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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
Q

what does neuro system look like in DECOMPENSATED stage of shock?

A

Confusion, agitation, lethargy, decreased pain response

26
Q

What is this stage of shock in neuro system?
comatose state

A

irreversible

27
Q

What is the skin like in the EARLY stage of shock?

A

Flushed, mottled, decreased cap refill, cool clammy extremities

28
Q

What is the skin like in the DECOMPENSATED stage of shock?

A

Pallor, cap refill > 3 sec, cold dry extremities, sunken eyes

29
Q

What is the skin like in IRREVERSIBLE stage of shock?

A

Pale, cold skin, cyanosis ,cap refill > 5 sec

30
Q

What happens in the renal system during the stages of shock?

A

Early: decreased urine output, increased specific gravity

Decomp: Oliguria, increased specific gravity

Irreversible: Anuria, No urine output

31
Q

What are the types of distributive shock?

A

septic

anaphylactic

neurogenic

32
Q

what does distributive shock result in?

A
  • peripheral vasodilation
  • decreased systemic vascular resistance (SVR)
  • with venous pooling and inadequate arterial tissue perfusion to meet metabolic demands
33
Q

How does septic shock occur?

A
  • infection (UTI, pneumonia, meningitis, appendicitis)
34
Q

What is bacteremia?

A

presence of viable bacteria in blood cultures

35
Q

what are some clinical signs of septic shock?

A

tachycardia, tachypnea, hyperthermia/hypothermia, leucopenia

36
Q

What are the signs of warm shock? and what type of shock is this?

A
  • 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
Q

What are the signs of cold shock? and what type of shock is this?

A
  • 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
Q

What is severe sepsis

A

Systemic Inflammatory Response Syndrome (SIRS)

39
Q

What may you see in severe sepsis/SIRS?

A
  • 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
Q

what occurs in anaphylactic shock?

A
  • 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
Q

What are the signs of anaphylactic shock? (FAST)

A

Face: swelling, changes to skin texture

Airway: wheezes, airway compromise

Stomach: nausea and vomiting

Total body: hives

42
Q

T or F: anaphylactic shock can be life-threatening in a child with respiratory issues? (ex. asthma)

A

True

43
Q

what occurs in neurogenic shock?

A

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
Q

What is the treatment for neurogenic shock?

A
  • First line of treatment is fluid resuscitation
  • O2 is still first line too
45
Q

What occurs in hypovolemic shock?

A
  • decreased cardiac filling
  • lower end-diastolic volume
  • decreased stroke volume
  • decreased cardiac output
46
Q

What is hypovolemic shock caused by?

A
  • 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
Q

What is obstructive shock?

A
  • Physical (and/or mechanical) impediment of blood flow
  • Impairs cardiac output
  • ex. pneumothorax
48
Q

What is cardiogenic shock?

A

Inability of heart to maintain CO and tissue perfusion

49
Q

T or F: cardiogenic shock resembles hypovolemic shock

A

True

50
Q

what are some examples of how cardiogenic shock may occur?

A
  • 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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