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N3122 Child Health > Shock & Fluids > Flashcards

Shock & Fluids Flashcards

1
Q

What is fluid maintenance based on?

A

patient weight

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2
Q

How is total fluid intake calculated?

A

(100ml x 10kg) + (50ml x 10kg) + (20ml x Xkg)

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3
Q

how do you calculate total maintenance fluid rate?

A

TFI/ 24hrs

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4
Q

why may we want to increase fluids?

A

dehydration

shock

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5
Q

why may we want to decrease fluids?

A

hypertension

edema

increase in intercranial pressure

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6
Q

what is the acceptable range for urine output?

A

1-2 ml/kg/hr

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7
Q

when should you notify the physician for urine output?

A

<1 or > 5 ml/kg/hr

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8
Q

How do you calculate urine output?

A

urine output/ patient weight / how many hours for that amount of output

ml/kg/hr

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9
Q

how much and how do you deliver a bolus

A

10-20ml/kg through IV or intra osseous (into bone marrow)

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10
Q

Define shock

A

when the organs and tissues of the body are not receiving adequate flow of blood which in turn deprives tissues and organs of oxygen

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11
Q

what does shock lead to?

A

decreased intravascular volume

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12
Q

How does shock lead to decreased intravascular volume?

A
  • decreases CO and SV due to vasodilation and 3rd spacing
  • hypoxia and acidosis develops
  • adrenergic and renal compensations
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13
Q

What are the compensatory mechanisms for shock?

A
  • increase in HR and BP
  • increase in respirations
  • increase in catecholamine and cortisol
  • renin > angiotensin > aldosterone
  • ADH > H2O and Na retention
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14
Q

what is decompensation of shock? and what may present?

A

continued intravascular volume depletion

  • can present with: DIC, hypotension, cellular death, multi-organ death, cardiac or resp arrest
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15
Q

What are the 4 main causes (etiology) of shock?

A
  • distributive
  • hypovolemic
  • cardiogenic
  • obstructive
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16
Q

what do each of the causes of shock have in common?

A

one or more of the physiologic principles that govern oxygen delivery or consumption is disturbed

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17
Q

What happens in the early/compensated stages of shock?

A

Vital organ function is sustained by intrinsic compensatory mechanisms

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18
Q

What happens in the decompensated stage of shock?

A

circulatory failure overcomes compensatory efforts: results in tissue hypoxia, metabolic acidosis, leading to multi-organ dysfunction

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19
Q

What happens in the profound shock stage?

A

Imminent cardiac and/or respiratory arrest

Irreversible organ damage due to prolonged ischemia

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20
Q

What is this stage of stock with the cardiac system?
Mild tachycardia, weak distal pulses strong central pulses

A

early

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21
Q

What is this stage of stock with the cardiac system?
Moderate tachycardia, thready distal, weak central pulses, decreasing BP

A

Decompensated

22
Q

What is this stage of stock with the cardiac system?
Hypotention, severe tachycardia or bradycardia, absent distal, thready central

A

irreversible

23
Q

What does the respiratory system look like in the stages of shock?

A

early: mild tachypnea

demcomp: moderate tachypnea

irreversible: severe tachypnea

24
Q

What does the neuro system look like in EARLY stage of shock?

A

Normal, restless, anxious

25
what does neuro system look like in DECOMPENSATED stage of shock?
Confusion, agitation, lethargy, decreased pain response
26
What is this stage of shock in neuro system? comatose state
irreversible
27
What is the skin like in the EARLY stage of shock?
Flushed, mottled, decreased cap refill, cool clammy extremities
28
What is the skin like in the DECOMPENSATED stage of shock?
Pallor, cap refill > 3 sec, cold dry extremities, sunken eyes
29
What is the skin like in IRREVERSIBLE stage of shock?
Pale, cold skin, cyanosis ,cap refill > 5 sec
30
What happens in the renal system during the stages of shock?
Early: decreased urine output, increased specific gravity Decomp: Oliguria, increased specific gravity Irreversible: Anuria, No urine output
31
What are the types of distributive shock?
septic anaphylactic neurogenic
32
what does distributive shock result in?
- peripheral vasodilation - decreased systemic vascular resistance (SVR) - with venous pooling and inadequate arterial tissue perfusion to meet metabolic demands
33
How does septic shock occur?
- infection (UTI, pneumonia, meningitis, appendicitis)
34
What is bacteremia?
presence of viable bacteria in blood cultures
35
what are some clinical signs of septic shock?
tachycardia, tachypnea, hyperthermia/hypothermia, leucopenia
36
What are the signs of warm shock? and what type of shock is this?
- septic shock signs: Tachycardia Tachypnea Fever Bounding pulses BP normal or slightly increased Wide pulse pressure 3040 mmHg Fussy/irritable/unable to console Flushed , mottled Normal urine output 1-2 cc/kg/hr
37
What are the signs of cold shock? and what type of shock is this?
- septic shock -signs: Severe tachycardia to bradycardia Increase WOB > resp depression Hypothermia Weak peripheral pulses Hypotension Narrow pulse pressure 10-20 mmHg Lethargic altered LOC Decreased cap refill 3-5 sec, cool to cold pale extremities Low urine output < 1cc/kg/hr
38
What is severe sepsis
Systemic Inflammatory Response Syndrome (SIRS)
39
What may you see in severe sepsis/SIRS?
- Core temp>38.5°C (high temp), significant increased HR and Resp. for age, increased Leukocyte counts, positive cultures or strongly suspected - disseminated intravascular coagulation - O2 therapy and fluid replacement given without pt. Improvement
40
what occurs in anaphylactic shock?
- due to massive hypersensitivity response (Type I) - Loss of vascular tone due to vasodilatation - Capillaries begin to leak fluids with mast cells initiating hypersensitivity cascade (Blood is where it is not supposed to be)
41
What are the signs of anaphylactic shock? (FAST)
Face: swelling, changes to skin texture Airway: wheezes, airway compromise Stomach: nausea and vomiting Total body: hives
42
T or F: anaphylactic shock can be life-threatening in a child with respiratory issues? (ex. asthma)
True
43
what occurs in neurogenic shock?
severe central nervous system trauma (i.e. spinal cord injury) causes a rapid loss in sympathetic stimulation Loss of sympathetic and parasympathetic control results in massive vasodilation and a decrease in peripheral vascular resistance causing blood to pool in the venous system
44
What is the treatment for neurogenic shock?
- First line of treatment is fluid resuscitation - O2 is still first line too
45
What occurs in hypovolemic shock?
- decreased cardiac filling - lower end-diastolic volume - decreased stroke volume - decreased cardiac output
46
What is hypovolemic shock caused by?
- blood loss due to significant injury/trauma or surgery - Plasma loss due to burns, nephrotic syndrome, or sepsis - Fluid and electrolyte loss associated with dehydration, diabetic ketoacidosis, diabetes insipidus, heat stroke, gastroenteritis (bug causing vomiting and diarrhea)
47
What is obstructive shock?
- Physical (and/or mechanical) impediment of blood flow - Impairs cardiac output - ex. pneumothorax
48
What is cardiogenic shock?
Inability of heart to maintain CO and tissue perfusion
49
T or F: cardiogenic shock resembles hypovolemic shock
True
50
what are some examples of how cardiogenic shock may occur?
- Hypoplastic left heart syndrome: born with underdeveloped heart - Cardiomyopathy - Myocarditis - Severe electrolyte imbalance - Severe acid-base imbalance

N3122 Child Health (14 decks)

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