shock, sepsis + MODS - powerpoint Flashcards
what is a normal pulse pressure? and how is it calculated?
30-40mmHg;
the difference between systolic pressure and diastolic pressure
what stage of shock does failure of the cardiac pump occur?
in the progressive stage
what are the 3 most common and SERIOUS side effects of fluid replacement?
cardiovascular overload
pulmonary edema
abdominal compartment syndrome
which type of shock is most common and characterized by a reduction in intravascular volume by 15-30%?
hypovolemic shock
what is a normal CVP (central venous pressure)?
2-6mmHg
where should a mean arterial pressure (MAP) be?
> 65
for a patient with hypotension, what position should they be in to bring BP back but while also avoiding more complications like increased ICP?
supine or modified Trendelenburg
what are the characteristics seen in all types of shock?
-inadequate tissue perfusion
-affecting all body systems
-rapid or slow onset
-any patient w/ any disease is at Rx. of developing shock
-hypoperfusion
-hypermetabolism
-inflammatory response is activated
what process is being explained related to shock?
-shock triggers a systemic stress response
-the sympathetic nervous system releases stress hormones (adrenaline + cortisol) –> this increases metabolic activity to meet the increased energy demands needed for tissue repair and immune function
hypermetabolism
-oxygen consumption increases
-protein + fat is broken down for energy
initially hypermetabolism is adaptive, but when its prolonged, what complications can result?
-muscle wasting
-negative nitrogen balance - Nitrogen is a key component of amino acids, which are the building blocks of proteins. This imbalance indicates that the body is breaking down more protein than it is synthesizing - leading to muscle wasting
-impaired recovery
The definition of shock is inadequate tissue ______ leading to cellular dysfunction and organ failure, if not corrected.
perfusion
After the initial stage of shock, following is the compensatory stage, this is where the sympathetic nervous system is activated to maintain perfusion. what 3 S/S will we see?
tachycardia
cool, clammy skin
decreased urine output
following the compensatory stage of shock is the ____________ stage. This is where you’ll see an increased anaerobic metabolism due to the persistent low blood flow. What 3 S/S will you see?
progressive;
-hypotension
-lactic acidosis
-altered mental status
The last stage of shock is the ___________ stage. This is profound ______ damage and irreversible ________ hypoxia.
irreversible stage; organ; tissue
Inotropic medications like:
-dobutamine
-dopamine
-epinephrine
-Milrinone
are given for shock because they
1.
2.
3.
4.
1, improve contractility
2. increase stroke volume
3. increase cardiac output
4. increase oxygen demand of the heart
this helps maintain adequate tissue perfusion + blood pressure
Vasodilators like nitroglycerin and nitroprusside are given for shock to reduce preload and afterload and reduce oxygen demand of the heart. What complication do we need to prioritize assessing for?
hypotension
Vasopressors like norepinephrine, dopamine, phenylephrine, vasopressin, epinephrine and angiotensin II are for shock to do what?
bring up blood pressure to ensure perfusion and oxygen to vital organs
When administering fluid replacement in a patient with shock, we give LR (crystalloid) because is helps with __________ ___________.
metabolic acidosis
Fluid replacement requires a large infusion of volume, over resuscitation can occur. What 2 complications do we need to monitor for?
pulmonary edema and abdominal compartment syndrome
Fluid resuscitation with NS also carries the risk of developing pulmonary edema and abdominal compartment syndrome, but what 3 fluid/ electrolyte imbalances can occur?
hypernatremia
hypokalemia
hyperchloremic metabolic acidosis
Colloids like albumin are really good for treating especially hypovolemic shock because it is going to rapidly expand plasma volume, but what are 4 negatives about albumin?
- expensive
- requires human donation
- limited supply
- can cause HF - this is due to heart function already being compromised and the rapid volume expansion can overwhelm the heart
what 3 blood products are given to treat hypovolemic shock because you can rapidly replace fluid volume?
plasma
PRBC’s
platelets
