Shock and HIV

Question 1

The Shock Syndrome

Answer 1

All organs will be affected by shock and will either work harder trying to compensate or fail

Question 2

Three major components of the circulatory regulating system must respond to maintain adequate blood pressure

Answer 2

Blood volume
Cardiac output
Vasculature

Question 3

MAP

Answer 3

mean arterial pressure
average of blood pressure
depends upon blood volume and elasticity of vasculature
60-70 for perfusion

Question 4

Initial/Early

Answer 4

Baseline MAP down

Question 5

Compensatory/Non-progressive

Answer 5

Fight or flight: Epi and norepi released
Body shunts blood from skin, kidneys, GI to heart and brain
MAP decrease 10-15
Vasoconstriction: increase HR
Altered mental Status: anxiety, confusion, combative
Thirst
Cool & clammy
Decreased UO and O2 sat
Increased HR, RR
Prognosis is good if treated

Question 6

Progressive/Intermediate

Answer 6

MAP decreased >20
can't maintain O2 to vital organs
Vital organs develop hypoxia and less vital organs become anoxic and ischemic
Increases body acid (lactic acid)
Severe thirst
Impending doom - bad anxiety
Cool & clammy
cyanosis
rapid weak pulse
anuria
Low pH
increased K and lactic acid
Must be treated and reversed within 1 hour!

Question 7

Refractory/Irreversible

Answer 7

overwhelming organ damage
body cannot respond to interventions
therapy may reverse the cause and correct MAP but tissue damage cannot be corrected
rapid LOC
non-palpable pulse
cold, mottled, dusky extremities
Slow, shallow resp
unmeasurable O2 sat

Question 8

MODS

Answer 8

multi organ dysfunction syndrome
damage that’s caused by release of toxic metabolites in shock
toxic metabolites are formed bc of cell death

Question 9

Hypovolemic shock causes

Answer 9

Dehydration: v/d diuretics, ng suction, diaphoresis, DI, hyperglycemia
Hemorrhage: trauma, surgery, GI ulcer, esophageal varices

Question 10

Hypovolemic shock interventions

Answer 10

treat the cause
oxygenate
position in trendelenburg
rehydrate: crystalloids (NS, LR, hypertonic saline) and colloids (albumin, blood products)

Question 11

Hypovolemic shock pharmacological therapy

Answer 11

increase venous returnn
improve cardiac perfusion through coronary vessel dilation
dopamine
norepinephrine
dobutamine
phenylephrine
nitroprusside

Question 12

Cardiogenic shock causes

Answer 12

occurs when the heart’s ability to contract blood is impaired
coronary: MI, myopathies, tamponade, pericarditis, pulmonary htn, pumonary emboli
metabolic: hypoxemia, acidosis, hypoglycemia, hypocalcemia
tension pneumothroax

Question 13

Cardiogenic shock manifestations

Answer 13

angina pain
dysrhythmias
decreased perfusion
hemodynamic instability : decreased bp, change in HR, incrased JVD

Question 14

Cardiogenic shock interventions

Answer 14

monitor
O2
morphine
arterial line to monitor hemodynamics
heart assist devices

Question 15

Distributive/ Circulatory shock

Answer 15

results from fluid shifting from central vascular space
total body fluid is normal or increased
caused by blood vessel dilation or increased permeability, pooling of blood
allergies/bee stings

Question 16

Distributive/ Circulatory shock causes

Answer 16

Neural induced: head trauma, anesthesia, opioids, sedatives

chemical induced: sepsis, anaphylaxis, capillary leak (burn, hepatic dysfunciton, hypoproteinemia)

Question 17

Neurogenic shock interventions

Answer 17

hob >30
SCD and TED hose to prevent blood pooling
IV fluids to keep BP up

Question 18

Septic shock

Answer 18

a complex type of distributive shock that generally begins as a bacterial or fungal infection and progresses to a dangerous condition over a period of days

Question 19

Sepsis

Answer 19

a widespread infection coupled with a general inflammatory response

Question 20

Systemic inflammaotry response syndrome

Answer 20

triggered when infection is out of control
hypotension
decreased uo
increased rr
decreased co
WBC high
microthrombi form
if stopped at this point damage can be reversed

Question 21

severe sepsis

Answer 21

all tissues have some hypoxia
DIC occurs
blood pooling and capillary leak stimulate HR and BP to increase
extremities feel warm and patient looks better
WBC may be lowered to WNL

Question 22

septic shock

Answer 22

multiple organ failure
uncontrolled bleeding
high mortality rate

Question 23

presdisposing factors for sepsis

Answer 23

malnutrition
immunosuppression
large open wounds
malignancy
over 80 yeras
infection
alcoholism
DM
CKD
transplant pt
hepatitis
HIV/aids

Question 24

septic shock interventions

Answer 24

treat underlying cause usulaly with mulitple abx
prior to abx draw blood
oxygen
low dose corticosteroids
maintain glucose

Question 25

obstructive shock

Answer 25

caused by probs that prevent the normal heart from pumping effectively
most common causes: pericarditis and cardiac tamponade