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Nursing 272: Final Semester > Unit 2: Obstructive Shock > Flashcards

Unit 2: Obstructive Shock Flashcards

1
Q

Obstructive Shock

A

caused by a mechanical barrier to ventricular filling or ventricular emptying (increased afterload) = decreased CO

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2
Q

Examples of Disorders Resulting in impaired filling

A
  • cardiac tamponade

- tension pneumothorax

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3
Q

Example of disorders resulting in increased afterload

A

severe valvular disease

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4
Q

Potential Cause of Obstructive Shock

A
  • tension pneumothorax
  • cardiac tamponade
  • severe valvular disease
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5
Q

What Hemodynamic Parameters would show in Obstructive shock

A
  • Decreased CO
  • Variable CVP and PAOP
  • Increased SVR
  • Decreased venous oxygen saturation (SvO2 or ScvO2)
  • Hypotension and Tachycardia
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6
Q

Risk Factors for Obstructive Shock

A

-extracardiac disorders that impair ventricular filling or emptying; impaired emptying also referred to increased right or left afterload; ex would be PE

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7
Q

Pathophysiology of Obstructive Shock

A
  • caused by a mechanical barrier to ventricular filling or ventricular emptying (increased afterload); decreases CO
  • symptoms independent of fluid volume status
  • mechanical obstruction to the pumping action of the heart results in decreased CO and poor perfusion at tissue level
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8
Q

Clinical Manifestations of Obstructive Shock

A
  • Decreased LOC
  • Decreased urine output
  • Poor pulses
  • Pale, cool skin
  • Decreased bowel sounds
  • Chest pain
  • N/V
  • SOB
  • Muffled heart sounds if cardiac tamponade
  • Signs of R heart failure (JVD) may be noted with increased right heart afterload or impaired filling
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9
Q

Hemodynamic Parameters

A
  • obtained through PA catheter
  • variable CVP and PAOP depending on problem, impaired filling or impaired emptying
  • SVR is high
  • CO is low
  • SvO2 decreased (oxygen consumption)
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10
Q

Medical Management

A
  • oxygen through 100% non-rebreather mask
  • intubation and mechanical ventilation
  • vasoactive medications to help maintain BP in short term
  • if cause of obstructive shock is impaired filling d/t cardiac tamponade, the blood or fluid in the pericardial sac must be removed or drained; if not death may ensue
  • if cause of shock is impaired ventricular emptying d/t PE, definitive tx is to remove the clot w/ thrombolytic therapy
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11
Q

Medical Management: Intubation and Mechanical Ventilation

A

improving or enhancing oxygenation may help decrease myocardial workload, increase myocardial oxygen supply, and preserve myocardial tissue

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12
Q

Nursing Management: Assessment and Analysis

A

Clinical manifestations are r/t decreased CO and impaired tissue perfusion

  • hypotension
  • tachypnea
  • tachycardia
  • decreased LOC
  • weak pulses
  • cold, cyanotic, mottled skin
  • may present w/ muffled heart sounds d/t presence of excessive fluid in the pericardial sac (cardiac tamponade) or signs of R heart failure d/t elevated right heart afterload
  • decreased or absent bowel sounds
  • decreased or absent urine output
  • death occurs rapidly w/o treatment
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13
Q

Nursing Assessments w/ Obstructive Shock

A
  • Neurological Status
  • Vital Signs
  • Hemodynamic parameters
  • Urine output
  • Skin color and Temperature
  • Laboratory Tests
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14
Q

Assessments: Neurological Status

A
  • decreased LOC occurs as a result of decreased CO and carotid vasoconstriction that occurs as a result of hyperventilation and respiratory alkalosis
  • anxiety and restlessness may occur initially but will rapidly progress to a further decreased LOC w/o treatment
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15
Q

Assessments: Vital Signs

A
  • hypotension and tachycardia b/c of decreased CO
  • respiratory rate increased in an effort to increase tissue oxygenation ad remove CO2 to compensate for metabolic acidosis
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16
Q

Assessments: Hemodynamic Parameters

A
  • filling pressures are variable depending on cause; elevated w/ impaired emptiness
  • decreased w/ impaired filling
  • right and left afterloads increase as a result of mechanical resistance to ventricular emptying
  • decreased SvO2; indicates increased oxygen consumption
  • CO low
17
Q

Assessment: Urine Output

A

decreased urine output as a result of decreased CO and stimulation of compensatory mechanisms that increase reabsorption of sodium + water

18
Q

Assessment: Skin color and Temperature

A

cool and clammy skin as a result of poor peripheral perfusion

19
Q

Assessments: Laboratory Tests

A
  • ABGs: initial respiratory alkalosis d/t hyperventilation

- Venous oxygenation: decreased SvO2/ScvO2 = inadequate oxygen delivery

20
Q

Nursing Actions

A
  • apply 100% non-rebreather oxygen mask
  • prepare for intubation + mechanical ventilation
  • administer meds as ordered (vasoactive, anticoagulation)
  • prepare for definitive Tx of cause
21
Q

Actions: Prepare for intubation + mechanical ventilation

A

frequently necessary w/ obstructive shock in an effort to decrease oxygen consumption (VO2) and increase oxygen availability

22
Q

Vasoactive Medications

A

norepinephrine, dopamine

  • produce vasoconstriction, increases BP
  • allows patient to stabilize until definitive tx is implemented
23
Q

Anticoagulation

A

via Heparin if cause of obstruction is PE

  • used to decrease the formation of new clot
  • prevents existing clot from increasing in size while body is naturally dissolving it
24
Q

Actions: Prepare for definitive Tx: for PE

A

suction thrombectomy

-done to remove obstruction to ventricular emptying

25
Q

Nursing Teachings

A 
>Causes of PE:
-avoid prolonged periods of inactivity
-walk every hour
-drink plenty of fluids
>Anticoagulation teaching
26
Q

Nurse Teachings: Causes of PE

A

> avoid prolonged periods of inactivity
walk every hour
drink plenty of fluids
-mobilization decreases the risk of likelihood of PE formation by decreasing formation of DVT
-dehydration increases tendency for blood to clot

27
Q

Anticoagulation Teaching

A

> use electric razor, soft tooth brushes, avoid contact sports
If on Coumadin (warfarin):
-regular follow-up laboratory testing (INR)
-limit foods high in vitamin K+ (leafy green vegetables)

28
Q

Evaluating Care Outcomes

A
  • rapid recognition
  • inotropic and vasoactive support helps maintain BP
  • monitoring of clinical manifestations and hemodynamic status help evaluate therapeutic interventions
  • successful tx = satisfactory BP, CO, and adequate tissue perfusion

Nursing 272: Final Semester (79 decks)

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