  • resp failure
  • vasodilation
  • maldistribution of blood flow
  • myocardial depression
  • Hypo or Hyperthermia
  • ↑ Coagulation and inflammation
  • ↓ Fibrinolysis
23
Q

Generalized inflammation in organs remote from the initial insult?

A

Systemic Inflammatory Response Syndrome (SIRS)

24
Q

Multiple Organ Dysfunction Syndrome (MODS)

A
  • failure of > 2 organ systems
  • homeostasis cannot be maintained without intervention
  • results from SIRS
25
Q

Obstructive Shock manifestations?

A
  • ↓ CO

- ↑ afterload

26
Q

Causes of Obstructive Shock?

A
  • Pulmonary embolism

- Pericardial tamponade

27
Q

3 clinically apparent stages of Shock?

A

compensatory, progressive, irreversible

28
Q

S/S of the progressive stage of Shock?

A
  • ↓ BP, MAP < 60, mental status changes, agitation

- lungs are 1st to show critical dysfunction

29
Q

What are the most reliable signs of shock during the compensatory stage?

A

anxious and slight ↓ in BP, other signs are very subtle and may be missed

30
Q

What is another name for the irreversible stage of shock?

A

the refractory stage

31
Q

What is the purpose of administering Isotonic crystalloids solutions?

A
  • to increase volume and BP

- convenient, inexpensive, few side effects

32
Q

Fluid Resuscitation: Colloid

A
  • expensive, hold volume in vessels

- Osmotic pressure draws water from interstitial spaces

33
Q

Fluid Resuscitation: Blood Products

A

If non-responsive to 2 to 3 L of crystalloids

34
Q

Pharmacotherapy for shock?

A
  • Achieve/maintain MAP ›65 mm Hg
  • Vasopressor drugs
    • NE (levophed)
  • Vasodilator therapy
    • nitroglycerin [cardiogenic shock]
    • nitroprusside [noncardiogenic shock]
35
Q

Why is nitroglycerin used in the treatment of a patient in cardiogenic shock?

A

nitroglycerin is a potent vasodilator. It will cause vasodilation of the coronary arteries, resulting an increased oxygen delivery to the myocardium.

36
Q

Vasodilator therapy for noncardiogenic shock?

A

nitroprusside

37
Q

Nutrition: Shock

A
  • 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
38
Q

Goal of care for cardiogenic shock?

A

restore blood flow to the myocardium by tx the cause and through hemodynamic management

39
Q

Fluid Therapy for Hypovolemic Shock?

A
  • Crystalloids
  • Blood
  • Fluid Challenge-250-500 NS bolus
  • 1cc/kg/hr = adequate fluid replacement
40
Q

How do you calculate fluid replacement for hypovolemic shock?

A

give 3 mL for q 1mL lost

41
Q

Care for Neurogenic Shock?

A 
- Fluids used cautiously–
Hypotension generally not from fluid loss
- Treat hypotension and bradycardia
   - Vasopressors
   - Atropine
- Monitor for hypothermia
42
Q

Drugs to treat hypotension and bradycardia during neurogenic shock?

A

Vasopressors and atropine

43
Q

Care-Specific for Anaphylactic Shock?

A
  • Remove source of reaction
  • Epinephrine IM; repeat q 5–15 min
  • Antihistamines (diphenhydramine)
  • Maintain a patent airway
  • Aggressive fluid replacement
44
Q

Care-Specific Septic Shock?

A
  • 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
45
Q

Shock Nursing Assessments?

A

A, B, C’s
D- Disability (AVPU)
E - Exposure (exam and assess pain)

46
Q

Pt positioning for Neurologic/Cardiac shock?

A

flat or slightly elevated for venous return

47
Q

Nursing ManagementFluids/Electrolytes

A
  • 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

6200 Adult /Older Adult II (17 decks)

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