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Critical Care and Emergency Nursing > Shock > Flashcards

Shock Flashcards

1
Q

shock definition

A

a syndrome due to impaired tissue perfusion resulting in cellular hypoxia and build up of toxic metabolites

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2
Q

pathophysiology of shock

A

a trigger decreases blood flow to organs, compensatory mechanisms initiate (HR increase, aldosterone released, vasoconstriction), metabolic acidosis occurs (lactic acid released r/t anaerobic metabolism), leading to organ failure if continues to progress

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3
Q

s/s of shock

A

tachycardia, tachypnea, hypotension, thready pulse, decreased peripheral pulses, cyanosis, neurological symptoms, decreased UOP and absent bowel sounds; neurogenic would have a slow bounding pulse and cardiogenic would have bradycardia

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4
Q

distributive shock (vasogenic)

A

severe peripheral vasodilation; technically enough blood in the vessels but it can’t be distributed properly - vessels are too dilated

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5
Q

cardiogenic shock

A

heart can’t consistently pump out enough blood to meet needs of the body; low CO with hypotension; caused by MI* (cardiomyopathic), arrhythmias (arrhythmogenic), or valve issues (mechanical)

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6
Q

hypovolemic shock

A

most common type; reduced intravascular volume which reduces CO; hemorrhagic (some source of bleeding) or non-hemorrhagic (diarrhea, excessive diuresis, third-spacing)

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7
Q

obstructive shock

A

causes outside of the heart that cause pump failure, often associated with poor R ventricular output; causes could be PE, pulmonary HTN, tension pneumothorax, pericardial tamponade, or cardiomyopathy

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8
Q

absolute hypotension

A

SBP less than 90 or MAP less than 65

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9
Q

relative hypotension

A

drop in SBP of 40 or more

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10
Q

initial stage

A

narrowing pulse pressure; decreasing CO, tissue perfusion, and aerobic metabolism; increase in anaerobic metabolism and lactic acid production

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11
Q

later changes with shock

A

DBP decreases then the SBP decreases

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12
Q

compensatory stage

A

body attempting to preserve vital organs; sympathetic nervous system response: hormonal, neurological, and chemical

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13
Q

hormonal compensation

A

renin-angiotensin and antidiuretic hormone release, and an intracellular fluid shift; goal to increase intravascular volume

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14
Q

sympathetic nervous system

A

releases epinephrine and norepinephrine –> vasoconstriction; increases HR, cardiac output, and bp

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15
Q

progressive stage

A

compensatory mechanisms beginning to fail, anaerobic metabolism continues, more lactic acid is produced

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16
Q

refractory stage

A

shock undetected or unresponsive to therapy; cells are dying r/t apoptosis and Na-K+ pumps fail; MODS; death

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17
Q

effects on heart

A

decreased coronary artery perfusion, SV, CO, and bp

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18
Q

effects on lungs

A

increased pulmonary capillary membrane permeability, decreased gas exchange –> hypoxia, possibly ARDS

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19
Q

effects on brain

A

decreased function r/t hypoxia, unconsiousness, further impairment of cardiac and respiratory function, impaired thermoregulation

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20
Q

effects on liver

A

glycogen stores are depleted by excess circulatory epinephrine, coagulation factors, metabolic acids are NOT detoxified by liver –> metabolic acidosis; recovers fairly well when blood flow is restored

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21
Q

effects on kidneys

A

AKI and decreased UOP

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22
Q

ABCDE assessment

A

airway, breathing, circulation, disability (alert/responsive), exposure (looking over physically)

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23
Q

additional assessments

A

capillary perfusion: skin color, temperature, moisture; JVD: distended w/ cardiogenic shock or pulmonary congestion; flattened w/ hypovolemic or distrubritive shock

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24
Q

ABGs

A

early: respiratory alkalosis r/t tachypnea; pt will fatigue and RR decreases –> CO2 buildup –> respiratory acidosis; anaerobic metabolism continues and metabolic acidosis worsens

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25
Q

CVP less than or equal to 4

A

hypovolemia or vasodilation

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26
Q

CVP b/t 12-14

A

tamponade, volume overload, or pulmonary edema

27
Q

lab monitoring

A

serum lactate greater than 2-4, base deficit +2 to -2, SVO2 (normal = 65-77%, critically ill = 60-80%)

28
Q

management options

A

fluids, vasoconstrictors, vasodilators, inotropes, or anti-dysrrhthmics

29
Q

causes of hypovolemic shock

A

whole blood loss (hemorrhagic shock), loss of fluids (n/v/d, massive diuresis), cirrhosis or severe sodium depletion

30
Q

s/s hypovolemic shock

A

dependent on severity of volume loss; hypothermia is common (can cause clotting, acidosis, dysrhythmias, and decreased liver metabolism)

31
Q

hypovolemic initial management

A

ABCDE, hemorrhage control, fluid therapy; large gauge bilateral (14-18) with short length and macro tubing; crystalloids, either LR or NS (LR preferred); colloids (albumin, hetastarch); blood replacement; warmed fluids

32
Q

class 1 shock

A

less than 750ml lost (15%), normal vitals but anxious

33
Q

class 2 shock

A

750-1500ml lost (15-30%), HR above 100, decreased pulse pressure, RR 20-30, anxious (start to see compensatory response)

34
Q

class 3 shock

A

1500-2000ml lost (30-40%), HR above 120, decreased SBP and pulse pressure, RR 30-40 and confused (compensatory mechanisms failing)

35
Q

class 4 shock

A

over 2000ml lost (over 40%), HR above 140, decreased SBP and pulse pressure, RR over 35 and lethargic

36
Q

hemorrhagic shock

A

SBP doesnt decrease until 30% of blood volume lost for adults, and 40-45% for kiddos

37
Q

trauma lethal triad

A

hypothermia, acidosis, coagulopathy

38
Q

transfusion considerations

A

hyperkalemia (every unit of blood has around 60meq of K+) and hypocalcemia (citrate added to banked blood to prevent coagulation, after transfused the citrate will bind with calcium and decrease blood calcium levels), acidosis (banked blood pH 7.1), alkalosis (liver metabolizes citrate into HCO3), hypothermia (warm the blood, need core temp above 35C), coagulopathy

39
Q

humerus fracture

A

500-1500ml blood loss

40
Q

elbow fracture

A

250-750ml blood loss

41
Q

rad/ulna fracture

A

250-500ml blood loss

42
Q

pelvis fracture

A

750-6000ml blood loss

43
Q

femur fracture

A

500-3000ml blood loss

44
Q

tib/fib fracture

A

250-2000ml blood loss

45
Q

ankle fracture

A

250-1000ml blood loss

46
Q

priority nursing dx with hypovolemic shock

A

deficient fluid volume r/t active blood loss; decreased CO r/t alterations in preload; anxiety r/t threat to biologic, psychologic, or social integrity

47
Q

classifications of distributive shock

A

septic, anaphylactic, and neurogenic shock

48
Q

anaphylactic shock pathophysiology

A

life-threatening..duh, intervention needed w/i MINUTES; exposed to antigen and sensitized, body develops antibodies and reacts the next time they’re exposed to that antigen; histamine released–> vasodilation; acute changes in vascular permeability (can lose up to 35% of fluid volume in less than 10 min) and bronchial constriction

49
Q

anaphylaxis & cardiovascular system

A

hypotension, HR usually goes up but sometimes decreases

50
Q

anaphylaxis & respiratory

A

bronchoconstriction, laryngeal edema (obstructing airway), stridor/wheezing, dyspnea

51
Q

anaphylaxis & skin

A

angioedema, redness, itching, urticaria

52
Q

anaphylaxis & CNS

A

restless and confused

53
Q

causes of anaphylaxis

A

medications, insect bites, food, contrast, etc

54
Q

treatment of anaphylaxis

A

ABC, O2, IM epinephrine, fluid resuscitation; epi can be repeat q5 min; antihistamines, albuterol, steroids; maybe glucagon, beta blockers

55
Q

anaphylactic shock nursing dx

A

ineffective breathing pattern, deficient fluid volume r/t relative loss, decreased CO r/t alterations in preload, decreased CO r/t alterations in afterload, impaired gas exchange r/t VQ mismatch or intrapulmonary shunting

56
Q

Neurogenic shock

A

disruption of sympathetic nervous system; most uncommon; cause: spinal cord injury (not the same as spinal shock); loss/decreases sympathetic tone, decreased tissue perfusion, initiated general shock response

57
Q

spinal shock

A

loss of activity below level of SCI and might not cause ineffective tissue perfusion

58
Q

neurogenic shock progression

A

loss of sympathetic tone –> massive vasodilation –> blood pooling (relative hypovolemia) –> decreased preload –> decreased CO –> inadequate tissue perfusion

59
Q

s/s of neurogenic shock

A

hypotension, bradycardia, peripheral vasodilation, warm and dry skin but progresses to hypothermia; pt dependent on environment to regulate temperature

60
Q

neurogenic shock nursing dx

A

deficient fluid volume r/t relative loss; decreased CO r/t sympathetic blockade; hypothermia r/t exposure to cold environment, trauma, or damage to the hypothalamus

61
Q

s/s of cardiogenic shock

A

EKG changes, dysrhythmias and HR increasing OR decreasing, hypertrophy of atrium or ventricles, tachypnea, hypoxemia, decreased bp, CO and CI, decreased LOC anxious–>confused–>lethargic–> unconscious; skin cool, pale and moist, long capillary refill; decreased UOP (less than 0.5ml/kg/hr), metabolic acidosis, peripheral pulses become thready

62
Q

treatment goal for cardiogenic shock

A

correcting either.. preload, afterload, or contractility; L vent. HF would want to decrease afterload; R vent. HF would want to increase preload; might need IABP/LVAD, heart cath/stenting, give supplemental O2, give antiarrhythmics PRN

63
Q

cardiogenic shock nursing dx

A

cardiogenic shock.. decreased CO r/t alterations in contractility and decreased CO r/t alterations in HR

Critical Care and Emergency Nursing (4 decks)

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