Shock Flashcards
Anoxia
total depletion or absence of oxygen
Hypoxemia
low oxygen in the blood
Hypoxia
abnormally low oxygen content in any tissue or organ
Inability to correct and reverse shock results in
- increasing oxygen debt
- acidosis
- organ system dysfunction
- death
What happens at the cellular level during shock?
- impaired oxygen use
- impaired glucose use
- buildup of metabolic end products
How does anaerobic metabolism lead to cell death?
a. inadequate energy production»_space; metabolic failure
b. lactic acid production»_space; metabolic acidosis
Gluconeogenesis
formation of glucose in the liver from non-carbohydrate carbon substrates
Systemic Effects of Shock
- Lungs (impaired gas exchange - ARDS, respiratory failure)
- Heart (myocardial deterioration)
- Blood (hypercoagulable)
- Neuroendocrine (SNS activation and increased ACTH)
- Immune, GI and renal systems
Acute Respiratory Distress Syndrome
sudden life-threatening lung failure
inflammation of alveoli causing them to fill with liquid and collapse. gas exchange cease and body becomes starved of oxygen
Disseminated Intravascular Coagulation (DIC)
Multiple thrombi or emboli in microvascular circulation
Lab findings:
a. thrombocytopenia
b. prolonged PT, aPTT, thrombin
c. decreased fibrinogen
d. elevated d-dimers
Adequate circulating volume is dependent on which 3 interrelated components of the CV system?
a. heart
b. vascular tone
c. blood volume
Name 4 compensatory mechanisms of shock
- baroreceptors
- chemoreceptors
- circulating vasoconstrictors
- kidney and the RAAS
Clinical manifestations of shock (CHORD ITEM)
C - cardiac output decreased H - hypotension O - oliguria R - rapid, shallow breathing D - drowsiness, confusion, decreased LOC
I - irritability
T - tachycardia
E - extremities cool, clammy skin
M - multi-organ damage
Types of Shock
a. Hypovolemic
b. Obstructive
c. Cardiogenic
d. Vasogenic (distributive)
Which type of shock is characterized by the following?
High SVR Poor skin turgor Thirst Oliguria Rapid HR Elevated RR Altered LOC Low BP
Hypovolemic Shock
Causes of obstructive shock
a. tension pneumothorax
b. pericardial tamponade
c. pulmonary embolism
d. superior vena cava syndrome
e. abdominal compartment syndrome
Which type of shock is characterized by the following?
tachycardia tachypnea hypotension jugular venous distension low CO cyanosis, skin mottling rapid/faint/irregular pulses low urine output occasional peripheral edema
Obstructive shock
Cardiogenic shock
Causes of cardiogenic shock
a. #1 myocardial infarction
b. structural damage to the heart
c. damage to the valves of vessels
d. dysrhythmias
e. CHF
f. valvular pathology
Subjective symptoms of cardiogenic shock
a. chest pain
b. dypsnea
c. faintness
d. feelings of impending doom
Progression of Neurogenic Shock
- imbalance between sympathetic and parasympathetic stimulation
- massive vasodilation
- decreased vascular tone
- decreased SVR
- inadequate CO
- decreased tissue perfusion
- impaired cellular metabolism
Systemic inflammatory response syndrome (SIRS)
2 or more:
a. T >38 or <36
b. HR > 90
c. RR >20
d. WBC >12,000 or <4,000 and >10% bands
e. PaCO2 <32 mmHg
occurs in response to infection, screening tools are used to recognize SIRS early so Tx and management can begin early on
What are the goals of nursing management of shock?
a. correct causative factor
b. improve oxygenation
c. restore and maintain adequate perfusion
d. prevent complications
Requires doctor’s orders
Assessment and timely deliverance of interventions!
Assessment of Shock
- History of causative and risk factors from the client
- Fluid intake and output for past 24 hours
- Signs of covert bleeding
- Mental status changes
- Cardiovascular status
- Respiratory status
- ABCs
- head-to-toe
- detailed attention to specific injuries after shock is stabilized
Which type of shock is characterized by the following?
Persistently low BP Low SVR Tachycardia Temperature instability Decreased LOC Tachypnea Altered WBC levels n/v, diarrhea Increased cap refill
Septic shock
Which type of shock is characterized by the following?
Anxiety Difficulty breathing Cough Gastrointestinal cramps Edema (lips and tongue) Hives/uticaria Sensations of burning/itching Decreased LOC Decreased SVR Hypotension Tachycardia Tachypnea Oliguria Audible wheezing, stridor cardiac/respiratory arrest
Anaphylactic shock
Which type of shock is characterized by the following?
Low SVR Bradycardia Warm skin temperature Flushed skin Hypotension ‘Warm’ shock
Neurogenic shock
Describe the pathophysiology of shock
Adequate circulating volume is dependent on 3 interrelated components of the CV system: Heart, Vascular tone and Blood volume
- A minor impairment in one system can be compensated by the other two (compensatory mechanisms)
- If compensatory mechanisms fail, or if more than one of the three factors are not functioning, circulatory failure results
- Prolonged or severe impairment leads to shock
Phases of shock
a. Initial
- Anaerobic metabolism
b. Compensatory
Four Mechanisms
1. CO is improved (catecholamine)
2. Blood flow is increased to central essential organs
3. Plasma volume is increased (ADH, RAAS)
4. Gluconeogenesis (cortisol)
c. Progressive
- exhaustion of the compensatory mechanism
- hypotension
d. Irreversible
- severe cellular irreversible ischemia and necrosis leading to organ failure
- MOD, severe acidosis
Three nursing management of shock
- improve oxygenation
- Restore and maintain adequate perfusion
- Monitor for complications
