Shock Ati 38 Flashcards
(21 cards)
What is shock?
Shock is a life-threatening condition caused by inadequate tissue perfusion leading to cellular dysfunction and organ failure. Early recognition and intervention are critical.
Key features of shock?
- Decreased oxygen delivery
- Impaired cellular metabolism
- Multi-organ dysfunction if untreated
How do older adults respond to shock?
Older adults may not mount a typical response (e.g., weak baroreceptor reflex, limited cardiac reserve).
Types of shock?
CHOD = Cardiogenic, Hypovolemic, Obstructive, Distributive
What is cardiogenic shock?
Cardiogenic shock is heart pump failure (e.g., MI, arrhythmias).
What is hypovolemic shock?
Hypovolemic shock is fluid volume loss (≥15–30%) (e.g., hemorrhage, burns).
What is obstructive shock?
Obstructive shock is non-cardiac blockage of blood flow (e.g., PE, cardiac tamponade).
What is distributive shock?
Distributive shock involves vasodilation & capillary leakage (e.g., Septic, Neurogenic, Anaphylactic).
Stages of shock?
- Initial: Cellular-level changes (aerobic → anaerobic metabolism)
- Compensatory (Non-progressive): SNS & RAAS activation
- Progressive: Worsening perfusion, lactic acidosis
- Refractory: Multi-organ failure, irreversible
Risk factors for cardiogenic shock?
MI, cardiomyopathy, valvular disease, arrhythmias.
Risk factors for hypovolemic shock?
Hemorrhage, burns, DKA, dehydration.
Risk factors for obstructive shock?
PE, cardiac tamponade, tension pneumothorax.
Risk factors for septic shock?
Gram-negative bacteria, catheters.
Risk factors for neurogenic shock?
Spinal cord injury, epidural anesthesia.
Risk factors for anaphylactic shock?
Bee stings, nuts, antibiotics, latex.
Expected findings in shock?
- BP: Hypotension, narrow pulse pressure
- HR: Tachycardia, thready pulse
- Resp: Tachypnea → respiratory failure
- Urine Output: < 30 mL/hr
- Skin: Cool, clammy (warm in distributive)
- LOC: Anxiety → confusion → lethargy
Lab findings in shock?
- ABGs: ↓ pH, ↓ PaO2, ↑ PaCO2
- Lactate: Elevated
- Cardiac enzymes: ↑ Troponin
- Cultures: Blood, urine, wound (septic)
- Coags: PT/INR, aPTT, ↓ fibrinogen, ↑ D-dimer
- Imaging: CT, X-ray, echo
Nursing care for shock?
- High-flow oxygen (NRB mask)
- 2 large-bore IVs
- Monitor VS, LOC, ECG, UO hourly
- Position: flat with legs up
- Foley catheter
- Prepare for ICU or intubation
Medications used in shock?
- Inotropes: Dobutamine, Milrinone
- Vasopressors: Dopamine, Norepinephrine
- Vasoconstrictor: Vasopressin
- Sympathomimetic: Epinephrine
- Analgesic: Morphine
- PPIs: Pantoprazole
- Anticoagulants: Enoxaparin
- Antibiotics: Vancomycin
- Antihistamines: Diphenhydramine
- Vasodilator: Nitroprusside
- Corticosteroids: Hydrocortisone
Therapeutic procedures for shock?
- Needle decompression/chest tube (tension pneumothorax)
- Pericardiocentesis (tamponade)
- Surgery to correct bleeding
- Hemodynamic monitoring: CVP, CO, MAP
Complications of shock?
MODS: Multi-organ dysfunction from hypoxia. First organ usually affected: lungs.
DIC: Clotting → bleeding due to clotting factor consumption.
- Monitor PT/INR, PTT, fibrinogen, D-dimer
- Treat with platelets, FFP, cryoprecipitate
