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Critical Care Nursing > Shock > Flashcards

Shock Flashcards

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1
Q

Shock

A

a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism

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2
Q

Shock is an imbalance of what?

A

Oxygen and nutrients

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3
Q

How can we prevent shock?

A
  • avoid trauma
  • assess for early manifestations
  • patient education
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4
Q

Cardio S/S

A
  • decreased CO
  • tachycardia
  • HTN
  • narrowing pulse pressure
  • postural hypotension
  • low CVP
  • flat neck and hand veins
  • slow cap refill
  • diminished peripheral pulse
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5
Q

Respiratory S/S

A
  • increased RR
  • shallow respirations
  • decreased PCO2
  • decreased PaO2
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6
Q

What does a low CVP tell the nurse?

A

indicator of a low circulating volume

-dehydration

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7
Q

What is the most common cause of Cardiogenic Shock?

A

Myocardial infarction

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8
Q

Cardiogenic Shock

A

actual heart muscle is unhealthy

-pumping is directly impaired

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9
Q

What is low blood flow Cardiogenic Shock?

A
  • systolic or diastolic dysfunction

- compromised CO

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10
Q

What are some precipitating events that cause low blood flow Cardiogenic Shock?

A
  • MI
  • cardiomyopathy
  • blunt injury
  • severe systemic/pulmonary HTN
  • cardiac tamponade
  • myocardial depression from metabolic probs
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11
Q

Patho of Systolic Dysfunction

A
  • ineffective forward movement of blood
  • decrease stroke volume
  • decrease CO
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12
Q

Low Blood Flow Cardio Shock S/S

A
  • tachycardia
  • hypotension
  • narrowed pulse pressure
  • increased Myocardial O2 consumption
  • anxiety
  • decrease in stroke volume
  • decrease urinary output
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13
Q

What medicine can you give to decrease myocardial O2 consumption?

A

Morphine

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14
Q

Physical Assessment of Patient with LBF Cardio Shock

A
  • tachypnea, pulmonary congestion
  • pallor/cool, clammy skin
  • decreased cap refill
  • anxiety, confusion, agitation
  • increase pulmonary artery wedge pressure
  • decreased renal perfusion and urinary output
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15
Q

Hypovolemic Shock is caused by what?

A

low circulating blood volume

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16
Q

What does low circulating blood volume cause?

A

mean arterial pressure to decrease causing inadequate total body oxygenation

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17
Q

What level does your MAP need to be?

A

> 60

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18
Q

Hypovolemic shock is commonly caused by what?

A

hemorrhage or dehydration

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19
Q

Absolute Hypovolemia is caused by what?

A
  • hemorrhage
  • GI loss
  • diabetes insipidus
  • hyperglycemia
  • diuresis
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20
Q

Relative Hypovolemia

A

results when fluid volume moves out of the vascular space into the extravascular space
-third spacing

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21
Q

You should give fluids w/ Relative Hypovolemia even if the patient has what?

A

CHF or CKD

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22
Q

Our response to Hypovolemic Shock depends on what?

A
  • extent of injury
  • age
  • general state of health
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23
Q

At what percentage would you begin to need to replace blood volume?

A

> 30% loss

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24
Q

What is the most complicated form of shock?

A

Neurogenic Shock

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25
Q

What is the most complicated form of shock?

A

Neurogenic Shock

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26
Q

Neurogenic Shock occurs how long after an injury?

A

w/in 30 minutes of SCI at T5 vertebra or above

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27
Q

How long can Neuro Shock last?

A

6 weeks

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28
Q

Causes of Neuro Shock

A
  • SCI

- anesthesia

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29
Q

Neuro Shock results in what?

A
  • massive vasodilation
  • pooling of blood in vessels
  • tissue hypoperfusion
  • impaired cellular metabolism
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30
Q

S/S of Neuro Shock

A
  • hypotension
  • bradycardia
  • inability to regulate body temp
  • dry skin
  • poikilothermia
31
Q

Poikilothermia

A

taking on temp of environment

32
Q

What medications would you want to ask you patient about when they are experiencing Neuro Shock?

A

beta blockers

calcium channel blockers

33
Q

What are the goals of Neuro Shock?

A
  • identify and manage fractures, spinal shock, cord syndromes
  • prevent further injury
34
Q

Neuro Shock Level A

A

no motor or sensory below Sacral segment

35
Q

Neuro Shock Level B

A

sensory but no motor function

36
Q

Neuro Shock Level C

A

motor function but majority of muscle grade strength less than 3

37
Q

Neuro Shock Level D

A

motor function preserved but muscle grade 3

38
Q

Neuro Shock Level E

A

normal motor and sensory function; NO injury

39
Q

Distributive Shock S/S

A
  • anxiety/confusion/dizziness
  • sense of impending doom
  • chest pain
  • incontinence
  • angioedema
  • wheezing/stridor
  • flushing/pruritis/urticaria
  • respiratory distress/circulatory failure
40
Q

What is Distributive/Anaphylactic Shock?

A

active, life-threatening hypersensitivity (allergic) reaction

41
Q

Distributive/Anaphylactic Shock results in what?

A
  • massive vasodilation
  • realease of vasoactive mediators
  • increase capillary permeability
42
Q

What are the Care Priorities for Anaphylactic Shock?

A
  • identify cause
  • control allergic response
  • prevent exposure
  • airway/oxygen/epinephrine
  • monitor ECG
43
Q

Why do we give epinephrine?

A

it counteracts the vasodilation b/c it is a massive vasoconstrictor

44
Q

What is Septic Shock?

A

systemic inflammatory response to documented or suspected infection

45
Q

Sepsis requires what?

A

identified cause

46
Q

What is the biggest signal that Sepsis may be causing organ dysfunction?

A

decreased urine output

47
Q

Sepsis Triggers

A
  • trauma
  • abscess formation
  • ischemic/necrotic tissue
  • microbial invasion
  • endotoxin release
  • perfusion deficits
48
Q

MODS

A

multiple organ dysfunction syndrome is failure of 2 or more organs

  • homeostasis cannot be maintained w/o intervention
  • results from SIRS
49
Q

SIRS Criteria

A
  • abnormal body temp
  • tachycardia
  • tachypnea
  • altered WBC
50
Q

What is a life threatening condition when the body’s response to an infection injures its own tissue and organs?

A

Sepsis

51
Q

What are the 4 main factors of Sepsis?

A
  • hyperinflammation
  • hypercoagualation
  • microvascular obstruction
  • increased endothelial
52
Q

If you give 30 ml/kg bolus of fluids and they are still hypotensive you can classify them as what?

A

in Septic Shock

53
Q

S/S of Septic Shock

A
  • increased coagulation and inflammation
  • fibrinolysis
  • hyperdynamic state: increased CO/decreased SVR
  • tachypnea/hyperventilation
  • decreased urine
  • altered neuro status
  • GI probs
54
Q

What are the 3 major Patho Effects of Septic Shock?

A
  • vasodilation
  • maldistribution
  • myocardial dysfunction
55
Q

When does Obstructive Shock develop?

A

when physical obstruction to blood flow occurs w/ decreased CO

56
Q

What is the most common cause of Obstructive Shock?

A

pregnancy

57
Q

Obstructive Shock S/S

A
  • decreased CO
  • increased afterload
  • variable left ventricular pressure
58
Q

What are the 4 stages of Shock?

A
  • inital
  • compensatory
  • progressive
  • refractory
59
Q

Initial Stage of Shock

A
  • not apparent
  • metabolism changes from aerobic to anaerobic
  • lactic acid builds up
60
Q

Compensatory stage of Shock

A

attempts to overcome consequences of anaerobic metabolism and maintain homeostasis

61
Q

What are the Compensatory Mechanisms w/ the Compensatory stage?

A
  • neural
  • hormonal
  • biochemical
62
Q

What does a decreased BP cause during Compensatory stage?

A

blood from peripheral areas is pulled away, but maintained in vital organs

  • heart
  • brain
63
Q

What happens during Compensatory Stage?

A
  • -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
64
Q

When does Pregressive Stage begin?

A

when compensatory mechanisms fail

65
Q

S/S of Progressive Stage

A
  • decreased cellular perfusion
  • altered capillary permeability
  • anascara
  • sustained hypoperfusion
  • fluid moves into alveoli
66
Q

Myocardial Dysfunction during Progressive stage causes what?

A
  • dysrhythmias
  • myocardial ischemia
  • possible MI
  • complete deterioration of cardio system
  • mucosal barrier of GI becomes ischemic
  • renal tubular ischemia
  • liver failure
67
Q

What happens when fluid moves to the Alveoli?

A
  • edema
  • decreased surfactant
  • worsening V/Q mismatch
  • tachypnea
  • crackles
  • increased work of breathing
68
Q

What happens when GI system becomes ischemic?

A
  • ulcers
  • bleeding
  • migration of bacteria
  • decreased ability to absorb nutrients
69
Q

What happens w/ renal tubular ischemia?

A
  • AKI
  • decreased urine output
  • elevated BUN/creatinine
  • metabolic acidosis
70
Q

What happens when the liver fails?

A
  • jaundice
  • elevated enzymes
  • loss of immune function
  • risk for DIC
71
Q

What happens in the Refractory Stage?

A
  • exacerbation of anaerobic metabolism
  • accumulation of lactic acid
  • profound hypotension and hypoxemia
  • recovery unlikely
72
Q

What is the overall goal for Cardiogenic shock?

A

restore blood flow to myocardium by restoring balance b/t O2 supply and demand

73
Q

Drug therapy for Cardio Shock

A
  • nitrates
  • diuretics
  • vasodilators
  • B-adrenergic blockers
74
Q

What is the main management focus of Hypovolemic Shock?

A

stopping loss of fluid and restoring circulating volume

Critical Care Nursing (14 decks)

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