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NURS 428: Evolution > Shock > Flashcards

Shock Flashcards

Exam 3 (57 cards)

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1
Q

ShockIntroduction:

What is it an activation of?

A

Activation of the sympathetic nervous system, inflammatory response, and the immune system

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2
Q

ShockIntroduction:

What is it a state of?

A

State of hypoperfusion

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3
Q

ShockIntroduction:

What does it result in?

A

Derangement of compensatory mechanisms that results in further circulatory and respiratory dysfunction with subsequent multiple organ damage

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4
Q

ShockIntroduction:

What happens to oxygen levels?

A

Oxygen is consumed at a much greater rate than it is delivered.

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5
Q

ShockIntroduction:

Compensatory mechanisms result in what?

A

Compensatory mechanisms result in increases in heart rate, systemic vascular resistance (SVR), preload, and cardiac contractility.

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6
Q

Compensatory mechanisms used to maintain circulatory function and blood volume in hypovolemic shock.

Include what?

A

Include what?

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7
Q

Systemic Inflammatory Response Syndrome (SIRS)

A

Local inflammatory response becomes a systemic response (overwhelming)

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8
Q

Systemic Inflammatory Response Syndrome (SIRS)

What is activated and leads to a response?

A

Endothelial cells are activated in many vessels throughout the body, causing widespread interstitial extravasation of fluid into the interstitial compartment

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9
Q

Systemic Inflammatory Response Syndrome (SIRS)

What is it associated with?

A

Associated with any type of shock or insult

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10
Q

Systemic Inflammatory Response Syndrome (SIRS)

Associated with any type of shock or insult such as?

A

Massive blood transfusion

Infection

Trauma/brain injury

Surgery

Burns

Pancreatitis

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11
Q

Systemic Inflammatory Response Syndrome (SIRS)

What does it typically precede?

A

Typically precedes septic shock

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12
Q

SIRS criteria

How is temperature?

A

Temperature less than 36o C or greater than 38o C

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13
Q

SIRS criteria

How is HR?

A

HR >90 bpm

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14
Q

SIRS criteria

How is RR?

A

RR > 20 BPM

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15
Q

SIRS criteria

How is PaCO2?

A

PaCO2<32mmHg

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16
Q

SIRS criteria

How is WBC levels?

A

WBC </= 4000cells/mm3 or > 12000cell/mm3 or >10% immature bands

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17
Q

Stages of Shock:

What are they?

A

Stage I: non progressive

Stage II: progressive

Stage III: irreversible

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18
Q

Stages of ShockStage I: non progressive

How are compensatory mechanisms?

A

Compensatory mechanism are effective in maintaining normal vital signs and tissue perfusion

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19
Q

Stages of ShockStage I: non progressive

What are the clinical signs and symptoms?

A

No obvious clinical signs and goes unrecognized

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20
Q

Stages of ShockStage I: non progressive

How is it?

A

Early, reversible

If SIRS criteria are recognized

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21
Q

Stages of ShockStage II: progressive

What occurs?

A

Compensatory mechanisms begin to fail

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22
Q

Stages of ShockStage II: progressive

Compensatory mechanisms begin to fail: What occurs?

A

One or more organ systems begin to fail

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23
Q

Stages of ShockStage II: progressive

What else occurs?

Study These Flashcards
A

Metabolic and circulatory derangements become more pronounced.

24
Q

Stages of ShockStage III: irreversible

What happens to compensatory mechanisms?

Study These Flashcards
A

Failure of compensatory mechanisms

25
Stages of Shock Stage III: irreversible What kind of injury occurs?
Cellular and tissue injury is severe- cannot correct the following derangements:
26
Stages of Shock Stage III: irreversible Cellular and tissue injury is severe- cannot correct the following derangements:
metabolic circulatory inflammatory derangements
27
Stages of Shock Stage III: irreversible What ensues?
MODS develops/death ensues
28
Classifications of Shock Hypovolemic shock
Inadequate circulating blood volume
29
Classifications of Shock Cardiogenic shock
Heart fails to act as an effective pump
30
Classifications of Shock Neurogenic shock
Imbalance between sympathetic and parasympathetic system
31
Classifications of Shock Anaphylactic shock
Allergic response to a specific antigen
32
Hypovolemic Shock: What is it?
Inadequate circulating volume
33
Hypovolemic Shock: What is it caused by?
Caused by sudden blood loss or severe dehydration, burns
34
Hypovolemic Shock: If left untreated, what can it lead to?
If left untreated, hypovolemia may lead to a variety of secondary complications, such as hypotension, electrolyte and acid–base disturbances, and organ dysfunction resulting from hypoperfusion.
35
Hypovolemic Shock: What causes the mycocardium to fatigue?
Failed compensatory mechanisms, which were initiated to restore cardiac output, eventually cause the myocardium to fatigue.
36
Hypovolemic Shock Assessment & Management Assessment: What is altered? What does it range?
Altered mentation Range from Lethargy-unresponsiveness
37
Hypovolemic Shock Assessment & Management Assessment: How are respirations?
Rapid deep respirations
38
Hypovolemic Shock Assessment & Management Assessment: Rapid deep respirations- what eventually happens?
Gradually become labored and shallow as patient condition deteriorates
39
Hypovolemic Shock Assessment & Management Assessment: What happens to urine output? Urine?
Decreased urine output Dark & concentrated urine
40
Hypovolemic Shock Assessment & Management Assessment: What else?
Cool and clammy skin-weak thread pulses Tachycardia from activation of SNS Hypotension
41
Hypovolemic Shock Assessment & Management Labs
Lactate, ABG, CBC, electrolytes, H&H, coagulation panels
42
Hypovolemic Shock Assessment & Management Management: What is given?
Blood products
43
Hypovolemic Shock Assessment & Management Management: What is monitored?
Oxygen, monitor VS, Labs, respiratory status, mentation, urine output
44
Hypovolemic Shock Assessment & Management Management: What is restored? How?
Restore circulating volume with crystalloids first (isotonic preferred over hypotonic) eg; lactated ringers
45
Neurogenic shock: What is it?
Interruption of sympathetic nervous system impulse transmission
46
Neurogenic shock: What is the most common cause?
The most common cause of neurogenic shock is a spinal cord injury above the level of T6, because sympathetic innervation occurs above this level.
47
Neurogenic shock: What are causes of this?
Causes subsequent decreased tissue perfusion. SCI above T6 Spinal anesthesia Emotional stress, pain CNS problems Venous pooling- decreased circulatory volume
48
Neurogenic shock: Manifestations:
Manifestations: Hypotension, bradycardia and hypothermia, skin may feel warm due to massive vasodilation
49
Neurogenic Shock management
Management: IV Fluids and vasopressors following fluid replacement, slow rewarming
50
Neurogenic Shock management How should SBP be?
Keep SBP> 90
51
Neurogenic Shock management Keep SBP> 90: how?
Norepinephrine Dopamine
52
Anaphylactic Shock What is it caused by?
Allergic response to a specific antigen that evokes a life-threatening hypersensitivity
53
Anaphylactic Shock Allergic response to a specific antigen that evokes a life-threatening hypersensitivity What are examples?
Food insect stings medications
54
Anaphylactic Shock Clinical manifestations
Erythema, urticaria, pruitus, anxiety restlessness, dyspnea, wheezing, chest tightness, warm feeling, N&V, angioedema, abdominal pain, laryngeal edema, severe bronchoconstriction
55
Anaphylactic Shock Management includes:
Preserve airway Early recognition Remove the offending antigen Pharmacology
56
Anaphylactic Shock Management includes: Pharmacology For mild symptoms, what is used?
Mild symptoms: oxygen, subcutaneous or IV diphenhydramine
57
Anaphylactic Shock Management includes: Pharmacology For life-threatening symptoms, what is used?
Life-threatening: epinephrine, fluids, steroids, bronchodilators, vasopressors

NURS 428: Evolution (17 decks)

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