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NUR370 Pathophysiology and Pharmacology > Shock > Flashcards

Shock Flashcards

1
Q

Anoxia

A

total depletion or absence of oxygen

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2
Q

Hypoxemia

A

low oxygen in the blood

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3
Q

Hypoxia

A

abnormally low oxygen content in any tissue or organ

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4
Q

Inability to correct and reverse shock results in

A
  • increasing oxygen debt
  • acidosis
  • organ system dysfunction
  • death
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5
Q

What happens at the cellular level during shock?

A
  1. impaired oxygen use
  2. impaired glucose use
  3. buildup of metabolic end products
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6
Q

How does anaerobic metabolism lead to cell death?

A

a. inadequate energy production&raquo_space; metabolic failure

b. lactic acid production&raquo_space; metabolic acidosis

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7
Q

Gluconeogenesis

A

formation of glucose in the liver from non-carbohydrate carbon substrates

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8
Q

Systemic Effects of Shock

A
  1. Lungs (impaired gas exchange - ARDS, respiratory failure)
  2. Heart (myocardial deterioration)
  3. Blood (hypercoagulable)
  4. Neuroendocrine (SNS activation and increased ACTH)
  5. Immune, GI and renal systems
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9
Q

Acute Respiratory Distress Syndrome

A

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

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10
Q

Disseminated Intravascular Coagulation (DIC)

A

Multiple thrombi or emboli in microvascular circulation

Lab findings:

a. thrombocytopenia
b. prolonged PT, aPTT, thrombin
c. decreased fibrinogen
d. elevated d-dimers

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11
Q

Adequate circulating volume is dependent on which 3 interrelated components of the CV system?

A

a. heart
b. vascular tone
c. blood volume

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12
Q

Name 4 compensatory mechanisms of shock

A
  1. baroreceptors
  2. chemoreceptors
  3. circulating vasoconstrictors
  4. kidney and the RAAS
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13
Q

Clinical manifestations of shock (CHORD ITEM)

A 
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

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14
Q

Types of Shock

A

a. Hypovolemic
b. Obstructive
c. Cardiogenic
d. Vasogenic (distributive)

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15
Q

Which type of shock is characterized by the following?

High SVR
Poor skin turgor
Thirst
Oliguria
Rapid HR
Elevated RR
Altered LOC
Low BP
A

Hypovolemic Shock

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16
Q

Causes of obstructive shock

A

a. tension pneumothorax
b. pericardial tamponade
c. pulmonary embolism
d. superior vena cava syndrome
e. abdominal compartment syndrome

17
Q

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
A

Obstructive shock

Cardiogenic shock

18
Q

Causes of cardiogenic shock

A

a. #1 myocardial infarction
b. structural damage to the heart
c. damage to the valves of vessels
d. dysrhythmias
e. CHF
f. valvular pathology

19
Q

Subjective symptoms of cardiogenic shock

A

a. chest pain
b. dypsnea
c. faintness
d. feelings of impending doom

20
Q

Progression of Neurogenic Shock

A
  1. imbalance between sympathetic and parasympathetic stimulation
  2. massive vasodilation
  3. decreased vascular tone
  4. decreased SVR
  5. inadequate CO
  6. decreased tissue perfusion
  7. impaired cellular metabolism
21
Q

Systemic inflammatory response syndrome (SIRS)

A

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

22
Q

What are the goals of nursing management of shock?

A

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!

23
Q

Assessment of Shock

A
  1. History of causative and risk factors from the client
  2. Fluid intake and output for past 24 hours
  3. Signs of covert bleeding
  4. Mental status changes
  5. Cardiovascular status
  6. Respiratory status
  • ABCs
  • head-to-toe
  • detailed attention to specific injuries after shock is stabilized
24
Q

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
A

Septic shock

25
Q

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
A

Anaphylactic shock

26
Q

Which type of shock is characterized by the following?

Low SVR
Bradycardia
Warm skin temperature
Flushed skin
Hypotension 
‘Warm’ shock
A

Neurogenic shock

27
Q

Describe the pathophysiology of shock

A

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
28
Q

Phases of shock

A

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

29
Q

Three nursing management of shock

A
  1. improve oxygenation
  2. Restore and maintain adequate perfusion
  3. Monitor for complications

NUR370 Pathophysiology and Pharmacology (20 decks)

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