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Nursing Semester 3 > Cyndi - Week 13 - Exam 6 > Flashcards

Cyndi - Week 13 - Exam 6 Flashcards

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1
Q

what is the definition of shock?

A

↓ tissue perfusion that results in impaired cellular metabolism

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2
Q

what are the stages of shock?

A
  • compensatory (early - body can compensate)
  • progressive ( harder to compensate - organs may start to shut down)
  • irreversible (organ damage and cant bring back)
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3
Q

shock has _____ _____ wide effects.

A

body system wide

  • neuro
  • cardiac
  • respiratory
  • renal
  • GI
  • skin
  • ** multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF)
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4
Q

what are the neuro sxs of shock?

A

restlessness, confusion, anxiety, feeling of impending

doom, decreased LOC

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5
Q

what are the cardiac sxs of shock?

A

weak pulse, tachycardia, hypotension, dysrhythmias

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6
Q

what are the respiratory sxs of shock?

A

tachypnea, dyspnea, shallow or irregular

respirations, decreased O2 sat

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7
Q

what are the GI sxs of shock?

A

extreme thirst, nausea, vomiting

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8
Q

what are the renal sxs of shock?

A

decreased or no urine output

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9
Q

what are the skin sxs of shock?

A

chills, pallor, cyanosis, obvious hemorrhage or injury, temperature dysregulation, cool, clammy skin

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10
Q

what are the steps to SIRS or CARS?

A
  1. initial insult (MI; infection; trauma; burns; surgery)
  2. SIRS - systemic inflammatory response syndrome
  3. Recovery (w/ ↓ inflam response → CARS conmpensatory anti-inflam response syndrome) MODS, or death
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11
Q

what is SIRS?

A

Systemic Inflammatory Response related to injury or insult
• Activation of entire immune and coagulation systems
• Compensatory anti‐inflammatory response
• Many normal nursing interventions work to prevent SIRS

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12
Q

what is CARS?

A

Period of dangerously decreased immunity
• Reduced immune response that follows an intense SIRS episode
• Period of increased susceptibility to infection
– Especially to nosocomial infection

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13
Q

what is MODS?

A

Multi-Organ Dysfunction Syndrome

- failure of 2 or more organs from shock

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14
Q

what is the common cause of MODS?

A

• Sepsis is most common cause
– Aggressive, early infection treatment is key to prevention
– Optimize oxygenation and perfusion
– Maintain nutritional support

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15
Q

what are the characteristics of MODS?

A

Can affect any organ
• Not only those involved in original condition
• Complete assessment in these patients
Support failing organs specifically
– Most common to fail (resp, kidney, bowel)
– Late failing systems (heart and brain)

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16
Q

what are the general diagnostic tests for shock?

A 
There is no single study for diagnosis
• Frequent vital signs
• Labs
• 12 lead ECG
• CXR
• Continuous oximetry
• Hemodynamic monitoring
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17
Q

what are the labs used for shock?

A

CBC, CMP, BNP, Trop, others based on cause
– Lactic acid
– Blood culture

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18
Q

what are the types of shock?

A 
--Distributive shock (vasodilation)
• Septic
• Neurogenic
• Anaphylactic
--Hypovolemic shock (volume loss)
• Absolute
• Relative
--Cardiogenic shock (pump failure)
--Obstructive shock
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19
Q

what are two teaching points for shock?

A
  • stop whatever started it!!

- fix/check BP first!! give fluids

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20
Q

what is distributive shock? what are the 3 types?

A

An abnormality in vascular tone (dilation) that leads to a loss of BP, and a pooling of blood in the venous system
- septic, neurogenic, anaphylactic

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21
Q

what is septic shock?

A

widespread vasodilation caused by blood infection

- Bacteria, fungi, virus, parasite

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22
Q

what is neurogenic shock?

A

widespread vasodilation caused by spinal

fracture and related dysfunction of SNS and PSNS

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23
Q

what is anaphylactic shock?

A

widespread vasodilation caused by a severe histamine response to allergen

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24
Q

what is sepsis?

A

diagnostic criteria are used to ascertain exact status of

assessment on the sepsis spectrum

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25
what is severe sepsis?
• Vasodilation causing maldistribution of blood flow to organs, showing signs of organ failure • Myocardial depression • Respiratory failure
26
what is septic shock?
``` – hypoperfusion state caused by sepsis • Despite adequate fluid resuscitation • Systemic immune response • Massive vasodilation of arteries • Endotoxins released • Massive vasodilation of arteries • Serious risk of multiple organ failure! ```
27
what is the criteria for SIRS?
``` T: > 100.4 F; < 96.8F RR: > 20 HR: > 90 WBC: > 12,000; < 4000; > 10% bands PCO2: < 32 mmHg ```
28
what is the criteria for sepsis?
2 SIRS + confirmed or suspected infection
29
what is the criteria for severe sepsis?
sepsis + signs of end organ damage + hypotension (SBP < 90) + lactate > 4 mmol
30
what is the criteria for septic shock?
severe sepsis with persistent: signs of end organ damage + hypotension (< 90 SBP) + lactate > 4 mmol
31
what are the compensatory sxs of septic shock?
* Tachycardia * Pallor/can be flushed * Early shock warm skin * Tachypnea
32
what are the progressive sxs of septic shock?
* Hypotension (<90) * Urine output * Confusion * Lethargy * Cold and clammy skin * Organ dysfunction
33
what are the diagnostic tests for septic shock?
``` Diagnostic criteria for sepsis • Obtain blood cultures before starting ATBs • Lactic acid level • CBC – Leukocytosis or leukopenia – Thrombocytopenia • Elevated procalcitonin (PCT) • Elevated CRP • Creatinine level • Liver enzyme levels ```
34
what is the tx for sepsis?
* EarlyATBs * Fluid resuscitation * Vasopressors * Respiratory protection * Insulin therapy as needed * Strict I&O with Foley * Enteral feeding
35
what is the tx for septic shock?
• Administer broad spectrum antibiotics – Obtain blood cultures prior to administration of ATBs • Reduce work of breathing early mechanical ventilation • Fluid resuscitation – – Administer 30 mL/kg crystalloid for hypotension or lactate 4mmol/L – Transfusion if needed • Use vasoactive agents – after fluid resuscitationo keep MAP ≥ 65 • Measure lactate level • Treat and monitor refractory hypotension or lactate > 4mmol/L
36
what are the key parameters to monitor for septic shock?
* Central Venous Pressure (CVP) * Mean Arterial Pressure (MAP) 65 – 90 mmHg * Urine output >0.5 ml/kg/hr * Mixed venous oxygen saturation >65% * Hematocrit >30%
37
what are the two characteristics of neurogenic shock?
HYPOTENSION – Loss of arteriole tone below spinal fracture – SNS unable to compensate due to spinal fracture at T‐5 or above BRADYCARDIA – From unopposed parasympathetic response
38
what is anaphylactic shock?
Acute life threatening hypersensitivity | reaction ‐ reaction can occur within minutes
39
what are the sxs of anaphylactic shock?
* Skin – itchy rash, hives * Angioedema – face, throat swelling * Respiratory – shortness of breath * Cardiac ‐ low BP, weak pulse * Gastrointestinal symptoms * Anxiety, feeling of impending doom
40
what are the diagnostics for anaphylactic shock?
No specific diagnostic tests
41
what is the goals for anaphylactic shock tx?
primary goal: ABCs | secondary goal: meds to reverse
42
what is the tx for anaphylactic shock?
``` -- Epinephrine ‐ Can be given SQ, IV, nebulizer, ETT • Opposes effect of histamine • Causes vasoconstriction + bronchodilation • Antihistamine (Benadryl) • Bronchodilators (Albuterol) • Corticosteroids • IV fluids for volume Prevention is the best option!! ```
43
what is the most common shock that occurs?
hypovolemic shock • Usually due to blood loss • Size of blood vessels normal, but volume of blood decreased
44
what are the two types of hypovolemia?
absolute and relative
45
what is absolute hypovolemia?
* Hemorrhage * GI loss * Renal loss
46
what is relative hypovolemia?
* Fluid shift * Pooling of blood or fluid * Internal bleeding * Massive vasodilation
47
what are the sxs of hypovolemic shock?
* Rapid & shallow breathing * Tachycardia * Altered LOC * Hypothermia * Cool, clammy, mottled skin * Thirst and dry mouth * Decreased urine output
48
what are the diagnostic tests for hypovolemic shock?
* General shock tests PLUS: * Hgb, Hct * Urine specific gravity * Lyte
49
what is the tx for hypovolemic shock?
``` • Stop the loss of fluid – Absolute – Relative • Restore blood volume – Colloid (Blood or albumin) – Crystalloid (NS or LR) – Large bore IVs – Warm fluid • Vasopressors are not used for this kind of shock – the pt needs fluids ```
50
what is cardiogenic shock?
Caused by failure of heart • Low cardiac output despite adequate fluid status • Heart unable to meet O2 demand of body • Major causes ‐ decompensated heart failure or acute MI Mortality rate about 60%
51
what are the diagnostic tests for cardiogenic shock?
``` • Echocardiogram • Cardiac markers – Troponin – CK‐MB • B‐Type natriuretic peptide (BNP) • Central venous pressure (CVP) ```
52
what are the sxs of cardiogenic shock?
* Chest pain * Jugular vein distention (JVD) * Tachycardia, ECG changes * Respiratory changes * Rales (crackles) in lungs * Hypotension (SBP)< 90 or MAP <65 * Altered level of consciousness * Peripheral Vascular changes
53
what is the main tx for cardiogenic shock?
Restore blood flow to the myocardium • Decrease workload of the heart – Cardiac catheterization – Cardiac surgery
54
what are the meds for cardiogenic shock?
- nitrates - inotropes - diuretics
55
what are the complications of cardiogenic shock?
respiratory failure and cardiac arrest
56
what is obstructive shock?
Physical obstruction of blood flow that | causes decreased CO
57
what are the causes of obstructive shock?
MI, PE, stroke
58
T/F there are no specific diagnostic tests for obstructive shock
TRUE
59
waht are the sxs of obstructive shock?
– Shock S/S – JVD – Pulsus paradoxis
60
what is the tx for obstructive shock?
• Priority ‐ treat cause of the shock • Supportive care with fluids, airway support, oxygenation, etc.

Nursing Semester 3 (29 decks)

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