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Ngozi's Acute and Chronic Care II > Sepsis and Shock > Flashcards

Sepsis and Shock Flashcards

Exam 3

1
Q

How does shock impact all body systems?

A
  • Can lead to organ failure and death
    and it is influenced by compensatory mechanisms and successful interventions
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2
Q

Life-threatening response to alterations in circulation
Inadequate tissue perfusion
Imbalance between cellular oxygen supply and demand

A

Shock is a clinical syndrome

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3
Q

What is shock?

A

Hypovolemic
Cardiogenic
Obstructive
Distributive
Septic, anaphylactic, or neurogenic

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4
Q

What is the cardiovascular system composed of?

A

Heart, blood, vascular bed (bed: arteries, arterioles, capillaries, venules, and veins)

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5
Q

What is the microcirculatory system?

A

Portion between arterioles and venules

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6
Q

What are the four components involved in shock?

A

Blood volume, myocardial contractility, blood flow, vascular resistance

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7
Q

What is the initial failure in shock?

A

Cardiovascular system failure

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8
Q

What are the causes of hypovolemic shock?

A

Dehydration, Trauma, Bleeding/Hemorrhaging

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9
Q

What is cardiogenic shock characterized by?

A

Inadequate myocardial contractility

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10
Q

What is obstructive shock caused by?

A

Obstruction of blood flow

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11
Q

What are the types of distributive shock?

A

Anaphylactic, Neurogenic, Septic

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12
Q

What is the first stage of shock?

A

Stage I: Initiation

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13
Q

What happens during hypoperfusion?

A

Inadequate delivery or extraction of oxygen

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14
Q

What are the clinical signs in stage I of shock?

A

No obvious clinical signs
↓ CO may be assessed with invasive hemodynamic monitoring

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15
Q

What are the stages of shock?

A

Stage II: Compensatory

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16
Q

What happens in the compensatory stage of shock?

A

Sustained reduction in tissue perfusion; initiation of compensatory mechanisms

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17
Q

What are the initiation of compensatory mechanisms for stage II: compensatory?

A

Initiation of compensatory mechanisms
Neural: baroreceptors and chemoreceptors
Endocrine: ACTH and ADH
Chemical: Low oxygen tension; Hyperventilation and respiratory alkalosis

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18
Q

What happens in Stage III (Progressive) of shock?

A

Failure of compensatory mechanisms

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19
Q

What are the cardiovascular effects of Stage III shock?

A

Hypoperfusion and vasoconstriction

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20
Q

What happens to the extremities in Stage III shock?

A

Extremity ischemia

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21
Q

What happens at the cellular level in Stage III shock?

A

Cellular hypoxia and anaerobic metabolism

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22
Q

What metabolic process increases in Stage III shock?

A

Lactic acid production

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23
Q

What type of acidosis occurs in Stage III shock?

A

Metabolic acidosis

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24
Q

What pump fails in Stage III shock?

A

Na+/K+ pump

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25
Q

What can the failure of the Na+/K+ pump affect in Stage III shock?

A

Rhythm and conductivity

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26
Q

What are the effects of Stage III of shock?

A

Interstitial edema, decreased circulating intravascular volume, decreased coronary perfusion, decreased myocardial contractility, and Increased capillary hydrostatic pressure

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27
Q

What is the stage IV of shock called?

A

Refractory

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28
Q

What happens in stage IV of shock?

A

Prolonged inadequate tissue perfusion

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29
Q

What is the response to therapy in stage IV of shock?

A

Unresponsive

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30
Q

What are some complications in stage IV of shock?

A

Dysrhythmias, pulmonary edema, respiratory distress syndrome, cerebral changes, renal decreased GFR

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31
Q

What can stage IV of shock lead to?

A

Multiple organ dysfunction and death

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32
Q

What is Systemic Inflammatory Response Syndrome (SIRS)?

A

Widespread systemic inflammatory response

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33
Q

What disorders are associated with SIRS?

A

Infection, trauma, shock, pancreatitis, ischemia

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34
Q

What is SIRS most frequently associated with?

A

Sepsis

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35
Q

What happens to intravascular volume in SIRS?

A

Increased permeability of endothelial wall, Fluid shifts into intravascular spaces, depletion of intravascular volume = relative hypovolemia

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36
Q

What is the central nervous system most sensitive to?

A

Early changes

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37
Q

What are the initial stage symptoms of shock in the central nervous system?

A

Anxiety/restlessness

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38
Q

What are the late stage symptoms of shock in the central nervous system?

A

Coma

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39
Q

In what stage of shock does blood pressure initially show compensatory changes?

A

Initial stages

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40
Q

What are the blood pressure changes in the early stages of shock?

A

Slightly elevated
Narrow pulse pressure

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41
Q

What lab values should be focused on?

A

cbc, cmp

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42
Q

What can happen to the heart rate?

A

tachycardia (early), brady (late)

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43
Q

What compensation mechanism does the body use?

A

ABGs

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44
Q

What is a sign that things are going wrong?

A

<0.5 mL/kg/hr

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45
Q

What are the early stage symptoms of shock in the pulmonary system?

A

Rapid, deep respirations

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46
Q

What are the late stage symptoms of shock in the pulmonary system?

A

Shallow respirations and poor gas exchange

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47
Q

What is the effect of shock on the renal system?

A

Decreased glomerular filtration

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48
Q

What system is activated in response to shock in the renal system?

A

Renin-angiotensin-aldosterone system

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49
Q

What is the result of sodium retention in the renal system during shock?

A

Water reabsorption

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50
Q

What is a possible symptom of shock in the renal system?

A

Oliguria

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51
Q

What are some signs of slowing intestinal activity in shock?

A

Decreased bowel sounds, distension, nausea, and constipation

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52
Q

What are some signs of altered liver function in shock?

A

Altered liver enzymes, clotting disorders

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53
Q

What is a potential consequence of hepatic dysfunction in shock?

A

Increased susceptibility to infection

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54
Q

What are common symptoms of issues with bacteria from the gut in the blood supply?

A

Decreased bowel sounds, nausea, distention

55
Q

What are some signs of consumptive coagulopathy (DIC)?

A

Enhanced clotting/inhibited fibrinolysis, depletion of clotting factors

56
Q

What is the significance of skin color, temperature, texture, and turgor in shock assessment?

A

Evaluation of integumentary system

57
Q

What is a late and unreliable sign of shock?

A

Cyanosis

58
Q

What happens when the body does not have enough clotting factor?

A

Compensate with platelet count but this does not occur in shock therefore leading to DIC

59
Q

What are some examples of laboratory studies?

A

Hemogram, serum chemistry, coagulation studies, serum lactate level

60
Q

What does serum chemistry measure?

A

Function of various organs and electrolyte balance

61
Q

What do coagulation studies measure?

A

Ability of blood to clot

62
Q

What does serum lactate level indicate?

A
  • Overall state of shock and adequacy of resuscitation
  • Indicator of decreased oxygen to cells
63
Q

What does an increased serum lactate level indicate?

A

Lack of perfusion and sepsis

64
Q

What are interventions for shock management?

A

include increasing the cardiac output and cardiac index, increasing the hemoglobin level, increasing the arterial oxygen saturation, and minimizing oxygen consumption.
two IV catheters: one in a peripheral vein (16 gauge) and ideally one in a central vein

65
Q

What is the general management of shock?

A
  • Treat underlying cause
  • Maintain circulatory volume
66
Q

What are the components of combination therapy for shock?

A

Fluid, pharmacotherapy, mechanical therapy

67
Q

What should be minimized in shock management?

A

Oxygen consumption

68
Q

What are the two IV catheter insertion sites you want for a shock patient?

A

Peripheral and Central line

69
Q

What gauge is commonly used for peripheral IV catheters?

A

14- or 16-gauge

70
Q

What is a fluid challenge?

A

Rapid infusion of a crystalloid solution

71
Q

What are the two common crystalloid solutions used for fluid challenge?

A

Lactated Ringer’s or normal saline

72
Q

What is the recommended volume for a fluid challenge?

A

250 mL up to 2 liters

73
Q

What is a potential complication of fluid challenge related to plasma protein?

A

Hemodilution of plasma protein

74
Q

What type of access is recommended for fluid challenge?

A

IV access of a 20-gauge and higher

75
Q

What should be done to prevent transfusion reactions during the fluid challenge?

A

Keep vein open with normal saline solution

76
Q

What are two potential complications of fluid challenge?

A

Pulmonary edema, transfusion reaction

77
Q

What is the recommended administration for d5 or ns 45?

A

Do not give want to use isotonic solution

78
Q

What is the importance of oxygenation?

A

Maintaining adequate oxygen levels in the body

79
Q

Why is it important to maintain the airway?

A

To ensure proper oxygenation and ventilation

80
Q

What is the purpose of mechanical ventilation?

A

To assist with oxygenation and ventilation

81
Q

Why is sedation used in the context of oxygenation and mechanical ventilation?

A

To keep the patient calm and comfortable during the process

82
Q

When is neuromuscular blockade utilized in the context of oxygenation and mechanical ventilation?

A

To temporarily paralyze the patient’s muscles for better control of ventilation and reduce oxygen demand

83
Q

What would you do to decrease afterload?

A

Decrease afterload
- arterial vasodilators
- ace or arbs inhibitors

To decrease RV afterload specifically
- oxygen

84
Q

What would you use to decrease contractility?

A
  • beta blockers
  • calcium channel blockers
85
Q

What would you do to increase contractility?

A
  • cardiac glycosides
86
Q

What would you do to decrease preload?

A
  • venous vasodilators
  • diuretics
  • ace or inhibitors
87
Q

What would you do to increase preload

A
  • fluids
  • blood and blood products
  • decrease vasodilator dosage
88
Q

What do you do to increase HR?

A
  • tx the cause
  • atropine
  • epinephrine
  • pacemaker
89
Q

What decrease HR

A
  • antidysrhythmic
  • vagal maneuvers
90
Q

What is the role of pharmacological support in patient management?

A

Manage symptoms and improve outcomes

91
Q

What factors affect cardiac output?

A

Heart rate, preload, afterload, contractility

92
Q

What does heart rate refer to?

A

Number of times the heart beats in one minute

93
Q

What is preload?

A

Volume of blood in the heart before contraction

94
Q

What is afterload?

A

Resistance that the heart must overcome to pump blood out of the left ventricle

95
Q

What is contractility?

A

Ability of the heart muscle to contract and pump blood

96
Q

Why is central venous access important?

A

To monitor central venous pressure and administer medications/fluids

97
Q

What is the purpose of hemodynamic monitoring?

A

Assess cardiovascular function and response to treatment

98
Q

What should you watch for?

A

Tissue necrosis

99
Q

When should you leave the IV in?

A

When inflating

100
Q

What is the role of chronotropic drugs?

A

Increase heart rate

101
Q

What is the role of dysrhythmia agents?

A

Manage irregular heart rhythms

102
Q

What medication is used to treat bradycardia in neurogenic shock?

A

Atropine

103
Q

What is the purpose of an IV fluid challenge in hypovolemic and distributive shock?

A

Assess and improve fluid status

104
Q

What type of medication is used for to change preload in cardiogenic shock?

A

Venous vasodilators

105
Q

What is the purpose of vasoconstriction in distributive shock?

A

Increase systemic vascular resistance to change the afterload

106
Q

What type of medication is used to change afterload in cardiogenic shock?

A

Arterial vasodilators

107
Q

What type of medication is used to increase contractility in cardiogenic shock?

A

Dobutamine

108
Q

What is the role of beta blockers?

A

Decrease heart rate and workload on the heart

109
Q

What are some med classes you would tx shock with?

A

Sedatives
Analgesics
Insulin (two consecutive glucose readings are above 180 mg/dL) – will implement the high bg management
Corticosteroids
Antibiotics
Low–molecular-weight heparin to prevent DVTs
H2-receptor antagonist or protein pump inhibitor to prevent gastric stress ulceration

110
Q

When would insulin be implemented for high blood glucose management?

A

Two consecutive glucose readings above 180 mg/dL

111
Q

What medications are commonly used to prevent DVTs?

A

Low-molecular-weight heparin

112
Q

What type of medication is used to prevent gastric stress ulceration?

A

H2-receptor antagonist or protein pump inhibitor

113
Q

What is one way to regulate body temperature?

A

Rapid administration of IV fluids

114
Q

What effect does hypothermia have on cardiac function?

A
  • Depresses cardiac contractility
  • Impairs cardiac output
  • Impairs oxygenation
115
Q

Rapid administration of IV fluids may reduce temperature are you should use what to compensate?

A

Anticipate hypothermia, and proactively use warming methods (e.g., fluid warmer, heated forced air blankets, blankets around the patient’s head).

116
Q

What can be used to keep the patient warm?

A

Warm blankets

117
Q

What is enteral nutrition?

A

Preferred route of nutritional support

118
Q

When should enteral nutrition be initiated?

A

Within 24 to 48 hours of admission

119
Q

What condition hinders enteral nutrition?

A

Paralytic ileus cannot do enteral nutrition if they have one

120
Q

What is an alternative to enteral nutrition?

A

Parenteral nutrition

121
Q

When is parenteral nutrition given?

A

If enteral nutrition is not tolerated

122
Q

Should you worry about overfeeding a patient?

A

Yes

123
Q

What are some important considerations for maintaining skin integrity?

A

Turn every 2 hours, use protective barrier cream, use pressure-relieving devices, elevate heels off the bed surface, foley catheter if indicated

124
Q

What is psychological support?

A

Emotional assistance for patients

125
Q

Who should psychological support be provided to?

A

Patients and their families

126
Q

What are advance directive discussions?

A

Planning for future medical decisions

127
Q

What is hypovolemic shock?

A

Inadequate intravascular blood volume

128
Q

What happens in cardiogenic shock?

A

The heart fails to act as an effective pump

129
Q

What causes obstructive shock?

A

Physical impairment to adequate circulating blood flow

130
Q

What is distributive shock characterized by?

A

Widespread vasodilation and decreased vascular tone resulting in a relative hypovolemia

131
Q

Name three types of distributive shock.

A

Neurogenic, Anaphylactic, Septic

132
Q

Why is a warmer needed when giving a lot of blood?

A

To prevent hypothermia

133
Q

What factors should be considered when determining fluid replacement?

A

Blood pressure, urine output, and hematocrit level

134
Q

What is the target MAP range?

A

65-70 mmHg

Ngozi's Acute and Chronic Care II (4 decks)

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