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NURS 416 > Week 7b: Circulatory Shock > Flashcards

Week 7b: Circulatory Shock Flashcards

1
Q

an acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in tissue hypoxia

A

circulatory shock

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2
Q

which type of shock involves:

  • loss of blood
  • loss of plasma
  • loss of extracellular fluid
A

hypovolemic

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3
Q

which type of shock involves:

  • inability of the heart to fill properly
  • obstruction of outflow of the heart
A

obstructive

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4
Q

which type of shock involves:

  • loss of sympathetic motor tone
  • presence of a vasodilation substance in the blood
  • presence of inflammatory mediators
A

distributive

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5
Q

which type of shock is caused by an alteration in cardiac function

A

cardiogenic shock

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6
Q

which type of shock: hypotension, tachycardia, weak thready pulse, cool pale moist skin, decreased urine output, decreased cardiac output and increased SVR?

A

hypovolemic

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7
Q

which type of shock: hypotension, tachycardia, cool pale moist skin, urine output less than 30ml/h, crackles and tachypnea, decreased CO and increased SVR?

A

cardiogenic

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8
Q

which type of shock involves hypotension, warm dry skin, bradycardia, decreased CO, venous and arterial dilation, and loss of sympathetic tone?

A

neurogenic

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9
Q

which type of shock: hypotension, tachycardia, cough, dyspnea, pruritus, urticaria, restlessness, decreased LOC, decreased CO and decreased SVR?

A

anaphylactic

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10
Q

which type of shock: hypotension, tachycardia, full bounding pulse, tachypnea, pink warm flushed skin, decreased urine output, fever, decreased CO and decreased SVR?

A

septic

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11
Q

what are some complications of shock?

A
  • acute respiratory distress syndrome
  • acute renal failure
  • gastrointestinal complications
  • DIC
  • multiple organ dysfunction system
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12
Q

treatment of shock

A
  • sustain CO
  • reduce workload and oxygen needs of the myocardium
  • increase coronary perfusion
  • affect peripheral vascular resistance
  • monitor volume
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13
Q

what is the first priority in the management of shock?

A

basic life support

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14
Q

what is second priority in the management of shock?

A

maintaining blood pressure, airway and breathing

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15
Q

what are the other signs and symptoms of cariogenic shock?

A
  • restlessness
  • confusion
  • pale cold sweaty skin
  • peripheral/central cyanosis
  • rapid weak pulse
  • low SAP and MAP
  • drowsiness and coma
  • decreased urinary output
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16
Q

What are 2 very important signs/symptoms of shock?

A
  • shallow, rapid breathing

- increased CVP and pulmonary artery pressure

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17
Q

medications used to treat cariogenic shock

A
  • nitroprusside
  • dobutamine
  • milrinone
  • epinephrine
  • dopamine
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18
Q

Nitroprusside for cariogenic shock

A

produces arterial and venous dilation, producing a decrease in venous return to the heart and a reduction in arterial resistance against which the left heart must pump

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19
Q

dobutamine for cariogenic shock

A

a beta adrenergic agonist which has greater inotropic than chronotropic effects

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20
Q

milrinone for cariogenic shock

A

increases myocardial contractility by letting more calcium into the cell, resulting in decreased after load and increased stroke volume

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21
Q

epinephrine and dopamine (catecholamines) for cariogenic shock

A
  • positive inotropes
  • used with caution because of arterial constriction and increased HR
  • organ failure due to vasoconstriction
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22
Q

when are vasoconstrictors used to treat shock?

A

to maintain the BP when fluid replacement has not been effective

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23
Q

why is treatment with vasoconstrictors considered last resort

A

due to potential organ damage

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24
Q

what are 3 commonly used vasoconstrictors?

A
  • norepinephrine
  • isoproterenol
  • phenylephrine
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25
Q

inotropic effect is usually generated by stimulating….?

A

beta1 adrenergic receptors

26
Q

what are 2 examples of inotropic agents used to treat shock

A
  • dobutamine

- dopamine

27
Q

what are two important signs/symptoms of hypovolemic shock?

A
  • deep rapid breathing

- low CVP

28
Q

crystalloids

A

consists of solutions that are usually isotonic with physiological concentrations of electrolytes. administered IV to replace lost fluids, maintain BP, and promote urine output

29
Q

therapeutic effects and uses of human serum albumin

A
  • low plasma volume
  • hypovolemic shock
  • hypoproteinemia
30
Q

important adverse effects of human serum albumin

A
  • pulmonary congestion
  • circulatory overload if too much fluid is drawn into the vasculature
  • renal failure can promote fluid overload
31
Q

causes of distributive or vasodilatory shock

A
  • decrease in sympathetic control of vasomotor tone
  • release of excessive vasodilatory substances
  • vessel damage from severe or prolonged hypotension due to haemorrhage
32
Q

what are the 3 types of distributive shock

A
  • neurogenic shock
  • anaphylactic shock
  • septic shock
33
Q

decreased sympathetic control of the vessel tone due to a defect in the vasomotor centre

A

neurogenic shock

34
Q

severe systemic allergic reaction most commonly mediated by IgE

A

anaphylactic shock

35
Q

a life threatening organ dysfunction caused by a dysregulated host response to an infection

A

sepsis

36
Q

what are some important manifestations of septic shock

A
  • warm flushed skin
  • fever and increased WBC
  • elevated lactate/ metabolic acidosis
  • decrease in systemic vascular resistance
37
Q

what is the end result of severe sepsis?

A

multiple organ dysfunction syndrome

38
Q

presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention

A

MODS

39
Q

which electrolyte is eliminated primarily though the kidneys and is conserved through reabsorption by aldosterone

A

Sodium

40
Q

Normal range of sodium

A

135-145 mEq/L

41
Q

signs and symptoms of hyponatremia

A
  • nausea and vomiting
  • headache
  • confusion
  • drowsiness/fatigue
  • restlessness/ irritability
  • muscle weakness, spasm or cramps
  • seizures
  • coma
42
Q

what will happen to the cells in hyponatremia?

A

cells swell because water moves in

43
Q

signs and symptoms of hypernatremia?

A
  • excessive thirst
  • lethargy
  • muscle twitching
  • seizures
  • coma
44
Q

what will happen to the cells in hypernatremia?

A

due to to increased osmolality of the ECF, water leaves the cells and the cells shrink

45
Q

which electrolyte plays an important role in transmission of electrical impulses, particularly in the nerve, heart, skeletal, intestinal and lung tissue?

A

potassium

46
Q

what triggers potassium excretion in the urine

A

aldosterone

47
Q

what is the most abundant electrolyte in the body?

A

calcium

48
Q

what is the normal value of calcium?

A

2.1-2.5 mmol/L

49
Q

what is the normal value of ionized calcium ?

A

1.15-1.35 mmol/L

50
Q

what are some causes of hypocalcemia?

A
  • decreased ionized Ca
  • excess loss
  • inadequate intake
  • Decreased absorption in GI tract
51
Q

what are some signs and symptoms of hypocalemia?

A
  • osteoporosis leading to fractures
  • tingling and convulsions
  • abnormal deposits of calcium in bodily tissues
  • muscle spasms and tetany
  • dysrhythmias and cardiac arrest
52
Q

what are two tests used to elicit calcium deficiency?

A
  • trousseaus sign

- Chvosteks sign

53
Q

causes of hypercalcemia?

A
  • loss from bones
  • excess intake
  • increase in factors causing mobilization from bone
54
Q

what are some signs and symptoms of hypercalcemia?

A
  • kidney stones and kidney damage
  • decreased tendon reflexes, lethargy and coma
  • bone pain, osteoporosis and fractures
  • muscle fatigue, hypotonia, decreased GI motility
  • dysrhythmias and cardiac arrest
55
Q

which electrolyte plays a major role in bone formation and metabolic processes?

A

phosphorus

56
Q

which electrolyte imbalances are related to starvation/refeeding?

A

hypophosphatemia

57
Q

which electrolyte maintains normal intracellular levels of potassium, helps maintain electrical activity in nervous tissue membranes and muscle membranes

A

magnesium

58
Q

what is the normal value of magnesium

A

1.5-2.5 mEq/L

59
Q

hypomagnesemia can cause?

A

hypokalemia

60
Q

high serum calcium results in?

A

excretion of magnesium by the GI tract

61
Q

relation between hypomagnesemia and calcium deficit

A

magnesium inhibits the transport of PTH, decreasing the amount of calcium being released from the bone, resulting in possible calcium deficit

NURS 416 (17 decks)

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