Week 7 Shock, Sepsis, & DIC Flashcards
Shock
↓Tissue perfusion => No O2 or nutrients delivered to tissues => CELL DEATH => Release of inflammatory chemicals
- Endgame for all types of shock?
- Priority nursing assessments
- Planning/Goals
SIRS/Sepsis
Systemic inflammatory response => Vascular damage; release of cytokines & free radicals =>
Vasodilation & edema
Multiple organ dysfunction syndrome (MODS)
Failure of ≥2 organ systems
- Results from?
- Mortality rate
Shock - Pathophysiology
- Stage 1: Compensated non-progressive
- Stage 2: Decompensated progressive
- Stage 3: Irreversible refractory
+ BP
+ Compensatory mechanism
+ Body system
+ Tx
Shock & MODS - Poor perfusion assessments & interventions
- S/S & interventions of following
+ Heart
+ Lungs
+ Renal
+ Skin
+ Neuro
+ GI
Cardiogenic shock
- Cause
- Pathophysiology
- Assessment
- Goals & interventions
- Dx/Labs
- Other Tx
- Nursing considerations
- Treatment procedures
Titratable IV med for Cardiogenic shock: Sodium nitroprusside
- Use
- Action
- Goal
- Evaluation
- Nursing considerations
Titratable IV med for Cardiogenic shock: Dobutamine
- Our go-to med
- Use
- Action
- Goal
- Evaluation
- Nursing considerations
Hypovolemic shock
- Main issue
- Causes
- Pathophysiology
- Assessment
- Diagnostics
- Goal
- Interventions
- Evaluation
Hypovolemic shock med: Isotonic fluid
- Initial volume replacement in most types of shock
- 0.9% NaCl, normal saline solution (NSS), LR
Hypovolemic shock med: Hypertonic fluids
- Volume expansion (=> pulls fluid from tissue into blood vessels)
- 1.8%, 3%, 5% NaCl
Hypovolemic shock med: Blood or blood products
- Replaces blood loss & ↑O2 carrying capability
- PRBCs, fresh frozen plasma (FFP), PLTs
Hypovolemic shock med: Colloids
- ↑Plasma colloid osmotic pressure & rapid volume expansion
- Human serum Albumin (5% or 25%)
Obstructive shock
- Main issue
- Causes
- Pathophysiology
- Assessment
- Dx/Labs
- Interventions
Distributive shock
- Pathophysiology
- Types of distributive shock
- Assessment
- Dx/Labs
- Goal
Titratable drip med for Distributive shock: Norepinephrine, Dopamine
- Action
- Use
- 5 things needed prior to admin
- Nursing consideration
- Evaluation
- Contraindication
- Complication for high-dose vasopressors for prolonged time
Septic shock
- Rx factors
- SIRS
- Key Dx test
- Stages
+ SIRS
+ Sepsis
+ Septic shock - Pathophysiology
- Nursing interventions for sepsis
- Treatments
- Prevalence/Incidence of sepsis
Shock meds: Inopressors
Nor/Epinephrine & Dopamine
- Drugs w/ both vasopressor & inotropic effects (sometimes called inopressors)
- Works on alpha & beta-1 receptors
Shock med: Pure vasopressors
Vasopressin, Angiotensin II, Phenylephrine
- Pure vasopressors w/ no effect on cardiac contractility
- C/I for cardiogenic shock
- Only works on alpha receptors (=> vasoconstriction)
Shock med: Purely inotropes
Milrinon, Isoproterenol, Dobutamine
- Purely inotropes that increase cardiac contractility
- Only used for contractility (i.e cardiogenic shock)
- C/I for septic pt’s
Anaphylactic shock
- Main issues
- Common causes
- Pathophysiology
- Assessment
- Intervention/Medication
- Pt teaching
- Collaborative care
Neurogenic shock
- Causes
- Pathophysiology
- Assessment
- Interventions
Disseminated intravascular coagulopathy (DIC)
Systemic activation of blood coagulation => Microvascular thrombi, severe clotting factor depletion, & bleeding
- Complication
- Pathophysiology
- Incidence
- A/S clinical conditions
- Labs
- Diagnostics
- Expected findings
- Tx aims
- Nursing interventions
- Effective outcomes