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Exam2 NRS 202 > Shock, Sepsis, MODS > Flashcards

Shock, Sepsis, MODS Flashcards

1
Q

Life-threatening condition in which tissue perfusion is inadequate to delivery o2 and nutrients to support cellular function

A

Shock

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2
Q

What 3 symptoms are common to all types of shock?

A

hypoperfusion, hypermetabolism, and activation of the inflammatory response

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3
Q

During shock, stress leads to what?

A

Depletion of glycogen, cell death, and clotting cascade

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4
Q

This stage of shock has manifestations of the following:
BP within normal limits
Adequate CO
Fight or flight response
Increased respirations
Inadequate perfusion
Anxiety
Confusion

A

Compensatory

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5
Q

What are the 3 stages of shock?

A

Compensatory, progressive, and irreversible

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6
Q

How is the compensatory stage of shock managed?

A

Treat underlying cause
Fluid replacement
Oxygen
Decrease anxiety
Maintain BP and perfusion
Frequent assessments (LOC, I&O, HR, BP, MAP >65, narrwed pulse pressure)
Promote safety

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7
Q

What is being frequently assessed during shock?

A

LOC
I&O
HR
BP
MAP
Pulse pressure
ABG
Hemodynamics
ECG
Electrolytes

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8
Q

How often are assessments done for shock patients?

A

every 15 minutes

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9
Q

This stage of shock has manifestations of the following:
BP no longer compensated
MAP <65
Decreased LOC
Rapid/shallow respirations
Chest pain
AKI
Liver failure
GI bleeding
Abnormal bruising and petechiae with prolonged clotting times

A

Progressive

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10
Q

Describe the pathophysiology of shock

A

Heart failure
Decreased cellular perfusion
Interstitial edema
Anaerobic metabolism
Hyperactive clotting cascade

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11
Q

How is the progressive stage of shock managed?

A

Treat underlying cause
Fluid resuscitation
Respiratory support
Assessment (ABGs, hemodynamics, ECG, LOC, electrolytes)
Nutritional support
Oral care to prevent VAP
Rest and comfort to decrease stress
Skin integrity

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12
Q

This stage of shock has manifestations of the following:
Severe organ damage
Unable to maintain BP w treatment
Unable to oxygenate w vent support
Unable to maintain MAP
MODS
Severe hypotension
Complete decline in mental status
Oliguria

A

Irreversible

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13
Q

Describe the pathophysiology of irreversible shock

A

Organ damage is too severe to respond to treatment
Acute metabolic acidosis develops
Lactic acidosis develops
Energy stores are depleted

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14
Q

How is the irreversible stage of shock managed?

A

Treat underlying cause
Respiratory support
Circulatory support
Nutritional support
Experimental treatments
Comfort measures
Infection prevention
Skin integrity
End of life measures

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15
Q

Which stage of shock is characterized by a normal BP?

A

Compensatory

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16
Q

What nursing management is central to all types of shock?

A

fluid replacement
vasoactive medications
nutritional support

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17
Q

What colloid is the preferred choice for fluid resuscitation for shock?

A

Albumin

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18
Q

When are vasoactive medications used during shock?

A

when fluid therapy does not maintain MAP

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19
Q

Vasoactive medications should be given through what when possible?

A

a central line

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20
Q

Why is nutritional therapy needed during shock?

A

to meet increased metabolic demands and prevent catabolism due to glycogen depletion

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21
Q

Why is glutamine given during shock?

A

To maintain plasma levels and prevent MODS

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22
Q

Why are H2 blockers and PPIs given during shock?

A

To prevent stress ulcers

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23
Q

What is the most common type of shock?

A

hypovolemic shock

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24
Q

What are external fluid loss causes of hypovolemic shock?

A

Trauma, surgery, diarrhea

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25
Q

What are internal fluid loss causes of hypovolemic shock?

A

Hemorrhage and burns

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26
Q

When does hypovolemic shock occur with internal fluid loss?

A

Occurs with 15-30% reduction in intravascular volume

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27
Q

What are the manifestations of hypovolemic shock?

A

Decreased blood volume
Decreased CO
Decreased tissue perfusion

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28
Q

How is hypovolemic shock managed?

A
  1. Treat underlying cause
  2. Fluids: NS, LR, blood/albumin @ 3:1 rule
  3. O2
  4. Meds - vasopressors
29
Q

Type of shock that occurs when the heart’s ability to contract and pump blood is impaired leading to inadequate supply of oxygen to heart and tissues

A

Cardiogenic shock

30
Q

What are the clinical manifestations of cardiogenic shock?

A

Angina
Unstable BP
Arrhythmias
Fatigue
Feelings of doom
ECG changes
Increased cardiac enzymes and cardiac biomarkers

31
Q

How is cardiogenic shock managed?

A
  1. Treat cause
  2. O2
  3. Drugs
  4. Pain and fluids
32
Q

What 3 drugs are used for cardiogenic shock?

A

Dobutamine
Nitroglycerin
Dopamine

33
Q

How does dobutamine effect cardiogenic shock?

A

Decrease left ventricular pressure and raises BP by increasing CO

34
Q

Why is dobutamine preferred over dopamine?

A

It does not cause vasoconstriction so therefore it is preferred when there is a need to increase CO

35
Q

How does dopamine effect cardiogenic shock?

A

Increase cardiac contractility

36
Q

Why is nitroglycerin used in cardiogenic shock?

A

It is a powerful vasodilator allowing for increased perfusion of the cells and decreased workload of the heart

37
Q

3 types of distributive shock

A

septic
neurogenic
anaphylactic

38
Q

Type of shock that involves pooling of peripheral blood vessels

A

distributive shock

39
Q

What is the most common type of distributive shock?

A

septic

40
Q

What lab result is key with septic shock?

A

Lactic acid

41
Q

Describe the pathophysiology of septic shock

A

microorganism invades
Immune response is triggered
Inflammatory response is triggered
Leads to decreased perfusion

42
Q

Type of shock that involves a systemic inflammatory response syndrome (aka cytokine storm)

A

septic shock

43
Q

This type of shock has manifestations of the following:
Hyperthermia (fever)
Tachycardia
Bounding pulses
Hypotension
Decreased urine output
N/V/decreased GI motility
Change in LOC
Cool, mottled skin
MODS

A

Septic shock

44
Q

What is the biggest, most immediate sign of septic shock in the elderly?

A

Subtle change in LOC and increasing temperature

45
Q

How is septic shock managed?

A

Septic bundle -
1. Abx
2 Fluids - 30 ml x kg over 30 min
3. Norepinephrine
4. O2

46
Q

What is done prior to starting broad spectrum abx for septic shock?

A

cultures

47
Q

Type of shock caused by an imbalance between parasympathetic and sympathetic stimulation

A

Neurogenic shock

48
Q

Causes of neurogenic shock

A

SCI, spinal anesthesia, or nervous system damage

49
Q

Describe the pathophysiology of neurogenic shock

A

Sympathetic stimulation occurs causing vascular smooth muscle contraction

Parasympathetic stimulation occurs causing vascular smooth muscle dilation, leading to blood volume displacement and inadequate perfusion

50
Q

What are the manifestations of neurogenic shock?

A

Hypotension
Bradycardia
Syncope
Dry, warm skin

51
Q

Which shock is characterized by warm, dry skin?

A

neurogenic shock

52
Q

How is neurogenic shock managed?

A

By restoring sympathetic tone through stabilizing the spinal injury
Treat underlying cause
Prevent through proper alignment and positioning of a patient with a SCI
Support CV and neuro function

53
Q

Type of shock that is due to a severe allergic reaction

A

Anaphylactic shock

54
Q

What are the most common triggers of anaphylactic shock?

A

Foods
Meds
Insect stings and bites

55
Q

What are the 3 defining characteristics of anaphylactic shock?

A

-Acute onset
-Presence of two or more of: respiratory distress, hypotension, GI distress, skin or mucosal irritation
-CV compromise

56
Q

Describe the pathophysiology of anaphylactic shock

A

Previously produced antibodies are exposed to an antigen and develop a systemic reaction (IgE)
Mast cells release potent vasoactive substances like histamine and bradykinin
Leads to inflammation with significant vasodilation and capillary permeability

57
Q

Type of shock that includes manifestations of:
-signs that occur w/in 2-30 min of exposure
-mild signs like: HA, lightheadedness, N/V, pruritus, flushing, dyspnea, bronchospasm, arrhythmias, hypotension
-severe signs like: rapid hypotension, decreased LOC, respiratory distress, and cardiac arrest

A

Anaphylactic shock

58
Q

How is anaphylactic shock managed?

A

1 Remove antigen

#2 Epinephrine
#3 Activate EMS
#4 Fluid replacement
#5 Meds like Benadryl
#6 CPR

59
Q

PICS =

A

Post-intensive care syndrome

60
Q

Syndrome that involves physical, cognitive, and mental impairments that can have an adverse effect on a patient’s long-term recovery.

A

PICS

61
Q

How can the nurse prevent PICS?

A

Early mobilization
Assess and manage delirium
Promoting adequate sleep
Respiratory weaning if on ventilator

62
Q

What are the risk factors or causes of septic shock?

A

Immunosuppression
Extremes of age
Malnourishment
Chronic illness
Invasive procedures
Emergent or multiple surgeries

63
Q

Risk factors for anaphylactic shock

A

History of med sensitivity
Transfusion reaction
History of reaction to insect bites
Food allergies
Latex sensitivity

64
Q

Risk factors for neurogenic shock

A

SCI
Spinal anesthesia
Depressant action of meds

65
Q

What needs to be completed within 1 hr of septic shock symptoms?

A

Measure lactate level
Obtain blood cultures prior to abx’s
Admin broad spectrum abx
Begin rapid infusion of 30 mL/kg crystalloid for hypotension or lactate >4

66
Q

What needs to be completed within 3 hrs of septic shock symptoms?

A

Measure lactate level
Obtain blood cultures prior to abx’s
Admin broad spectrum abx
Begin rapid infusion of 30 mL/kg crystalloid for hypotension or lactate >4

67
Q

What needs to be completed within 6 hrs of septic shock symptoms?

A

Begin vasopressor agents if hypotension is not corrected by fluids
Reassess VS using 2 of the following: measurement of CVP or scVo2, bedside CV US, or assess fluid responsiveness w PLR or fluid challenge

68
Q

scVo2 should be maintained at what?

A

> 70%

Exam2 NRS 202 (7 decks)

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