Unit 8 Chapter 34 Shock (Cardiogenic Shock, Septic shock, Obstructive Shock,Neurogenic shock, Hypovolemic shock, Anaphylactic Shock, Flashcards
What are the 4 stages of shock?
-Initial
-Compensatory
-Progressive
-Irreversible(REFRACTORY)
What is shock?
Basically shock is the inability of the
heart to meet the body’s demands of
oxygenated blood for different reasons
What are the types of shock
- Hypovolemic
- Cardiogenic
*Obstructive - Distributive:
-Septic
-Neurogenic
-Anaphylactic
What Mean Arterial Pressure is minimally required for perfusion of vital organs?
A. 65
B. 58
C. 40
D. 50
A. 65
In what amount of time can shock be corrected
The effects are temporary and reversible if the cause of shock is corrected within 1 to 2 hours after onset.
When shock conditions continue for longer periods without help, the resulting increased metabolites cause so much cell damage in vital organs that they are unable to perform their critical functions. When this problem, known as multiple organ dysfunction syndrome (MODS), o
What is the normal MEAN ARTERIAL PRESSURE
70-110
What occurs during the Initial stage of shock?
(NO SYMPTOMS PRESENT)
The initial stage is present when the patient’s baseline MAP is decreased by less than 10 mm Hg.
Because vital organ function is not disrupted, the indicators of shock are difficult to detect at this stage.
Slight increase in diastolic Bp.
* Increased heart rate and respirations.
* Compensatory mechanisms control blood flow to vital
organs.
* Anaerobic metabolism occurs-
Lactic acid is produced.
(Watch for acidosis)
What is the function of lactic acid
marker of muscle breakdown
What is the normal range for lactic acid
0.5-1.0
What occurs during the Compensatory stage of shock?
- Vasoconstriction, increased HR, and increased heart contractility.
- Body shunts blood from skin, kidneys, and GI tract.
*Results in cool, clammy skin, hypoactive bowel
sounds, and decreased urine output. - Perfusion of tissues is inadequate.
- Acidosis occurs as a result of anaerobic
metabolism. (lactic acid) - Respiratory rate increases due to acidosis. * Confusion may occur.
- Na and glucose levels are elevated in response to the release of aldosterone and catecholamine.
- Decrease in MAP of 10-15 mm Hg from baseline value
- Continued sympathetic stimulation * Moderate vasoconstriction
- Increased heart rate
- Decreased pulse pressure
- Chemical compensation
- Renin, aldosterone, and antidiuretic hormone secretion * Increased vasoconstriction
- Decreased urine output
- Stimulation of the thirst reflex
- Some anaerobic metabolism in nonvital organs
- Mild acidosis
- Mild hyperkalemia
What occurs during the Progressive stage of shock?
- Mechanisms that regulate BP can no longer compensate, and BP and MAP decrease.
- All organs suffer from hypoperfusion.
*Results in cool, clammy skin, hypoactive bowel - Vasoconstriction continues, further
compromising cellular perfusion.
*Mental status further deteriorates as a result of decreased cerebral perfusion and hypoxia. - Lungs begin to fail, decreased pulmonary blood flow causes further hypoxemia; carbon dioxide levels increase; alveoli collapse and pulmonary edema occurs.
- Inadequate perfusion of the heart leads to dysrhythmias and ischemia.
- As MAP falls below 70, GFR cannot be maintained.
- Liver function, GI function, and hematologic function are all affected.
Decrease in MAP of >20 mm - Anoxia of nonvital organs
- Hypoxia of vital organs
- Overall metabolism is anaerobic * Moderate acidosis
- Moderate hyperkalemia
- Tissue ischemia
INCREASE LACTIC ACID INIDATES MUSCLE BREAKDOWN
What occurs during the Refractory(IRRIVERSIBLE) stage of shock?
Organ damage is so severe that the patient does not respond to treatment and cannot survive.
* BP remains low.
* Renal and liver functions continue to fail. * Anaerobic metabolism increases acidosis. * Multiple organ dysfunction progresses to complete organ failure.
* Severe tissue hypoxia with ischemia and necrosis
* Release of myocardial depressant factor from the pancreas * Buildup of toxic metabolites
* Multiple organ dysfunction syndrome (MODS)
* Death
DEATH IS IMMINENT
Nursing intervention for Refractory stage
HOSPICE OR PALLIATIVE CONSULT
ENCOURAGE FAMILY VISITATION, family at bedside to share last moments
-there is nothing that can the team can do it is irreversible
expected O2 sat for Compensatory Stage
Oxygen saturation is assessed through pulse oximetry. Pulse oximetry values between 90% and 95% occur with the compensatory stage of shock,
Expected O2 sat for progressive Stage
values between 75% and 80% occur with the progressive stage of shock
Expected O2 sat for Refractory Stage
Any value below 70% is considered a life-threatening emergency and may signal the refractory stage of shock.
What is the method of tx for ALL TYPES OF SHOCK
Early identification and timely treatment
*Identify and treat the underlying cause
* The sequence of events for the different types of shock will vary.
Therefore, the management and care of the patient will vary.
S/S OF SHOCK
Decreased LOC
* Confusion
* Pale, mottled, cool skin.
* Poor skin turgor.
* Cool, cyanotic extremities. rate.
* Delayed capillary refill.
* Dyspnea
* Diaphoresis
* Hypothermia
* Decreased:
* Blood pressure
* Cardiac output
* Low Urine output
* Rapid, thready pulse.
* Increased respiratory
What is hypovolemic shock
The basic problem of hypovolemic shock is a loss of vascular volume, resulting in a decreased mean arterial pressure (MAP) (see Fig. 34.1) and, in some cases, a loss of circulating red blood cells (RBCs). The reduced MAP slows blood flow, decreasing tissue perfusio
What can cause hypovolemic shock
-hemmrohage
-dehyration
-vomitting
-diahrea
Careful considerations of hypovolemic shock
Dehydration is due to fluid not being in vascular space, therefore, a patient with extreme edema, can actually be dehydrated!
It is important to recognize the cause of hypovolemic shock!
If due to lack of plasma – GIVE IV fluids – Red blood cells are still there for oxygen carrying capacity
If due to loss of blood – GIVE Blood – Red blood cells are missing and they need these back
What is the best position for a client in hypovlemic shock
A. high fowlers
B.left lying
C. low fowlers
D. modified trensdelenburg
D. modified trensdelenburg
Which of the following is an early sign of shock?
A. altered level of consciousness
B. organ necrosis
C. O2 sat 70
D. BP 50/70
A. altered level of consciousness
Changes in mental status and behavior occur early in shock. Assess mental status by evaluating LOC and noting whether the patient is asleep or awake
What is the primary intervention for hypovolemic shock
IV therapy for fluid resuscitation is a primary intervention for hypovolemic shock.
Nursing Care for Hypovolemic shock
Ensure a patent airway.
* Insert an IV catheter or maintain an established catheter. A large-bore catheter is suggested.
* Administer oxygen to maintain O2 saturation at 92% to 96%; supplemental oxygen is no longer recommended if saturation is normal (Chu et al., 2018).
Elevate the patient’s feet, keeping his or her head flat or elevated to no more than a 30-degree angle.
* Examine the patient for overt bleeding.
If overt bleeding is present, apply direct pressure to the site.
* Administer drugs as prescribed.
Increase the rate of IV fluid delivery.
Do not leave the patient.
Your client has come from an abdominal resection surgery. When assessing vital signs you notice the MAP has decreased by 10 from baseline. What stage of shock do you anticipate the client experiencing
A. Initial
B. Compensatory
C. Progressive
D. Refractory
A. Initial
What is Cardiogenic Shock
the heart has a low pump, isn’t able to functionally pump the blood to other vital organs in the body
What is the cause of Cardiogenic shock?
A. the client with a history of smoking 1 pack of cigarettes a year
B. The client who has sustained multiple myocardial infarctions
C. The client who has been taking prednisone for 10 years
D. The client with a left leg amputataion
B. The client who has sustained multiple myocardial infarctions
Usually due to compromised
heart from MI or some other
“heart failure” (failure of heart
to pump effectively)
Labs for Hematocrit
37-47 F
42-52 M
Labs for Hemoglobin
12-16 F
14-18 M
What is the normal range for potassium?
3.5-5.0
S/s for Cardiogenic shock
- bradycardia
-hypotension
-cool skin
-pallor
-afib
-blood pools and clots
-weak thread pulse
-pulmonary edema
-tachycardia
Medical tx for Cardiogenic shock (DD)
Digoxin and Dobutamine increase heart contractability
* Decrease anxiety
* Increase contractility
* Decrease workload & O2 demand
Your client has been diagnosed with Cardiogenic shock. On the ecg you notice fibrillation on the monitor. What is the nurses priority action?
A. Assess the client for signs of stroke
B. Check pupil dilation
C. increase IV fluid
D. Administer metformin
A. Assess the client for signs of stroke
when the blood pools and clots and the (Dobutamine D are administered The clot may dislodge and cause the client to experience a stroke