Shock Flashcards

1
Q

What is Shock?

A

widespread abnormal cellular metabolism that occurs when the bodies need for O2 and tissue perfusion is not met for the level to maintain cell function

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2
Q

Shock is what type of response?

A

“Whole-body” response

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3
Q

What are the stages of Shock?

A

Initial stage
Nonprogressive stage (compensatory)
Progressive stage
Refractory stage

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4
Q

What happens during the initial stage?

A
  • cells switch to anaerobic metabolism creating lactic acid
  • low CO
  • HR/RR increase or slight increase in BP
  • baseline MAP decreased by < 10
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5
Q

What happens in Nonprogressive Stage?

A
  • MAP decreases by 10-15
  • kidney and hormonal adaptive mechanisms activated
  • tissue hypoxia in nonvital organs
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6
Q

What adaptive mechanisms begin in Nonprogressive stage?

A
  • SNS begins “fight or flight response”
  • Epinephrine/norepinephrine release = vasoconstriction = increase BP/HR
  • Kidney’s begins Renin-Angiotensin System
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7
Q

Renin-Angiotensin System

A

Renin stimulates angiotensin = Angiotensin I which turns to Angio II

  • causes vasoconstriction
  • releases aldosterone causing sodium and water retention
  • releases ADH to help increase blood volume
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8
Q

What stage at shock can you still correct damage done to body?

A

Nonprogressive

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9
Q

What happens during Progressive Stage?

A
  • decrease in MAP of more than 20
  • vital organs develop hypoxia
  • progressing to MODS
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10
Q

When conditions enter Progressive Stage how long does the nurse have to correct the cause?

A

1 hour

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11
Q

What happens in Refractory Stage of Shock?

A
  • too much cell death and tissue damage from too little oxygen
  • body can no longer respond effectively to interventions
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12
Q

What is Multiple Organ Dysfunction Syndrome? (MODS)

A

-sequence of cell damage caused by massive release of toxic metabolites and enzymes

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13
Q

Where does MODS occur first?

A

liver
heart
brain
kidney

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14
Q

Where are metabolites released from?

A

dead cells

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15
Q

What happens in MODS?

A
  • metabolites released
  • microthrombi form
  • myocardial depressant factor released from the ischemic pancreas
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16
Q

When does Cardiogenic Shock occur?

A

the heart can not pump enough blood to meet the perfusion needs of the body

17
Q

Why does Cardiogenic Shock occur?

A
  • Filling issue (Diastolic dysfunction)
  • Contraction issue (systolic dysfunction)
  • dysrhythmias
  • structural defect
18
Q

Cardio Shock leads to what?

A
  • Decreased CO and perfusion

- Decreased oxygen to cells that make up organs/tissues

19
Q

What is Cardiogenic Shock?

A

actual heart muscle is unhealthy and pumping is directly impaired

20
Q

What is the most common cause of direct pump failure?

A

Myocardial infarction

21
Q

Causes of Cardio Shock

A
  • MI (main cause)
  • pericardial tamponade
  • dysrhythmias
  • myo-endo/carditis
22
Q

S/S of Cardio Shock

A
  • JVD
  • increased CVP/PCNP/PAWP
  • weak pulses
  • pulmonary edema
  • dyspnea
  • increased RR/HR
  • severe SOB
  • mental alteration
23
Q

Nursing Interventions For Cardio Shock

A
  • mech. ventilation
  • central line placement
  • vasopressors
  • fibrinolysis
  • revascularization-PCI/CABG
  • cardiac transplant
24
Q

Medications for Cardio Shock

A
  • diuretics
  • vasopressors
  • dobutamine
  • dopamine