Shock Flashcards
Shock
a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism
Shock is an imbalance of what?
Oxygen and nutrients
How can we prevent shock?
- avoid trauma
- assess for early manifestations
- patient education
Cardio S/S
- decreased CO
- tachycardia
- HTN
- narrowing pulse pressure
- postural hypotension
- low CVP
- flat neck and hand veins
- slow cap refill
- diminished peripheral pulse
Respiratory S/S
- increased RR
- shallow respirations
- decreased PCO2
- decreased PaO2
What does a low CVP tell the nurse?
indicator of a low circulating volume
-dehydration
What is the most common cause of Cardiogenic Shock?
Myocardial infarction
Cardiogenic Shock
actual heart muscle is unhealthy
-pumping is directly impaired
What is low blood flow Cardiogenic Shock?
- systolic or diastolic dysfunction
- compromised CO
What are some precipitating events that cause low blood flow Cardiogenic Shock?
- MI
- cardiomyopathy
- blunt injury
- severe systemic/pulmonary HTN
- cardiac tamponade
- myocardial depression from metabolic probs
Patho of Systolic Dysfunction
- ineffective forward movement of blood
- decrease stroke volume
- decrease CO
Low Blood Flow Cardio Shock S/S
- tachycardia
- hypotension
- narrowed pulse pressure
- increased Myocardial O2 consumption
- anxiety
- decrease in stroke volume
- decrease urinary output
What medicine can you give to decrease myocardial O2 consumption?
Morphine
Physical Assessment of Patient with LBF Cardio Shock
- tachypnea, pulmonary congestion
- pallor/cool, clammy skin
- decreased cap refill
- anxiety, confusion, agitation
- increase pulmonary artery wedge pressure
- decreased renal perfusion and urinary output
Hypovolemic Shock is caused by what?
low circulating blood volume
What does low circulating blood volume cause?
mean arterial pressure to decrease causing inadequate total body oxygenation
What level does your MAP need to be?
> 60
Hypovolemic shock is commonly caused by what?
hemorrhage or dehydration
Absolute Hypovolemia is caused by what?
- hemorrhage
- GI loss
- diabetes insipidus
- hyperglycemia
- diuresis
Relative Hypovolemia
results when fluid volume moves out of the vascular space into the extravascular space
-third spacing
You should give fluids w/ Relative Hypovolemia even if the patient has what?
CHF or CKD
Our response to Hypovolemic Shock depends on what?
- extent of injury
- age
- general state of health
At what percentage would you begin to need to replace blood volume?
> 30% loss
What is the most complicated form of shock?
Neurogenic Shock
What is the most complicated form of shock?
Neurogenic Shock
Neurogenic Shock occurs how long after an injury?
w/in 30 minutes of SCI at T5 vertebra or above
How long can Neuro Shock last?
6 weeks
Causes of Neuro Shock
- SCI
- anesthesia
Neuro Shock results in what?
- massive vasodilation
- pooling of blood in vessels
- tissue hypoperfusion
- impaired cellular metabolism
S/S of Neuro Shock
- hypotension
- bradycardia
- inability to regulate body temp
- dry skin
- poikilothermia
Poikilothermia
taking on temp of environment
What medications would you want to ask you patient about when they are experiencing Neuro Shock?
beta blockers
calcium channel blockers
What are the goals of Neuro Shock?
- identify and manage fractures, spinal shock, cord syndromes
- prevent further injury
Neuro Shock Level A
no motor or sensory below Sacral segment
Neuro Shock Level B
sensory but no motor function
Neuro Shock Level C
motor function but majority of muscle grade strength less than 3
Neuro Shock Level D
motor function preserved but muscle grade 3
Neuro Shock Level E
normal motor and sensory function; NO injury
Distributive Shock S/S
- anxiety/confusion/dizziness
- sense of impending doom
- chest pain
- incontinence
- angioedema
- wheezing/stridor
- flushing/pruritis/urticaria
- respiratory distress/circulatory failure
What is Distributive/Anaphylactic Shock?
active, life-threatening hypersensitivity (allergic) reaction
Distributive/Anaphylactic Shock results in what?
- massive vasodilation
- realease of vasoactive mediators
- increase capillary permeability
What are the Care Priorities for Anaphylactic Shock?
- identify cause
- control allergic response
- prevent exposure
- airway/oxygen/epinephrine
- monitor ECG
Why do we give epinephrine?
it counteracts the vasodilation b/c it is a massive vasoconstrictor
What is Septic Shock?
systemic inflammatory response to documented or suspected infection
Sepsis requires what?
identified cause
What is the biggest signal that Sepsis may be causing organ dysfunction?
decreased urine output
Sepsis Triggers
- trauma
- abscess formation
- ischemic/necrotic tissue
- microbial invasion
- endotoxin release
- perfusion deficits
MODS
multiple organ dysfunction syndrome is failure of 2 or more organs
- homeostasis cannot be maintained w/o intervention
- results from SIRS
SIRS Criteria
- abnormal body temp
- tachycardia
- tachypnea
- altered WBC
What is a life threatening condition when the body’s response to an infection injures its own tissue and organs?
Sepsis
What are the 4 main factors of Sepsis?
- hyperinflammation
- hypercoagualation
- microvascular obstruction
- increased endothelial
If you give 30 ml/kg bolus of fluids and they are still hypotensive you can classify them as what?
in Septic Shock
S/S of Septic Shock
- increased coagulation and inflammation
- fibrinolysis
- hyperdynamic state: increased CO/decreased SVR
- tachypnea/hyperventilation
- decreased urine
- altered neuro status
- GI probs
What are the 3 major Patho Effects of Septic Shock?
- vasodilation
- maldistribution
- myocardial dysfunction
When does Obstructive Shock develop?
when physical obstruction to blood flow occurs w/ decreased CO
What is the most common cause of Obstructive Shock?
pregnancy
Obstructive Shock S/S
- decreased CO
- increased afterload
- variable left ventricular pressure
What are the 4 stages of Shock?
- inital
- compensatory
- progressive
- refractory
Initial Stage of Shock
- not apparent
- metabolism changes from aerobic to anaerobic
- lactic acid builds up
Compensatory stage of Shock
attempts to overcome consequences of anaerobic metabolism and maintain homeostasis
What are the Compensatory Mechanisms w/ the Compensatory stage?
- neural
- hormonal
- biochemical
What does a decreased BP cause during Compensatory stage?
blood from peripheral areas is pulled away, but maintained in vital organs
- heart
- brain
What happens during Compensatory Stage?
- -baroreceptors activate CNS in response to decreased BP
- SNS stimulation increases myocardial O2 demand
- shunting blood from lungs increases dead space
- impaired GI motility/paralytic ulcers
- cool clammy skin
- decrease blood to kidneys
When does Pregressive Stage begin?
when compensatory mechanisms fail
S/S of Progressive Stage
- decreased cellular perfusion
- altered capillary permeability
- anascara
- sustained hypoperfusion
- fluid moves into alveoli
Myocardial Dysfunction during Progressive stage causes what?
- dysrhythmias
- myocardial ischemia
- possible MI
- complete deterioration of cardio system
- mucosal barrier of GI becomes ischemic
- renal tubular ischemia
- liver failure
What happens when fluid moves to the Alveoli?
- edema
- decreased surfactant
- worsening V/Q mismatch
- tachypnea
- crackles
- increased work of breathing
What happens when GI system becomes ischemic?
- ulcers
- bleeding
- migration of bacteria
- decreased ability to absorb nutrients
What happens w/ renal tubular ischemia?
- AKI
- decreased urine output
- elevated BUN/creatinine
- metabolic acidosis
What happens when the liver fails?
- jaundice
- elevated enzymes
- loss of immune function
- risk for DIC
What happens in the Refractory Stage?
- exacerbation of anaerobic metabolism
- accumulation of lactic acid
- profound hypotension and hypoxemia
- recovery unlikely
What is the overall goal for Cardiogenic shock?
restore blood flow to myocardium by restoring balance b/t O2 supply and demand
Drug therapy for Cardio Shock
- nitrates
- diuretics
- vasodilators
- B-adrenergic blockers
What is the main management focus of Hypovolemic Shock?
stopping loss of fluid and restoring circulating volume
