week7 Flashcards
What is shock?
A physiological response to something that’s happening within the body
When does shock occur?
The body is unable to meet the metabolic demands of the tissues, hypoperfusion resulting in cellular dysfunction and when the adaptive responses can no longer accommodate circulatory changes
What are the different types of shock?
Hypovolaemic Cardiogenic
Distributive shock
What is Hypovolaemic shock?
This is when there is a decreased volume of blood circulating through the body, this can be caused by bleeding, diarrhoea, vomiting or dehydration
What is Cariogenic shock?
This is when an obstruction causes a blockage of circulation, these can include cardiac tamponade and PE
What is Distributive shock?
This is shock that occurs when there is a maldistribution of circulation, these include sepsis, anaphylaxis and neurogenic conditions
What are the clinical manifestations of shock?
Global hypoperfusion Lactate and acid base disturbances
Increaed lactate (organ failure waring sign) Tachycardia
Altered consciousness Tachypnoea
Decreased urine output Hypotension
What is the management for shock?
Fluid resuscitation, fluid infused has to reflect fluid lost
Monitor their observations
Administer medications
Treat cause
What assessments must be carried out on a patient in shock?
Frequent bloods – checking lactate, U&E, ABG’s
Invasive observations – HR & BP by arterial line monitoring, cardiac output by central line
What is the nursing management of hypovolaemia?
Minimise fluid loss Maintain fluid replacement 2 large bore cannulae Keep patient warm Prepare patient for theatre/transfer
What is the nursing management of cardiogenic shock?
Frequent assessment of condition and treatments required
Increase oxygen supply through decreasing activity, positioning and machinery (BiPAP, CPAP)
Fluids
Inatropes
Early indication of shock
Tachycardia Altered consciousness Cold diaphoretic skin Tachypnoea Shallow resps Decreased urine output (<30 mls/hr) Hypotension (SBP <90) – Late/misleading - emergency
Septic Shock?
Systemic Inflammation caused by Sepsis Burns Pancreatitis Trauma
Neurogenic shock
Know as Spinal Shock Loss of Vasomotor tone (sympathetic) Disruption/inhibition neural output Spinal cord injury above T6 Decreased vascular resistance Vascular dilation Commonly cased by Trauma Can be as result of anaesthesia (spinal)
What are Inatropes?
A drug which promotes myocardial contractility to improve cardiac output and blood pressure (dopamine/adrenaline)
What is the nursing management of anaphylaxis?
Patient history Allergies Time of onset ABC assessment Remove any causative agents Secure airway IM adrenaline administer medication (antihistamine/corticosteroid)
What is the nursing management of sepsis?
Fluid management
Address underlying infection
Administer inatrope
What is the nursing management of neurogenic shock?
ABC assessment Stabilise neck/torso Consider administering fluids respiratory assessment & monitoring Maintain core temperature make sure NBM Pressure area care
What is the primary survey for shock?
Airway – with c-spine control Breathing Circulation Disability Exposure – with temperature control
What is the secondary survey for shock?
Top to toe assessment Thorough assessment of other injuries/symptoms Continued assessment (a-e + obs) Documentation Medications/fluid management
Paracetamol IV is a
Analgesic, Antipyretic
Contraindications of Paracetamol
Other paracetamol containing drugs
Reactions of paracetamol
Dizzyness Allergic reactions Vomiting Nausea Constipation Pruritis And others……..
Dosage of paracetamol
1g
