Week 4 - Distributive Shock Flashcards

1
Q

Distributive Shock is AKA ________________

A

AKA: Vasogenic Shock

This is a SHOCK of the blood vessels and the inability of the body (veins / arteries) to VASOCONSTRICT. The vasodilation permits the blood to distribute into incorrect places in the body (usually our periphery) —leading to a DECREASED PRELOAD, Decreased Stroke Volume, Decreased Cardiac output

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2
Q

what is Distributive Shock?

A

Wipespread Vasodilation and increased capillary permeability

*Neurogenic, septic, anaphylactic shock

Because the BLOOD VOLUME does NOT change–relative hypovolemia results

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3
Q

What is Relative Hypovolemia

A

Inadequate distribution of blood volume between the central and peripheral compartments

_Because of vasodilation it appears that the our blood volume is decreased–even though we didnt lose any volume

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4
Q

Causes (2) of Distributive Shock (overall)

A

1) Loss of sympathetic tone

2) Release of biochemical mediators (ie, histamine) from cell

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5
Q

most common type of SHOCK and IN HOSPITAL SHOCK across the board

A

SEPTIC SHOCK

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6
Q

Most common cause of death in the ICU

Mortality rate of 40-70%

A

SEPTIC SHOCK

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7
Q

Type of Shock that initiates activation of biochemical response and systemic inflammatory response

A

Septic Shock

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8
Q

What happens with Septic Shock?

include the “three” defining points

A

activation of biochemical response and systemic inflammatory response
1) Increased capillary permeability-leaky cells

  2) widespread vasodilation
  3) Activation of clotting / fibrinolytic cascade
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9
Q

Medical Management (4) of Septic Shock

A

1) Cardiopulmonary Support
-FLUID REPLACEMENT (essential)
30 ml/kg of fluid over 30-60 minutes
If MAP <60 or hypotensive (from baseline value)
Vasoconstrictors are then added!

2) Identify and eliminate cause of infection
- collect cultures first
- antiobiotic therapy

3) Glucorticoids (hydrocortisone)
- pts with septic shock show better response with it

4) Control Fever
- dont want their body working extra hard

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10
Q

Nursing Management (4) of SEPTIC Shock

A

1) Identify High Risk Patients
- Immunocompromised
- Indwelling lines
- invasic procedures
- debilitated

2) Assess perfusion status / intervene PRN
- Titration of meds

3) Prevent infection
- handwashing
- aseptic technique for invasive procedures
- proper use of central lines

4) Monitor responsiveness to interventions
- Improved CVP
- MAP > 60
- LOC
- Urine Output
- Pulses

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11
Q

Type of shock that results from the loss of balance between the parasympathetic and sympathetic–resulting in vasodilation

A

NEUROGENIC SHOCK

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12
Q

Causes (4) of Neurogenic Shock

A

1) Spinal cord injury (above T6)
2) Spinal Anesthesia
3) head injury
4) Nervous System Damage

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13
Q

Sympathetic vs Parasympathetic

A

Sympathetic = “fight or Flight”

Parasympathetic = “Rest and Digest”

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14
Q

Neurogenic shock signs and symptoms

A

Hypotension with bradycardia

Warm, dry skin

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15
Q

Treatments for Neurogenic Shock

A

1) Restore sympathetic tone with vasopressors

2) Increase HR with atropine

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16
Q

Type of Shock caused by severe allergic reaction and affects Airway, Breathing and Circulation

A

Anaphylactic Shock

17
Q

what does Histamine do in the body?

A
Vasodilation (Epinepherine causes vasoconstriction)
Cardiac Depression (Epi causes cardiac stimulation)
Bronchospasm (Epi causes Bronchial relaxation)
18
Q

S/S of Anaphylactic Shock (4)

A

1) severe bronchospasm
2) Urticaria
3) angioedema (swelling in face, tongue)
4) profound hypotension

19
Q

Medical / Nursing Management

Anaphylactic Shock

A

1) Remove causative agent

2) Medications
Fluids: 2 L of crystalloids
First Line agent: Epinepherine Pen
H1 and H2 antagonist: (histamine blocking)
Bronchodilator (Relaxes the airway)
Corticosteroids: (to decrease inflammation)

3) Emergency support (airway protection)
4) Check for allergies and / or possible reaction to blood products
5) education on avoiding future exposure

20
Q

ANAPHYLACTIC SHOCK:

FLUID…

First line tx (medication)

Second Line Tx (medications)

A

1) FLUID:
- -2 L of Crystalloids (IV)

2) 1st line tx:
- -Epinephrine (IM) if not in shock

3) 2nd line tx:
- -Epinephrine (IV) if pt is in shock

21
Q

NEUROGENIC SHOCK

FLUID…

First line tx (medication)

Second Line Tx (medications)

A

1) FLUID:
- -2 L of Crystalloids (IV)

2) 1st line tx:
- - Norepinephrine,
- -Vasopressin

3) 2nd line tx:
- -Phenylephrine (monitor for reflex bradycardia)

22
Q

SEPTIC SHOCK

FLUID…

First line tx (medication)

Second Line Tx (medications)

A

1) FLUID:
- -30 mLs / kg over 30-60 minutes

2) 1st line tx:
- - Norepinephrine,

3) 2nd line tx:
- -Dopamine
- -Epinephrine
- -Vasopressin (if catecholamine resistant)
- -Phenylephrine (combined w/initial agent-or given alone if tolerated)