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Complex DMR > Shock > Flashcards

Shock Flashcards

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1
Q

What is shock

A

Inadequate circulating oxygen to meet metabolic demands

Imbalance between cellular oxygen supply and demand

Lead to Tissue hypoxia

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2
Q

Initiation phase of shock

A

Subclinical Hypoperfusion. There is inadequate DELIVERY

of O2 to the cells

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3
Q

Compensatory stage

A

Initiation of compensatory mechanisms

to maintain blood flow to vital organs

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4
Q

Progressive stage what happens

A 
Compensatory measures begin to fail;
vasoconstriction and shunting of blood,
peripheral ischemia, lactic acidosis,
electrolyte imbalances, respiratory
acidosis
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5
Q

Refractory stage

A

Irreversible; loss of aerobic metabolism,

inefficient anaerobic metabolism, multisystem failure

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6
Q

What happens in Neural compensation

A

Baroreceptors in carotid sinus and aortic bodies sensitive to
changes in pressure
• Stimulation of SNS

• Release of catecholamines
– Increased heart rate
– Increased contractility
– Systemic vasoconstriction
     \+Increased BP  
     \+Redistribution of blood flow
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7
Q

What happens in Endocrine compensation

A

RAAS
Stimulation of anterior pituitary gland->
Adrenal cortex

• Glucocorticoids
– Increase circulating glucose levels

• Mineralocorticoid (Aldosterone)
– Increase circulating volume

►Stimulation of posterior pituitary gland
• ADH

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8
Q

What happens in Chemical compensation

A 
Chemoreceptors in carotid and aortic bodies react to low oxygen
tension
• Respiratory rate and depth increase
– Increased oxygenation
• Respiratory alkalosis occurs
– Constriction of carotid arteries
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9
Q

What happens to the body in the progressive stage

A

Compensatory mechanisms not reversing shock
• Systemic vasoconstriction/shunting of blood to vital organs
– Peripheral ischemia
• Failure of the sodium potassium pump
– Electrolyte Imbalances
• Metabolic/Respiratory acidosis

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10
Q

What happens to the body in the refractory stage

A 
►Prolonged hypoperfusion
►Loss of aerobic metabolism
►Cell death
►Multiple organ dysfunction
►Death
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11
Q

Causes of Hypovolemic shock

A 
External loss 
-Hemorrhage
– Trauma/GI bleeds
• Excessive urination
• Burns
• GI tract
– Vomiting
– Diarrhea

Internal loss
• Internal hemorrhage
– Fractures
– Ruptured aneurysms

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12
Q

Treatment for hypovolemic shock

A

Fluid resuscitation

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13
Q

Hypovolemic shock
CVP/PAOP/PAWP
CO
SVR

A

dec dec inc

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14
Q

Cardiogenic shock
CVP/PAOP/PAWP
CO
SVR

A

Inc dec inc

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15
Q

Obstructive shock causes for Impaired ventricular filling

A

Tension pneumothorax

Cardiac tamponade

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16
Q

Obstructive shock causes for Impaired ventricular emptying

A

• Increased Pulmonary Vascular Resistance (PVR)
– MASSIVE pulmonary embolism
• Increased Systemic Vascular Resistance (SVR)
– Severe valvular disease

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17
Q

Clinical manifestations of Obstructive shock

A 
Decreased cardiac output/impaired peripheral perfusion:
• Decreased level of consciousness
• Hypotension
• Tachycardia
• Tachypnea
• Decreased urine output
• Weak pulses, cold, cyanotic, and mottled skin
►Chest pain, SOB, N/V
►Muffled heart sounds
►R heart failure
• JVD
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18
Q

Obstructive shock
CVP/PAOP/PAWP
CO
SVR

A

Inc/dec
dec
inc

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19
Q

How do you treat obstructive shock

A 
O2 management 
Definitive treatment: 
• Tension pneumothorax – Needle decompression
• Cardiac tamponade - Pericardiocentesis 
MASSIVE pulmonary embolism –
– Anticoagulants/Thrombolytics-tPA
– CDT thrombolysis
– Suction thrombectomy
– Surgery- Pulmonary embolectomy
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20
Q

If obstructive shock is suspected, how would you assess

A 
►Neurological status
►Vital signs/Respiratory status
• SpO2/ABGs
►Hemodynamic parameters
• CO/Filling pressures/ScvO2
/SvO2
►Urine output
►Skin color and temperature
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21
Q

If obstructive shock what are your nursing actions

A

►Apply a 100% non-rebreather oxygen mask
►Prepare for intubation and mechanical ventilation
►Administer medications as ordered
• Vasoactive medications
• Anticoagulation via heparin administration
• Thrombolytic therapy
prep for definitive treatment

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22
Q

Distributive shock definition

A

A physiological problem that causes massive
vasodilation and poor vascular tone (decreased SVR,
increased vascular capacity, venous pooling) that creates a
RELATIVE hypovolemia.

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23
Q

Types of distributive shock

Study These Flashcards
A

Neurogenic shock
anaphylactic shock
septic shock

24
Q

sepsis cause

Study These Flashcards
A

A life-threatening organ dysfunction caused by a dysregulated host
response to infection

a life-threatening condition that arises when
the body’s response to an infection injures its own tissues and organs

25
neurogenic shock definition/cause
Disruption of sympathetic nervous system resulting in poor vascular tone/relative hypovolemia/unopposed parasympathetic stimulation Upper spinal cord injury – at or above T5 • Spinal anesthesia • Neurological/brain injury
26
Anaphylaxis (general) cause
Histamine release
27
Clinical manifestation of Neurogenic shock
``` VASODILATION • Hypotension • Decreased cardiac output • Warm, dry skin • Often accompanied by BRADYCARDIA ```
28
Neurogenic shock | CVP, PAOP/PAWP CO SVR
Dec, dec, dec
29
Anaphylactic shock cause (specific)
Severe systemic hypersensitivity reaction Allergic reaction/antigen antibody reaction with a release of histamine resulting in: Venous dilation Increased capillary permeability Smooth muscle contraction
30
Anaphylactic shock symptoms
Hypotension, edema, respiratory distress. there is rapid airway compromise/circulatory collapse
31
Anaphylactic shock CVP, PAOP/PAWP CO SVR
Dec, dec, dec
32
Anaphylactic Medical management
Epinephrine 0.3-0.5 mg IM - Promotes bronchodilation/vasoconstriction Epinephrine .05 - 0.1mg slow IV push Support airway & ventilation – 100% non-rebreather Support circulation - IV Fluids
33
Other medications for Anaphylactic shock
Methylprednisolone (Solu-Medrol) Antihistamines - Diphenhydramine 25-50mg (Benadryl) IV or PO Histamine blockers - Ranitidine (Zantac) or other H2 blockers Racemic Epinephrine Inhaled for stridor Bronchodilators - Albuterol
34
Nursing assessments for anaphylactic shock
►Respiratory assessment ►Vital signs ►Skin assessment
35
What should you do as the nurse if pt has anaphylactic shock
►Remove trigger immediately ►Epinephrine IM ►Apply oxygen via a 100% non-rebreather mask ►Insert an IV and administer IV fluid as ordered ►Administer medications as ordered
36
Most common type of sepsis
Bacterial
37
What happens during Septic shock (patho)
Response no longer localized Pro-inflammatory cytokines outnumber anti-inflammatory cytokines Overwhelming inflammation, profound vasodilation, increased capillary permeability, enhanced coagulation (microemboli) Relative hypovolemia, hypotension, clotting
38
SOFA & Value
Organ dysfunction identified via the Sequential Organ Failure Assessment (SOFA): A higher SOFA score (>2) is associated with an increased probability of mortality
39
Sepsis manifestations
Persistent hypotension requiring vasopressors to maintain MAP ≥65 mm Hg and Serum lactate level >2 mmol/L Despite adequate volume resuscitation
40
``` Early Sepsis (WARM) Hint: HR RR BP CO SVR Filling Pressures SvO2 Pulses Skin appearance Temp UO PACO2 WBC ```
``` ►HR> 100 ►RR > 20 ►BP normal or low ►Increased CO ►Decreased SVR ►Decreased filling pressures ►Increased SvO2 ►Bounding pulses ►Flushed ►Temp up ►Change in mental status ►Oliguria ►PaCO2 < 32 mmHg ►WBC > 12,000 ```
41
``` Late Sepsis (Cold) Hint: HR RR BP CO SVR Filling Pressures SvO2 Pulses Skin appearance Temp UO PACO2 WBC ```
``` ►HR>100 ►RR up or down ►Hypotension ►Decreased CO ►SVR variable ►Filling pressures variable ►Decreased SvO2 ►Weak pulses ►Cool, pale ►Temp down ►Decreased LOC ►Anuria ►Metabolic acidosis ►Decreased WB ```
42
Preventing septic shock
``` Management—Prevention • Hand hygiene • Aseptic technique • Identification of patients at risk (e.g., mechanically ventilated patients mouth care) ```
43
Important after recognition of septic shock
Prompt recognition of infection • Source control • Antibiotic therapy based on culture results
44
What must be done within one hour of septic shock recognition
1. Measure lactate level 2. Obtain blood cultures prior to administration of antibiotics 3. Administer broad spectrum antibiotics 4. Administer 30 ml/kg crystalloid for hypotension or lactate > 4mmol/L 5. Apply vasopressors if hypotension continues during or after fluid resuscitation
45
Lab values to check in septic shock
``` Laboratory values – SvO2 , ScvO2 – ABGs – Metabolic profile – Lactate/base deficit ```
46
Nursing assessments in Septic shock
* Neurological status * Vital signs/respiratory status * Hemodynamic readings * Hourly Urine output * Skin color and temperature * Bleeding
47
Actions of nurse w/ septic patient
► Administer oxygen as ordered/Anticipate and prepare for intubation ► Administer fluid replacement as ordered ► Administer vasoactive drips such as norepinephrine as ordered ► Obtain two blood cultures from two different sites: urine, sputum, and wound cultures ► Administer antibiotics as ordered after cultures are obtained ► Meticulous hand washing and aseptic technique with all procedures ► Mouth Care every 4 hours
48
Early DIC
► Enhanced coagulation/thousands of small clots in capillaries leads to: • Poor tissue perfusion • Consumption of clotting factors
49
Late DIC
``` Late ► Excessive clot formation leads to: • Stimulation of fibrinolysis – release of fibrin degradation products – potent anticoagulants which leads to: BLEEDING ```
50
DIC lab values
►Platelets, protein C, antithrombin 3, fibrinogen – decreased ►Fibrin degradation products increased ►PT, PTT prolonged
51
Medical management of DIC
``` Volume replacement • Crystalloids • Blood products ►Supportive Care • Maximize oxygenation • Maintain BP ```
52
DIC Nursing actions
``` ►Monitor vital signs ►Assess for bleeding/Avoid activities that may cause bleeding ►Monitor laboratory values ►Administer blood products as ordered ►Supportive care ```
53
What happens in the body during MODS
``` ARDS = 40% Mortality AKI/CKD Liver failure CNS dysfunction Heart failure ```
54
Supportive care DIC
``` ►Supportive • Maximize Oxygenation/Mechanical Ventilation • Control Infection/Antibiotics • Fluids/Blood Products • Vasoactive Drips ```
55
DIC Nursing management
``` ►Assessment! • Respiratory • Cardiovascular • Neurological • Renal ►Actions • Provide care as ordered • Supportive Care ```

Complex DMR (12 decks)

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