Class 3 Flashcards by Chelsea Hooker

inadequate tissue perfusion
anaerobic metabolism
cellular and tissue injury
organ damage
mutli-system organ failure
death
complications of what?

shock

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condition in which there is decreased systemic blood flow and decreased cardiac output

shock

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shock that occurs due to direct or indirect pump failure

cardiogenic

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most common type of shock

hypovolemic

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shock that occurs due to loss of vascular volume

hypovolemic

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ways that vascular volume can be lost

hemorrhage
dehydration
burns
third spacing

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shock that occurs due to maldistribution of vascular volume or decreased vascular tone, blood pools in peripheral BVs

circulatory

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3 types of circulatory shock

septic
anaphylactic
neurogenic

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most common type of circulatory shock

septic

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temp parameters for septic shock

less than 36 or greater than 38 (96.8, 100.4)

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HR to be considered septic shock

> 90

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severe sepsis

sepsis PLUS sepsis-induced organ dysfunction or hypoperfusion

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septic shock

severe sepsis PLUS hypotension not reversed with fluid resuscitation

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type of shock in which there is an immediate, exaggerated immune response to an allergen/antigen

anaphylactic

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s/s of anaphylactic shock

urticaria
pruritus
angioedema
laryngeal edema

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type of shock in which there is SNS depression/block leading to vasodilation and bradycardia

neurogenic

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type of shock in which the heart’s ability to contract and pump is impaired, the supply of o2 is inadequate for the heart and tissues

cardiogenic

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s/s in initial stage of shock

vasoconstriction

increased HR

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in what type of shock is there vasodilation in the initial stage

circulatory
neurogenic
anaphylactic

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when will the HR not be increased in the initial stage of shock

MI with damaged SA node
neuorgenic shock
taking certain meds

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main compensatory mechanism in initial stage of shock

cardio

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main compensatory mechanism in non-progressive stage of shock

renal

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s/s of non-progressive stage of shock

increased norepi and epi
renal induced vasoconstriction and retention of Na and h2o
interstitial fluid moving to intravascular space

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stage of shock in which there is decreased urine output and a fluid shift

non-progressive

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s/s in progressive stage of shock

cellular hypoxia pooling and stasis of blood DIC

in which stage of shock is DIC seen

progressive

in which stage of shock is there vasodilation

progressive

in which stage of shock does the Na/K pump fail

progressive

s/s in refractory stage of shock

myocardial deterioration vascular failure tissue/organ necrosis MSOF

in which stage of shock is there MSOF

refractory

important to discuss in refractory stage of shock

advanced directives, living will, etc

when can hypothermia be seen in relation to shock

neurogenic shock rapid fluid replacement sepsis septic shock

when can hyperthermia be seen in relation to shock

sepsis | septic shock

when can bradycardia be seen in relation to shock

MI with SA node damage | neurogenic shock

when can hypotension be seen in relation to shock

distributive shock | late sign when compensatory mechanisms fail

skin characteristics in vasoconstriction

pale cool clammy/moist

skin characteristics in vasodilation

pink warm flushed

why would there be diminished peripheral pulses in shock

blood being diverted to vital organs

ABGs in relation to respiratory system in shock

respiratory alkalosis | metabolic acidosis with compensation

normal pH

7.35-7.45

normal paCO2 (acid/resp)

35-45

normal HCO3 (base/metabolic)

22-26

ABG indicative of respiratory alkalosis

pH increased PaCO2 decreased HCO3 decreased

ABG indicative of metabolic acidosis with compensation

pH decreased PaCO2 decreased HCO3 decreased

hallmark signs of ARDS

noncardiac pulmonary edema | refractory hypoxemia

ABGs seen in ARDS

respiratory acidosis | mixed resp/metabolic acidosis

ABG indicative of respiratory acidosis

pH decreased PaCO2 increased HCO3 increased

ABG indicative of mixed resp/metabolic acidosis

pH decreased PaCO2 increased HCO3 decreased

GI issues with shock

stress ulcers | impaired liver fxn

albumin, clotting factors, glucose: increased or decreased in shock

decreased

liver enzymes, ammonia, bilirubin: increased or decreased in shock

increased

BUN and creatinine: increased or decreased in shock

increased

hypo or hyperkalemia in shock

hyperkalemia

is SNS stim increased or decreased in early stages of shock

increased

s/s of increased SNS stim in early shock

restless irritable anxious

neuro s/s in later stages of shock

``` confusion lethargy obtunded (extremely drowsy, sluggish) stuporous comatose ```

what labs are indicative of fibrin clot breakdown

increased FDP increased FSP increased d-dimer

these lab values will be decreased in DIC

fibrinogen | platelets

bleeding, clotting, lysis: s/s of what

DIC

when there is a shift to the L, there is an increase in what

immature neutrophils (bands)

when there is a shift to the R, there is an increase in what

mature netrophils (segments)

main interventions for shock

support oxygenation improve CO prevent malnutrition

ways to improve CO

fluids positive inotropes vasopressors

a venous blood o2 sat below what indicates shock

70%

evaluates severity of tissue hypoperfusion

central venous o2 monitor

percent of blood ejected by left vent under normal conditions

25%

normal MAP

70-105

normal CO

4-8 L/min

normal SV

60-120 ml/beat

normal ejection fraction

50-60%

normal left vent preload

4-12 mmHg

normal right vent preload

0-8 mmHg

pulmonary artery wedge pressure measures what

L vent preload

central venous pressure monitor can measure what

R vent preload

when should you draw ABGs

when there is a change in the amount of o2 being administered

a PAWP greater than what indicates severe pulmonary edema

isotonic crystalloid solutions

0.9% NS | LR

hypertonic crystalloid solutions

3% sodium chloride

examples of colloids

dextran hetastarch albumin plasma protein fraction

this class of med improves perfusion to vital organs

vasopressors

examples of vasopressors

dopamine epinephrine norepinephrine neosynephrine

meds that prevent stress ulcers

zantax | protonix

goals in hypovolemic shock

restore fluid volume | correct underlying cause

when would modified trendelenburg be used

hypovolemic shock

goals in cardiogenic shock

improve contractility decrease afterload limit further myocardial damage correct underlying cause

in what type of shock are positive inotropes most commonly given

cardiogenic

examples of positive inotropes

dopamine dobutamine inocor primacor

positive inotropes that vasodilate instead of vasoconstrict

inocor | primacor

in what type of shock are vasodilators most commonly given

cardiogenic

examples of vasodilators used in cardiogenic shock

nitroglycerin | nitroprusside

s/s of nitroprusside toxicity

changes in LOC tinnitus blurred vision

mechanical devices used to manage cardiogenic shock

ventricular assist device | intra-aortic balloon pump

goals in septic shock

early recognition/intervention | correct underlying cause

med used to treat septic shock that acts as anti-inflammatory, anti-thrombotic, profibrinolytic

xigris

goals in neurogenic shock

restore sympathetic tone | correct underlying cause

hypoglycemia is most commonly seen in which type of shock

neurogenic

goals in anaphylactic shock

eliminate antigen maintain patent airway administer meds to alter immune response

meds given in anaphylactic shock

epi benadryl steroids

goals in DIC

monitor for and stop bleeding | correct underlying cause

tx of DIC

platelets fresh frozen plasma heparin cryoprecipitate