Med Surg: Care of Patients with Shock Flashcards
What is shock?
Widespread abnormal cellular metabolism that occurs when the human need for oxygenation and tissue perfusion is not met to the level needed to maintain cell functions
Whole body response
Is a syndrome
Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to the life-threateneing emergency
What is total blood volume
CO and blood volume related to mean arterial pressure
What is the size of the vascular bed
indirectly related to MAP
What is hypovolemic shock?
Most common
inadequate circulating blood volume
blood loss
massive shift of fluid
dehydration
intravascular volume decrease to point the compensatory mechanisms
Cant perfuse organs or tissues
What is cardiogenic shock?
pump problem
inadequate pumping action of the heart
cardiac muscle dysfunction
mechanical obstruction blood flow
decrease CO and evidence tissue hypoxia
What is distributive shock?
changes in blood vessel tone that increase vascular space without increasing circulating blood volume
bigger places for fluid
relative hypovolemia
What is obstructive shock?
Sudden obstruction of blood flow
causes indirect pump failure
throacic tumor
emboli
too much pressure on heart for it to pump
obstruct blood flow
What are the causes of hypovolemic shock?
Hemorrhage: acute loss blood, symptoms with 15-25% loss, 1/2 loss = shock, wounds to chest, abdoment, thigh, H&H levels
Burns: shift plasms from vasular space to interstitial
Dehydration: decrease oral intake or large fluid loss, all compartments depleted
What is cardiogenic shock?
either systolic or diastolic dysfuncion of the pumping action of the heart results in reduced cardiac output
cause can be myocardial dysfunction, structural problem, or dysrhythmia
myocardiacl infarction is the most common cause of direct pump failure
What are signs and symptoms of cardiogenic shock?
Tachycardia: decrease output, increase rate
Hypotension: low blood flow
narrowed pulse pressure
tachypnea and crackles
peripheral hypoperfusion
decreased urine output
anxiety, confusion and agitiation
What is obstructive shock?
frequently considered part of cardiogenic as heart muscle is not able to function adequately
large pulmonary embolism: occlude from lungs
pericardial tamponade: blood/fluid in pericardial space, compress myocardium from pumping
tension pneumothorax: air in pleural space, impede venous return to heart
What is chemical induced distributive shock?
Anaphylactic shock-acute allergic reaction: release histamine, massive vasodilation, urticaria (hives), laryngeal edema, bronchial contriction
Septic shock-infection: systemic inflammatory response, abnormalities in 2 of these 4: body temp, heart rate, respiratory rate or leukocyte count
Capillary leak syndrome-biologic mediator effect: fluid shifts from blood vessels into interstitial tissues, caused by increase size of capillary pores, loss of plasma osmolarity, increased hydrostatic pressure in the blood
What is neural induced distributive shock?
Autonomic NS affected-vasodialtion
decreased venous return
decreased cardiac output
decreased tissue perfusion
triad of hypotension
bradycardia
hypotermia is typical presentation
What is the pathophysiology of shock?
occurs when there is not adequate circulating colume to maintain aerobic metabolim in the cells
adequate volume depeonds on heart, vasuclar tone and blood volume
if 1 of 3 fails, other 2 compensate
if compensation fails or more then 1 fails then they develop shock
Cariogenic: LV fails, release of catecholamines to increase HR and systemic vascular resistance which increases venous return
Anaphylactic large amount of histamine release
Septic: get systemic inflammatory response
That is the process of shock?
Initial: return to mornal, blodd flow remains to organs, maintian MAP & blood flow, hart to detect
Nonprogressive (conpensatory): MAP decrease 10-15 mmHG, cardiac compensate, decrease uring output
Progressive Stage
Refractory stage
Multiple organ dysfunction Syndrome
