Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

med-surg > Sepsis / Shock > Flashcards

Sepsis / Shock Flashcards

1
Q

shock

A

complex pathophysiologic process that often results in MODS and death, all types of shock involve inadequate tissue perfusion and acute circulatory shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

causes of shock are classified according to

A

the pathophysiologic cause and hemodynamic profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

cause of shock

A
  • hypovolemic
  • cardiogenic
  • distributive; septic, anaphylactic, neurogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

compensation in shock

A

neuroendocrine responses in response to ineffective circulating blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

compensation in shock

A

neuroendocrine responses in response to ineffective circulating blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what response occurs during compensation shock

A

SNS “fight or flight”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why does “fight or flight” occur during compensation shock

A

compensation for increase venous return, CO, and oxygen delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

progression of shock stages

A

initial stage, compensatory stage, progressive stage, refractory stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

progression through each stage varies with

A

the pts condition, duration of initiating event, response to therapy, and correction of underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

clinical manifestations of all shock states are the result of

A

inadequate oxygen delivery and activation of compensatory mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

traditional parameters for assessment of shock states

A
  • appearance
  • VS
  • LOC
  • decrease urinary output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

objective parameters when assessing shock states

A
  • arterial pH
  • serum lactate
  • base excess and base deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how would arterial pH be affected in a pt experiencing shock

A

acid or alkaline state of the arterial output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how would serum lactate be affected in a pt experiencing shock

A

lactic acidosis -> anaerobic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how would base excess and base deficit be affected in a pt experiencing shock

A

base deficit indicates a buildup of lactic acidosis from impaired tissue oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

general management of shock states

A
  • oxygen therapy
  • fluid resuscitation
  • vasoactive pharmacotherapy
  • nutritional support
  • hypovolemic shocl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why provide oxygen therapy to shock pts

A

to improve oxygen delivery to hypoxic tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

why provide fluid resuscitation to shock pts

A

to restore intravascular volume (restoring preload and increase CO of oxygen delivery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why provide vasoactive pharmacotherapy to shock pts

A

to restore vasomotor tone and improve cardiac function; used when fluid resuscitation has not adequately improved the pts perfusion status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why provide nutritional support to shock pts

A

to address the metabolic requirements which are greatly increased in shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

hypovolemic shock occurs when

A

inadequate circulating volume results in inadequate CO to meet tissue oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

hypovolemic shock results from

A

an absolute fluid volume deficit or relative fluid volume deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

absolute hypovolemia

A

loss of fluid from the intravascular space resulting from an external loss of fluid from the body or from internal shifting of fluid from the intravascular to the extravascular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

relative hypovolemia

A

vasodilation produces an increase in vascular capacitance relative to circulating volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

in hypovolemic shock decrease blood volume leads to ______________ leads to _____________ leads to ____________ leads to ____________

A

decrease blood volume leads to decrease venous return -> decrease SV decrease which leads to CO and results in altered tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

clinical manifestations of hypovolemic shock are dependent on the

A

severity of fluid loss and the pts ability (age and health) to compensate for it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

clinical manifestations of hypovolemic shock

A
  • increase HR
  • decrease bp as volume loss increases
  • dry mouth
  • pale
  • cool, clammy skin
  • poor cap refill
  • faint/absent peripheral pulses
  • low urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

management of hypovolemic shock

A
  • secure pts airway
  • support breathing
  • control bleeding
  • restore fluid volume
  • primary prevention of shock
  • targeted treatment at the cause of shock and restoring intravascular volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is cardiogenic shock

A

occurs when the heart’s ability to contract and pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

cardiogenic shock most often is seen in pts with a

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

cardiogenic shock is decreased cardiac contractility -> ________ -> ____________ and __________

A

decrease SV and CO -> pulmonary congestion -> systemic tissue perfusion and decrease coronary artery perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

clinical manifestations of cardiogenic shock

A
  • decrease BP
  • tachypnea
  • cyanosis
  • pulmonary crackles and wheezes
  • increased respiratory distress as fluid overload occurs
  • increase HR
  • increase CVP
  • increase PAWP
  • decreased urine output
  • pale, cool, clammy skin
32
Q

goals of cardiogenic treatment

A
  • limit further myocardial damage and preserve the healthy myocardial tissue
  • improve cardiac function by ↑ myocardial contractility and ↓ ventricular afterload or both (achieved by ↑ oxygen supply to the heart muscle while ↓ oxygen demands)
33
Q

management of cardiogenic shock

A
  • prevention of cardiogenic shock
  • monitoring hemodynamic status
  • administering fluids and medications
  • enhancing safety and concern
34
Q

pharmacologic management of cardiogenic shock

A
  • oxygen
  • analgesia
  • antiplatelet and beta blockers
  • vasoactive medications
  • diuretics
  • antiarrhythmic medications
35
Q

distributive shock

A

the body’s ability to adjust vascular tone is impaired (due to endothelial insult or loss of SNS response) and blood volume is abnormally displaced in the vasculature

36
Q

classifications of distributive shock

A
  • Septic shock
  • Neurogenic shock
  • Anaphylactic shock
37
Q

septic shock is characterized by

A
  • altered fluid volume r/t vasodilation
  • increased capillary permeability
  • maldistribution of circulating volume
38
Q

bacteremia

A

presence of bacteria in the blood

39
Q

infection

A

presence of microorganisms that trigger an inflammatory response

40
Q

what does SIRS stand for

A

systemic inflammatory response syndrome

41
Q

what is SIRS

A

a syndrome resulting from a severe clinical insult that indicates an systemic inflammatory response

42
Q

sepsis

A

a systemic response to infection that may occur post burn, surgery, or serious illness

43
Q

sepsis is the presence of SIRS plus the presence of

A

an infectious source

44
Q

severe sepsis

A

defined as sepsis plus at least one of the following signs
- areas of mottled skin
- cap refill > 3 sec
- decreased urinary output
- lactate > 2mmol/L
- abrupt change in mental status
- platelet count of <100 000 or DIC
- acute lung injury (ALI) or ARDS
- cardiac dysfunction

45
Q

septic shock

A

Shock associated with sepsis; defined as severe sepsis, plus one of the following
- MAP < 60 mmHg post fluid resuscitation
- Need for vasoactive medication in order to maintain MAP of > 60 mmHg

46
Q

clinical manifestations of septic shock

A
  • Temperature (> 38.3°C or < 36°C)
  • Heart rate > 90/min
  • Tachypnea
  • Altered mental status (d/t hypoxia)
  • Significant edema or positive fluid balance (> 20 mL/kg over 24 hr)
  • Hyperglycemia (plasma glucose > 7.7 mmol/L) in the absence of diabetes
47
Q

inflammatory variables

A
  • leukocytosis - increased WBC (neutrophils)
  • elevated plasma C reactive protein
  • increase plasma procalcitonin
48
Q

goal of sepsis management

A

The goal of management is the identification and elimination of the cause of the infection and aggressive cardiopulmonary support

49
Q

managing sepsis

A
  • fluid resuscitation
  • pharmacologic therapy
  • nutritional therapy and glycemic control
50
Q

why fluid resuscitation in pts with sepsis

A

increased CVP, increased BP

51
Q

what pharmacological therapy for pts with sepsis

A
  • if fluid administration fails to increase BP and restore organ perfusion
  • vasopressor or inotropic agents
  • hydrocortisone, activated protein C
52
Q

why nutritional therapy and glycemic control for sepsis pts

A
  • malnutrition further impairs patient’s compensatory mechanisms
  • glycemic control decreased mortality
53
Q

two types of shock from spinal cord injury

A
  • spinal shock
  • neurogenic shock
54
Q

clinical manifestations of spinal and neurogenic shock are related to

A

lost sympathetic innervation & unopposed parasympathetic innervation with a triad of expected signs (hypotension, bradycardia & hypothermia)

55
Q

treatment goals of spinal and neurogenic shock

A
  • Maintain stability of spine
  • Optimize oxygen delivery
  • Restore intravascular volume
56
Q

anaphylactic shock

A
  • Severe, systemic allergic reaction to allergens including food, drugs, blood products, insect venom, and latex
  • A combination of massive vasodilation and ↑ capillary permeability results in a ↓ in venous return, ↓ in CO, and a ↓ in oxygen delivery
  • Involves multiple organ systems, but most life threatening are those involving the cardiovascular and pulmonary systems
57
Q

anaphylactic shock onsets rapidly within ________ or slowly __________

A

5-30 min ; 6-12 hrs

58
Q

clinical manifestations of anaphylaxis

A
  • Respiratory distress due to laryngeal edema, bronchospasm
  • Dizziness, chest pain, facial swelling
  • Wheezing, stridor
  • Pruritis, urticaria, angioedema
  • Anxiety
  • LIFE THREATENING
59
Q

goals of treatment for anaphylaxis

A
  • *Maintain an airway
  • *Support blood pressure
  • Oxygen as necessary
  • Early intubation if necessary, why?
  • Fluid resuscitation
  • If hypotensive, to restore vascular volume
  • Drug therapy
  • Stopping the hypersensitivity response and reversing manifestations of the response
  • Obstructive Shock
60
Q

obstructive shock

A

A physical obstruction to blood flow, either in the heart or major blood vessels resulting in a ↓ in CO and ultimately, a ↓ in tissue perfusion

61
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
61
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
61
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
61
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
61
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
62
Q

causes of obstructive shock

A
  • Pulmonary Embolism
  • Early initiation of anticoagulant therapy (heparin)
  • Tension Pneimothorax
  • Trapped air is decompressed (needle or chest tube)
  • Cardiac Tamponade
  • Emergency removal of pericardial fluid (pericardiocentesis)
  • MODS: Multiple Organ dysfunction syndrome
  • SIRS: Systemic Inflammatory response Syndrome
63
Q

SIRS stimulates an overwhelming __________

A

inflammatory, immunologic, and hormonal response similar to that seen in sepsis patients

64
Q

although SIRS presents clinically like sepsis the difference is that

A

there is NO identifiable source of infection

65
Q

SIRS -> _______ -> ________

A

SIRS -> sepsis -> septic shock

66
Q

SIRS -> _______ -> ________

A

SIRS -> sepsis -> septic shock

67
Q

SIRS can lead to

A

MODS

68
Q

This inflammatory, systemic response is manifested by two or more of the following conditions:

A
  • Temperature >38 or <36
  • HR >90
  • RR >20, or Pa CO₂ <32
  • WBC > 12,000/mm3 or < 4,000/mm3
69
Q

MODS

A

Severe organ dysfunction of at least two organ systems lasting at least 24 to 48 hours in the context of sepsis, trauma, burns, or severe inflammatory conditions

70
Q

MODS can result from SIRS or any type of

A

shock due to inadequate tissue perfusion

71
Q

two MODS pathways

A

primary
secondary

72
Q

4 factors that lead to pathologic changes associated with MODS

A

Uncontrolled systemic inflammation
- Pro-inflammatory mediators initiate a systemic, inflammatory response
Tissue hypoxia
- Patient may appear to have adequate oxygenation but regional tissue hypoxia may occur
Unregulated apoptosis (cell death)
- ↓ levels of certain immune cells (↑ susceptibility) and ↑ levels of other immune cells that ↑ tissue damage
Microvascular coagulopathy
- Abnormal clotting in the small blood vessels resulting in micro-thrombosis and obstruction of blood flow

73
Q

clinical manifestations of MODS

A
  • Difficult to identify because much of organ damage occurs at the cellular level & therefore, can’t be directly measured or observed
  • Most common types of organ dysfunction are ARF and ARDS
74
Q

focus of MODS is

A

prevention

med-surg (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions