Unit 5 Flashcards
What is the initial stage of shock?
MAP is decreased by 10
Compensation: vascular constriction, increase heart rate
Increased HR and RR, or an increase of BP (only slightly) may be the only indications
Wha is the nonprogressive/compensatory stage of shock?
MAP is 10-15 below
s/s: thirst, anxiety, restlessness, tachycardia, shorter difference of BP numbers, decrease UO, cooler extremities, decrease O2
*Compare the s/s to earlier values and observations is critical to identifying shock
What is the progressive stage of shock?
MAP is decreased 20
s/s: Sense of impending doom, thirst, rapid/weak pulse, decreased BP, cyanosis, cool/moist skin, O2 decreased up to 20%, hyperkalemia, low pH
- Vital organs develop MODS, which needs to be corrected in 1 hour
What is the refractory stage of shock?
Interventions are ineffective
Mini clots form (DIC)
Function of liver, brain, heart, and kidneys decreases
s/s: Loss of consciousness, nonpalpable pulse, dusky extremities, slow/shallow respirations, unmeasurable O2
What is the pathophysiology of hypovolemic shock? Main causes?
Decreased intravascular volume due to fluid loss
MC: ascites, DI, HEMORRHAGE, INADEQUATE CLOTTING, DEHYDRATION
What is the pathophysiology of cardiogenic shock? Main causes?
Impairment of myocardium (pump failure)
MC: Myocardial infarction, drug overdose
What is the pathophysiology of distributive shock? Main types?
Fluid shift from central vascular space (total body fluid increased)
Neurogenic, sepsis, anaphylaxis
MC: chemically induced, neural, sepsis
What is the pathophysiology of neurogenic shock? Main causes?
Resulting from loss of sympathetic tone (blood vessel tone-dilation) causing relative hypovolemia (hypoperfusion)
MC: Emotional trauma, spinal anesthesia, T06 level or higher injury
What is the pathophysiology of obstructive shock? Main causes?
Cardiac function is decreased by non-cardiac function (indirect pump failure)
MC: cardiac tamponade, Pulmonary embolism, tension pneumothorax
In shock, how does pH, PaCO2, PaO2, lactic acid, hematocrit, hemoglobin, and potassium change?
pH: <7.35
PaCO2: > 45
PaO2: <80
Lactic: >7mg/dL
Hematocrit/hemoglobin: if increased its a fluid shift (dehydration); if decreased it is hemorrhage
K+: >5.0 indication of dehydration, acidosis
What to know about all types of shock?
Early identification and timely treatment are key
The sequence of events for different types of shock will vary, and the management of care will vary, BUT ALL NEED NUTRITION.
What are interventions for patients experiencing shock? (i.e. respiratory system, intravascular volume restoration, support cardiac function, nutrition)
Involve the family in cares
Support/encourage expression of feelings
What are s/s of hypovolemic shock?
Hypotension
Oliguria
Tachycardia
What to know about cardiogenic shock?
Treat underlying causes
Meds: aspirin, fentanyl, oxygen, nitroglycerin, antidysrhythmic, diuretics
s/s: angina, fatigue, jugular venous distension
What are s/s of neurogenic shock?
Hypotension
Bradycardia
Warm, dry extremities
Peripheral vasodilation
Poikilothermia
Decreased CO
What to know about anaphylactic shock?
Determine cause
Give Epi
Give O2
What is a primary survey for trauma?
Assessment of
Airway
Breathing
Circulation
Disability - neurological status
Exposure
What is a secondary survey for trauma?
Assessment of
alleergies
medications being used
past illnesses/pregnancy
last meal
events related to injury
T/F you should allow family to see the critical cares performed.
True
What are the phases of trauma care?
Assessment - performed systematically, starting with a primary survey and moving to a secondary survey
Resuscitation - goal-directed volume support, maintenance of normothermia, prevention/correction of acidosis, hemostasis to control hemorrhage
What is tranexamic acid?
Prevents bleeding in clients by blocking the breakdown of blood clots
What are PRBC, FFP, platelets, and cryoprecipitate?
Trauma treatment options
What to know about nitroglycerin, antiarrhythmic medications, and dopamine?
Nitroglycerin - vasodilator, needs to be weaned
Antiarrhythmic - VS Q15min, central line if possible, titration
Dopamine (most common) - high doses cause vasoconstriction
Morphine: for pain and O2 needs (air hunger reduced), dilates blood vessels
What to correct during critical care phase of trauma?
Hypothermia
Coagulopathy
Acidosis
What are complications of trauma?
HYPERMETABOLISM
Rhabdomyolysis
Infection
Sepsis
MODS
Missed injury - usually from lack of assessment
