Shock - Exam 6 Flashcards
dopamine (Intropin)
Classfication: Adrenergic agonist
Mechanism of action: acts on (alpha) receptors causing vasocontriction of blood vessels, and to a lesser degree beta receptors (inotropic effects) which increase cardiac output
Use: shock, hypotension, to increase perfusion to VS
Side/adverse effects: HA, tachycaardia, dysrhythmias, N/V/diarrhea, dyspnea
Nursing Implications: need continuous ECG monitoring, BP monitoring, I/O, monitor for fluid volume excess (CHF) should have CVP or PWP during injection
epinephrine (Adrenalin)
Classification: non-selective adrenergic agonist
Mechanism of action: beta agonist (B1 and B2) leading bronchodilation, cardiac, and CNS stimulation
Use: shock, cardiac arrest, anaphylaxis, allergic reactions, acute asthma attacks
Side/Adverse effects: tremor, anxiety, insomnia, cerebral hemorrhage, tachycardia, dysrhythmias, hypertension, anorexia, N/V, dyspnea
Nursing Implications:
Continuous ECG monitoring during administration with CVP, PCWP if possible arterial BP monitoring recommended. Can give VIA ET tube
***Risk for Shock
What is shock?
A syndrome characterized by hypo-perfusion of body tissues that leads to diffuse tissue hypoxia, abnormal cellular metabolism and ultimately cell death
What are factors that contribute to normal regulation of blood flow?
- Adequate blood volume
- Ability of the heart to effectively pump
- Vascular tone
Shock develops when cells do not receive adequate blood flow/O2 thus altering metabolism
- Supply/demand problem
Shock cannot be defined as a specific disease, but manifests within many disease processes
What is the impact of shock on society?
- Increasing incidence
- Critical care environment
- Increased incidence of sepsis
- Brings high mortality rate
- Financial burden
What are risk factors for developing shock?
- Age extremes
- Poor general health
- Immunosuppression
- Trauma
- Multiple medical/surgical therapies
- Long term medical instrumentation
What is the general pathophysiology of shock?
Shock is a syndrome that occurs when the body attempts to achieve homeostasis in response to perfusion/oxygen problem.
What are the causes of hypovolemic shock?
- Hemorrhage
- Burns
- Loss of other body fluids (vomiting, diarrhea, DI)
- Pooling of blood from ascites, peritonitis
- Internal bleeding from ruptured spleen
What is actual hypovolemia?
Loss of whole blood or plasma
What is relative hypovolemia?
Internal shift of fluids from intravascular space to extravascular space
What is hypovolemic shock?
Decreased circulating blood volume (size of the vascular compartment remains the same, while the blood volume decreases)
What is cardiogenic shock?
Defect in ability of heart to pump and move blood forward
What are the causes of cardiogenic shock?
- Previous acute MI
- Large MI
- LVEF 35% or less
- Elderly
Most commonly ventricular ischemia particularly related to acute MI. Other causes are dysrhythmias and structural defects which interfere with the heart’s ability to effectively pump blood
What is distributive shock (neurogenic, anaphylactic, septic)?
Defect in vascular smooth muscle tone: size of the vascular compartment enlarges but blood volume remains the same (vasodilation). Same mechanism for neurogenic, anaphylactic and septic shock
What is neurogenic shock?
- Hemodynamic result of SCI at T5 or above
- Spinal anesthesia
- Vasomotor center depression