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Nursing 4 Exam 3 > Unit 15 Shock Syndrome/AAA > Flashcards

Unit 15 Shock Syndrome/AAA Flashcards

1
Q

What is shock?

A

Life threatening imbalance between the supply of oxygen and tissue demand/ perfusion issue.

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2
Q

What are types of shock?

A

Low blood flow:

  • Hypovolemic shock
  • Cardiogenic shock

Maldistribution of blood: (poor distribution/circulation)

  • Neurogenic shock
  • Anaphylactic shock
  • Septic shock

Obstructive shock:

  • Pneumothorax
  • Cardiac tamponad
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3
Q

What are stages of shock?

A

Initial decreased tissue perfusion

Compensated (pre-shock)

Uncompensated (shock)

Irreversible (multiple organ dysfunction)

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4
Q

What initially are the problems happening in shock?

What do these metabolic changes cause a buildup of?

A

Hypo-perfusion

Hyper-metabolism

Activation of inflammatory response (anaerobic metabolism)

They cause a build up of Lactic Acid

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5
Q

Describe the compensatory stage (pre-shock).

A
  • Flight or fight mechanism is activated
  • Blood flow to vital organs are increased
  • Body is reacting because of imbalance between oxygen supply and demand / decreased perfusion

If cause of decreased perfusion is correct at this stage, PT will recover with little or no effect.

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6
Q

What chemicals does your body release during stage 1?

A

Epinephrine and Norepinephrine

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7
Q

What are signs and symptoms of the Compensatory stage/pre-shock?

A
  • BP normal, narrowing pulse pressure
  • Elevated HR/ weak pulse
  • Increased RR and depth
  • Decreased peristalsis
  • Restless/combative
  • Cool and clammy skin (except for septic shock and neruogenic shock)
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8
Q

How is MAP calculated?

What is normal?

A

SBP + 2(DBP) / 3

Normal = 65 or >

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9
Q

What is the nursing care during the compensatory stage (pre-shock)?

A

-IV fluids to correct hypovolemia
(multiple large bore IV’s, minimum two)

  • Administer O2
  • Foley for fluid management
  • Medications to maintain BP and tissue perfusion
  • Nutritional needs
  • Identify and correct underlying disorder
    (ex: bleeding-stop it, infection-antibiotics, etc)
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10
Q

What makes older patients at risk for shock?

A

Medications such as beta-blockers that mask tachycardia, tachycardia keeps BP up so this will make BP drop faster in the older adult!

Dysrhythmias

Sudden change in mentation (consider infection, not just sun-downers)

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11
Q

During the Uncompensated shock stage (shock) what leaks out of the cells with increased permeability?

What will it cause?

A

Protein which will cause edema

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12
Q

What are signs and symptoms of Uncompensated shock (shock)?

A

Increased edema

Tachypnea, crackles, increased respiratory effort (symptoms of pulmonary edema, M. Vent possibly needed here)

Tachycardia

Decreased BP (~90/40) and cardiac output

Decreased LOC

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13
Q

What is the correct PT positioning for a PT experiencing shock?

A

Modified Trendelenberg

-For low BP during shock, head flat - feet up

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14
Q

What is nursing care during the uncompensated stage or progression of shock?

A

IVF and medications to restore tissue perfusion

Support respiratory system

Early intervention! PT should be in ICU

Promote rest and comfort

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15
Q

What happens during Irreversible (multiple organ dysfunction) last stage of shock?

A

Peripheral vasoconstriction

Decreased cardiac output

Accumulation of waste products

Cerebral ischemia

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16
Q

What is Multiple Organ Dysfunction Syndrome (MODS)?

A

Dysfunction of two or more organs with inability to maintain homeostasis without intervention

-can be complication of any type of shock

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17
Q

What are signs and symptoms of MODS?

A

Decreased BP and HR (needs to be maintained w/meds)

Profound hypoxemia

Increased lactic acid, BUN/Cr

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18
Q

Describe Hypovolemic shock.
What are the two types?
What are the s and s’s?

A
  • Decreased blood volume leads to decreased cardiac output ultimately leading to deceased tissue perfusion.
  • Most common type of shock

2 types
absolute = loss of blood volume
relative = fluids shifted to other spaces

S and S’s:

  • Anxiety
  • Decreased urine output
  • Increased HR
  • Decreased BP
19
Q

What are causes of Hypovolemic Shock?

A

External/absolute:

  • Trauma/Hemorrhage
  • Vomiting/Diarrhea
  • Diabetes Insipdus

Internal/relative:

  • Burns
  • Dehydration
  • Sepsis
  • Liver failure
  • Pancreatitis
20
Q

What are the goals in care of hypovolemic shock?

A

Restore and Redistribute fluid volume

Correct underlying cause of fluid loss

21
Q

What are interventions to restore volume?

A

IV fluids w/crystaloids/colloids- volume expanders
(ex: hetastarch, dextran, albumin)

Blood products

Control bleeding

Stop vomiting and diarrhea

22
Q

How would you provide redistribution in hypovolemic shock?

What can test if PT needs fluid?

A

-PT positioning: lower head, raise feet

-Meds: vasopressin, phenylephrine, epinephrine/norepinephrine, dopamine
(these all constrict blood vessels ^ BP)

Passive leg raising (head flat, legs up) can will show if PT needs fluid because if BP increases with manuever = PT needs fluid

23
Q

What are non-pneumatic shock garments (NPSG)?

A

Keeps pressure on legs and abdomen to try and distribute blood to vital organs

24
Q

What is the nursing management for hypovolemic shock?

A
  • Monitor PT at risk for fluid volume deficit w/ VS, I and O’s, daily weights
  • Fluid replacement before shock develops
  • Treat cause
  • Observe for side effects of treatment
25
Q

What is the side effect of hypovolemic shock treatment?

What patients are at high risk for this complication?

A

Circulatory overload:
-When large volumes are administered rapidly

-High risk PT’s those with HF, Renal failure

26
Q

At what angle is JVD tested?

A

45 degrees sitting up

27
Q

What should you first do with fluids and blood before given?

A

Warm them

28
Q

Describe Cardiogenic shock.
What are some causes?
What are S and S’s?

A
  • Heart suddenly can’t pump enough blood to meet body’s needs. (Pumping issue)
  • Decreased cardiac output leading to decreased perfusion

Causes: MI, Cardiomyopathy, etc

S and S’s: Those of HF

  • Pulmonary congestion
  • Tachycardia
  • JVD
  • S3
  • Increased wedge pressure
  • Cool clammy skin
29
Q

What are surgical treatments for Cardiogenic shock?

What do they all help do?

A

Correct underlying problem:

  • Acute MI - emergency procedure ex: angioplasty,etc
  • Treat dysrhythmias

Circulatory assist with mechanical devices ex:

  • Intra Aortic Balloon Pump (catheter thru groin, intermittent pumping, helps heart pump efficiently)
  • LVAD

They increase preload and decrease afterload

30
Q

What are the pharmacological interventions for cardiogenic shock?

A

Diuretics

Volume expanders: IVF

Vasodilators: nitroprusside, nitroglycerin

Vasopressors: norepinephrine, epi, dopamine

Positive inotropes: dobutamine, dopamine, digoxin

(Medication selected for whatever the cause)

31
Q

What is a complication of medication administration to prevent cardiogenic shock?
What is the treatment?

A

Extravasation-Tissue sloughing:
-accidental infiltration of a vesicant or drug into the surrounding IV site.

(better to administer in central line)

Tx: phentolamine

32
Q

What are findings that indicate abdominal aortic aneurysm?

What are signs of impending rupture?

A
  • Abdominal bruit
  • Complaint of heart beat in abdomen
  • Feeling of abdominal mass/throbbing
  • Cyanosis

Intense back pain
Decreased BP
Decreased Hct

33
Q

What is an aneurysm?
What can they form from?
What are the other kinds of aortic aneurysms?

A

Abnormal bulge that occurs in major blood vessels

Can form from fats and other substances that cause atherosclerosis

Thoracic aortic aneurysms and dissecting aortic aneurysm

34
Q

What are risk factors of aortic aneurysms?

A

Age
Smoker
HTN
Male

and Family hx

35
Q

What are signs and symptoms of thoracic aortic aneurysms?

A

Dyspnea
Cough/stridor
Cyanosis
Chest pain

36
Q

What diagnostic testing can be done for aortic aneurysms?

A

Abdominal Ultrasound

Aortagram w/contrast

CT

X-ray

Pulsating mass in abdomen

Systolic bruit over mass

37
Q

What is an aortic dissection?

A

Inner layer of aorta tears, then blood escapes through tear causing layers to separate (dissect)

38
Q

Describe the process of surgical repair of abdominal aortic aneurysm.

What is the nurses role in witnessing consent?

A
  • General anesthesia
  • Cut out affected part, synthetic graft put in place.

Observe PT signs and writes date and time

39
Q

What is percutaneous treatment for aortic aneurysms?
What is the advantage to this procedure over sx repair?
What is the risk?

A

Endovascular grafts are inserted into thoracic aorta via femoral artery.

Advantage: recovery time is shorter than Sx repair

Increased risk for need of another intervention

40
Q

What are signs and symptoms of aorta dissection?

A
  • Intense lower back pain
  • Tachycardia
  • Hypotension
  • Cool clammy skin
  • Restlessness/agitation
41
Q

What are the nurses priorities during an aortic dissection?

A

Large bore IV’s

Rush to OR

Rapid response

VS

42
Q

Regardless of the type of aortic aneurysm what are the treatments?

A

Sx repair with synthetic graft

or

Percutaneous intervention w/ graft through femoral artery

43
Q

Describe uncompensatory shock (shock).

A

Further decrease in circulating volume and organ perfusion

BP dropping

Impaired gas exchange

Nursing 4 Exam 3 (7 decks)

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