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Shock > Shock > Flashcards

Shock Flashcards

1
Q

What is stroke volume (SV)?

A

The amount of blood ejected from the left ventricle with each contraction

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2
Q

What is Cardiac Output (CO)?

A

The amount of blood ejected from the left ventricle in 1 minute
Stroke Volume X HR = CO

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3
Q

Preload

A

The amount of blood in the ventricle during diastole, which is prior to systole.
The amount of blood in venous return and refers to filling pressure.

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4
Q

Afterload

A

Systemic Vascular Resistance (SVR)
Blood volume ejected from the left ventricle during systole along with the peripheral (extremities) resistance experienced at the same time.
SVR also reflects pressure or workload in the heart.

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5
Q

Would an increased SVR increase or decrease cardiac workload?

A

Increase

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6
Q

Vasopressors with SVR

A

Vasopressors can increase SVR and cause fingers to fall off.

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7
Q

What can cause an increase in SVR with peripheral resistance?

A

It could be from an increased blood pressure or from the cold

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8
Q

What does high SVR do?

A

puts more pressure on the heart and more workload on the heart

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9
Q

Define Shock

A

A life threatening condition that develops when there is inadequate tissue perfusion to deliver oxygen and nutrients needed to maintain cellular function.

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10
Q

Shock Pathophysiology

A

Inadequate tissue perfusion results in tissue hypoxia which can lead to organ failure if not treated.

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11
Q

The nurse understands that which of these increase as the delivery of oxygen to the tissues falls below the tissues’ requirements? (Select all that apply.)
A. VO2
B. Oxygen debt
C. SvO2
D. Pa02
E. Preload

A

A and B

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12
Q

Oxygen delivery

A

The amount of oxygen delivered to the tissues.

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13
Q

Oxygen consumption (VO2)

A

Reflects the amount of oxygen extracted from the blood at the tissue level

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14
Q

Oxygen debt

A

The difference between normal VO2 and VO2 during the low-DO2 state.

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15
Q

Normal SvO2

A

60-75%

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16
Q

SvO2 value below normal

A

The tissues are extracting more oxygen than normal

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17
Q

What causes a low SvO2?

A

A decrease of DO2 which may be a decrease in oxygen, hemoglobin, or cardiac output.

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18
Q

Classifications of shock

A

Hypovolemic
Cardiogenic
Distributive
Obstructive

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19
Q

Hypovolemic shock

A

An intravascular content issue resulting from rapid fluid loss resulting in inadequate circulating volume.

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20
Q

Cardiogenic shock

A

Heart pump issue
Inadequate pumping ability of the heart muscle, most typically a result of acute MI

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21
Q

Distributive shock

A

Due to massive vasodilation caused by poor vascular tone.
Relative hypovolemia
Warm extremities

22
Q

Obstructive Shock

A

Blockage
Caused by a mechanical barrier to ventricular filing or ventricle emptying causing decreased cardiac output.

23
Q

The nurse understands that which patient is at risk of developing hypovolemic shock?
A. A patient with severe valvular disease
B. A patient receiving spinal anesthesia
C. A patient with severe diarrhea
D. A patient with a large pneumothorax

A

C

24
Q

Types of distributive shock

A

Anaphylactic
Neurogenic
Early septic
Late septic

25
Q

Neurogenic Shock causes

A

Brain injury
Spinal injury
Spinal anesthesia
Decreased sympathetic tone

26
Q

Anaphylactic shock causes

A

Severe allergic reaction

27
Q

Septic shock cause

A

Overwhelming systemic infection

28
Q

Goal for all shock types

A

To restore circulating blood volume and increase tissue perfusion

29
Q

Causes of Hypovolemic shock

A

Blood loss from:
Hemorrhage (can be postpartum)
Penetrating or blunt trauma
Severe GI bleeds
Penetrating: GSW/knife injuries
Blunt: damage to the liver, trauma to the thoracic cavity, ruptured aorta, long bone/femur fractures.
Severe Vomiting/diarrhea
Extensive burns
Surgery

30
Q

Stages of shock

A

Initial
Compensatory
Progressive
Refractory

31
Q

Causes of obstructive shock

A

Tension pneumothorax
Cardiac tamponade
Severe vascular disease

32
Q

Initial stage of shock

A

Hypoxia
Decrease cardiac output
Subtle

33
Q

Compensatory stage of shock

A

Increase in heart rate
Increase in blood pressure
Vasoconstriction
Hyper-dynamic VS due to working hard to keep a semi normal BP

34
Q

Progressive shock stage

A

Failure of compensatory mechanisms to maintain BP and fluid volume

35
Q

Refractory stage of shock

A

Cell death
Multisystem organ failure
Irreversible
Coma

36
Q

What are the signs and symptoms of decreased cardiac output?

A

Weak pulses
Cool extremities
Organs start to have dysfunction
Decreased urine output

37
Q

What happens in shock

A

An event occurs causing a shock state
Cells are deprived of oxygen and nutrients
Decrease cellular function resulting in cell death
Body responds through compensatory mechanisms
Most shock types cause decreased blood pressure and and increase in heart rate and respiratory rate
Distributive neurogenic shock causes bradycardia

38
Q

How does neurogenic shock present?

A

With bradycardia due to activation of the parasympathetic nervous system

39
Q

Other causes of hypovolemic shock

A

Diabetes insipidus
Excessive diuresis, urination

40
Q

Signs and symptoms of hypovolemic shock

A

Hypotension, tachycardia, tachypnea, altered/decreased level of consciousness, anxiety/restlessness, decreased urine output, delayed capillary refill, pale/cool/clammy skin, decrease cardiac output, decreased central venous pressure (cvs), increased systemic valvular resistance (SVR)

41
Q

What is CVP

A

Central Venous Pressure
Pressure in the right atrium measured with the use of a pulmonary artery catheter

42
Q

SVR refers to…

A

Increased pressure in the extremities which put pressure back in the heart and then decreases cardiac output

43
Q

4 likens of a Pulmonary Artery Catheter

A

Proximal (CVP)
Distal (pulmonary artery wedge pressure)
Thermistor (measure temp)
Inflator (port used to inflate the balloon within the end of the pulmonary catheter)

44
Q

Hypovolemic Shock Labs

A

CBC, HMG/HCT, Lactate and BMP
Occult Blood (GI bleed)

45
Q

Lactate levels

A

Increased lactate levels indicates the body is in anaerobic metabolism due to tissue hypoperfusion.
Body is not receiving enough oxygen

46
Q

Hypovolemic Shock Diagnostics

A

Labs
CT scan
Endoscopic- EGD and Colonoscopy
Hemodynamic monitoring
Decreased BP

47
Q

Hypovolemic Shock Nursing interventions

A

Identify and treat cause
Volume replacement before IV Vasopressors meds
Monitor- VS, oxygenation, labs
Promote venous return- elevate legs 10-12”, head slightly elevated, no transdelenburg positioning

48
Q

Why does volume replacement come before Vasopressors?

A

You need to refill the vascular system before “squeezing” it with Vasopressors.

49
Q

Why is transdelenburg contraindicated?

A

Increased the workload on the heart
Increased ICP
Increases pressure in the legs

50
Q

Cardiogenic Shock

A

Pump issue- inadequate tissue perfusion due to impairment of ventricular contraction

51
Q

Cardiogenic Shock most often due to

A

Inadequate systole (contracting)
Usually adequate volume with inadequate ventricular contraction

Shock (8 decks)

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