Shock Flashcards
(33 cards)
catecholamines cause _____, _____, and ____ resulting in _______
increased HR, increased contractility, and vasoconstriction; resulting in increased CO
Baroreceptors
(pressure receptors) located in the carotid sinus and aortic arch.
A decreased MAP causes decreased stretching of the baroreceptors which results in sympathetic response of the ANS
Chemoreceptors
located in the aortic arch and carotid arteries
- receptive to oxygen changes in blood
- regulate BP and HR
What is the compensation for metabolic acidosis?
increased RR, which causes resp alkalosis
vasoconstriction increases _____, ____& ______
preload, SVR, and CO
what is systemic vascular resistance (SVR)?
how hard the heart has to pump to get blood out into the system
when the kidneys release rennin what happens?
it leads to the conversion of angiotensin I to angiotensin II (vasoconstrictor)
what does aldosterone do?
causes retention of Na and H2O= ^BP, preload, and CO
an increase in Na triggers…
release of ADH
Shock causes “pre-renal” acute renal failure. Ischemia of tubule epithelium leads to…
vasoconstriction, decreased GFR, *oliguria, and azotemia
What is stage 1 of shock also called?
Compensatory stage, Non-Progressive
what do glucocorticoids do?
- save water
- increase blood glucose
- decrease inflammation
- decrease immune response
What is stage 2 of shock also called?
Progressive shock
what are some initial s/sx of the progressive shock stage?
decreased LOC, confusion, thirsty, dizzy, restless, nauseated
What are some things that are going on during the 2nd stage of shock?
- Anaerobic metabolism leading to metabolic acisosis
- Cellular damage (Na enters cell, K leaves cell, cell ruptures)
- Coagulation defects- blood clots
- Cardiovascular changes- incrased HR, increase in O2 demands, circulating volume is decreased by 25-35%, vasoconstriction
- Signs of failure of more than one organ may be apparent
**2 early signs of shock
decreased LOC and tachycardia
Causes of hypovolemic shock
trauma anticoagulants diuretics dehydration third spacing draining wounds and burns (weeping) water loss from vomiting, diarrhea, sweating diabetes insipidus
*S/sx of hypovolemic shock
- altered mentation: lethargy to unconsciousness
- *rapid and deep or shallow respirations
- cool, clammy skin
- tachycardia (pulse weak and thready)
- decreased BP
- decreased CO
- decreased urinary output
Diagnostic findings with hypovolemic shock
- low hematocrit
- decreased hemoglobin
- decreased RBCs and platelets
- elevated serum electrolytes, elevated creatinine and BUN
- increased urine SG (>1.02)
- decreased pH
what kind of fluids do you give the hypovolemic pt?
Isotonic (Normal Saline, Lactated Ringers)
also may need to give blood products
NSG care for hypovolemic pt
- Elevate lower extremities to prevent venous pooling and enhance return to heart
- Assess extent of fluid loss
- O2
- monitor VS, neuro stat, cardiac rhythm
- monitor hemodynamic parameters and I&Os
- admin blood products and monitor H&H
- monitor for pulm congestion
- observe for signs of impending coagulopathy, petechie, bruising, and blood or oozing from gums or puncture sites
Complications that can occur from hypovolemic shock
renal damage
cerebral anoxia
death
Causes of Cardiogenic Shock
- impaired tissue perfusion as a result of cardiac dysfuction (pump failure)
- MI or severe CHF
- cardiogenic drugs, penetrating wounds, papillary muscle rupture, cardiac tamponade, septal rupture, cardiomyopathy, myocarditis, valvular disease, or dysrhythmias, tension pneumothorax
- Heart or Vessels are obstructed/compressed
what happens when SVR decreases?
the ventricle does not fully eject volume. Pressure backs up in the system to the lungs causing pulmonary congestion
