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MS_Primers for Exam 3 Content > Shock Primer > Flashcards

Shock Primer Flashcards

1
Q

Normal MAP range?

A

• 70-100 mmHg

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2
Q

Normal CVP range?

A

• 2-6 mmHg

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3
Q

What is Shock?

A

• A critical condition where the body has decreased tissue perfusion eventually leading to organ failure and death

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4
Q

What are the 5 steps in the pathophysiology of shock?

A
  • Not enough blood flow to organs
  • Inflammatory response is triggered
  • Anaerobic metabolism
  • Metabolic acidosis
  • Multiple Organ Dysfunction Syndrome (MODS)
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5
Q

What is the body’s immediate reaction to not enough blood flow to the organs?

A

• It speeds up the heart and respiratory rates in an attempt to get more blood/O2 out to the body

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6
Q

What triggers the inflammatory response of shock?

A

• Organs start to become damaged due to lack of blood flow

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7
Q

What does the inflammatory response trigger?

A
  • Vasodilation
  • Capillary permeability which leads to third spacing of fluids
  • Third spacing causes blood to become more viscous and causes blood to clot
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8
Q

Vasodilation in shock causes…

A
  • Low blood pressure
  • Swelling
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9
Q

True or False
The severity of the inflammation stage of shock is the same regardless of the type of shock.

A

• False, there is a greater swelling response with septic and anaphylactic shock

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10
Q

Describe what is meant by anaerobic metabolism in shock.

A
  • As the tissues of the body aren’t getting enough oxygen, the body tries to function temporarily without oxygen.
  • If not corrected, this will lead to metabolic acidosis
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11
Q

Explain the relationship between anaerobic metabolism and metabolic acidosis.

A
  • As the body tries to work without oxygen, it produces a waste product of lactic acid
  • This causes the blood pH to drop and impairs the body’s ability to function
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12
Q

Untreated shock will eventually lead to MODS. What is this?

A
  • Multiple Organ Dysfunction Syndrome
  • This is when 2 or more organs fail.
  • Due to acidic and anaerobic conditions within the body, organs begin shutting down, leading to death
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13
Q

What are the circulatory s/s of shock?

A
  • Tachycardia
  • Low BP
  • Cap refill >3sec
  • Decreased peripheral pulses
  • Cyanosis
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14
Q

What are the respiratory s/s of shock?

A

• Tachypnea

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15
Q

What are the neurologic s/s of shock?

A

• Agitation and confusion

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16
Q

What are the GI/GU s/s of shock?

A
  • Decreased urine OP
  • Absent bowel sounds
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17
Q

What happens regarding temperature and shock?

A
  • The initial vasodilation will cause the patient to be warm
  • As shock progresses, vasoconstriction will occur to try and bring up BP, this will cause the pts temp to drop
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18
Q

What are the nursing interventions for shock?

A
  • Give O2 and maintain airway
  • Start IV and admin fluids
  • Collect labs
  • Insert foley
  • Get type and x-match
  • Continue to assess
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19
Q

A patient arrives at the ED at risk of shock. What factors do we keep in mind regarding IVs?

A
  • Do not remove field start (IV placed in ambulance) until a new IV is placed
  • Make sure IV is patent and ready to go
  • Warm fluids before giving to maintain body temp
  • A CVC line may be inserted to give fluids/meds faster
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20
Q

True or False
The type of fluids given depends on the type of shock.

A

• True

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21
Q

What Labs might we want to collect for shock?

A
  • Hct/Hgb
  • ABG
  • PT, PTT
  • Cardiac enzymes (cardiogenic shock)
  • Creatinine/BUN
  • Electrolytes
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22
Q

Why is a foley catheter needed for patients in shock?

A

• To be able to accurately monitor renal function and success/failures of interventions

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23
Q

Why do we continue to assess the patient with shock?

A

• It is a medical emergency and can take a negative turn quickly

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24
Q

What is Obstructive Shock?

A

• A type of shock caused by something blocking the blood flow from moving forward in the circulatory system

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25
Q

What are some examples of conditions that may cause obstructive shock?

A
  • Pulmonary embolism: block blood from moving through lungs
  • Cardiac tamponade: pressure restricts pumping of heart
  • Tension pneumothorax: pressure restricts pumping of heart and perfusion of lungs
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26
Q

What is Distributive Shock?

A

• A systemic reaction when the blood vessels of the body vasodilate

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27
Q

What is an example of something that may cause distributive shock?

A

• Sepsis

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28
Q

What are the different types of shock?

A
  • Cardiogenic
  • Neurogenic
  • Spinal
  • Hypovolemic
  • Septic
  • Anaphylactic
29
Q

What is the general cause Hypovolemic Shock?

A

• An overall lack of blood circulating in the body (20% loss).

30
Q

What are the two types of hypovolemic shock?

A
  • Absolute
  • Relative
31
Q

What is absolute hypovolemic shock?

A

• Actual loss of fluids from the body

32
Q

Give examples of absolute hypovolemic shock.

A
  • Loss of whole blood from trauma, surgery, GI bleed
  • Loss of body fluids from vomiting, diarrhea, diabetes insipidus/mellitus, excessive diuresis
33
Q

What is relative hypovolemic shock?

A

• Change in vascular fluid levels to internal spaces

34
Q

Give examples of relative hypovolemic shock.

A
  • Pooling of blood: bowel obstruction
  • 3rd spacing of fluids (burns, ascites)
  • Internal bleeding (ruptured spleen/appendix)
  • Massive vasodilation (as occurs in sepsis)
35
Q

S/S of hypovolemic shock?

A
  • Anxious, agitated and pale
  • Skin is cool and clammy (due to vasoconstriction to try and raise BP)
  • Urine OP decreases
  • Absent bowel sounds
36
Q

Treatment for hypovolemic shock?

A
  • O2
  • Fluids (Lactated Ringers or NS)
  • Catheterize
  • Treat source of fluid loss
37
Q

What is the general cause Anaphylactic shock?

A

A severe allergic reaction where the immune system overreacts

38
Q

What are some examples of things that can trigger anaphylactic shock?

A
  • Drugs/vaccine
  • Food (peanuts)
  • Insect venom
39
Q

What method of transmission is used for allergen to trigger an anaphylactic response?

A
  • Contact
  • Inhalation
  • Ingestion
  • Injection
40
Q

What is the pathophysiology of anaphylactic shock?

A
  • Massive vasodilation w/ capillary permeability and fluid leak
  • Resulting inflammation causes respiratory distress, laryngeal edema and/or bronchospasm
  • Severity of inflammation can cause circulatory failure
41
Q

S/S of anaphylactic shock?

A
  • Dizziness, anxiety, confusion, sense of impending doom
  • Swelling of lips and tongue
  • Wheezing and stridor, Chest pain
  • Skin changes
42
Q

What type of skin changes might be seen with anaphylactic shock?

A
  • Flushing
  • Puritis
  • Uticaria
  • Angioedema (swelling in face)
43
Q

What is the treatment for anaphylactic shock?

A
  • O2
  • Epinephrine (immediate)
  • Followed by
    • IV antihistamines, steroids
    • Possible bronchodilators (such as albuterol) later
44
Q

What is general cause of Septic Shock?

A

• A widespread bloodborne infection

45
Q

What is the pathophysiology of septic shock?

A

• Acquired infection causes a systemic cytokine release inside the bloodstream that causes extreme vasodilation and fluid leakage from capillaries (triggering the systemic shock process)

46
Q

What are the two major conditions that will develop if septic shock is not treated?

A
  • DIC as the body tries to plug up the leaky capillaries
  • ARDS as O2 exchange will not be able to occur
47
Q

What are some examples of infections that can lead to septic shock?

A
  • Parasites
  • Fungi
  • Bacteria
  • Viruses
48
Q

How often should LOC/vitals be assessed w/ a patient experiencing hypovolemic shock?

A

Every 10-15mins

49
Q

What labs should be taken for the patient with hypovolemic shock?

A
  • CBC
  • U&E’s (urea and electrolytes)
  • BUN
  • LFTs
  • Type and Cross
50
Q

If source of bleeding causing hypovolemic shock is GI related, what may be indicated and why?

A
  • Placement of NG tube
  • For gastric decompression
51
Q

What is partial arterial wedge pressure (PAWP)?

A

pressure within the pulmonary arterial system when catheter tip ‘wedged’ in the tapering branch of one of the pulmonary arteries

52
Q

The normal pulmonary arterial wedge pressure is between…

A

4 to 12 mmHg

53
Q

True or False

Anaphylactic shock is not normally due to the first exposure but the second causes a trigger response and mass release of chemical mediators.

A

True

54
Q

What is the treatment for anaphylactic shock?

A
  • Make sure airway is patent
  • Supply 100% O2 on 15 liters via re-breather mask
  • Insert 2 large bore IVs
  • Remove stinger (if cause)
  • Administer meds
55
Q

What is the order of meds given for anaphylactic shock?

A
  • Epinephrine (immediate)
  • Nebulized albuterol
  • Benadryl (IM or IV)
  • Antihistamines
  • Corticosteroids
  • Antipuritics
  • Anti-mast cell drugs
56
Q

What do mast cells do?

A

They are responsible for releasing cytokines triggering immediate allergic reactions

57
Q

Patients with beta blockers may be resistant to epinephrine treatment during anaphylactic shock and can develop _____ and _____.

A

bradycardia and hypotension

58
Q

If a pt on beta blockers is resistant to the epinephrin tx for anaphylaxis, what should be given instead?

A

Glucagon

59
Q

Which patients are most at risk for developing septic shock?

A
  • Those with recent, prolonged, or multiple hospitalizations
  • Neutropenic patients,
  • Those with difficult-to-treat, multidrug-resistant microorganisms.
60
Q

The major focus of resuscitation from septic shock is on supporting

A

cardiac and respiratory functions.

61
Q

For those experiencing septic shock, early intubation and mechanical ventilation should be strongly considered for patients with any of the following:

A
  • Oxygen requirement
  • Dyspnea or tachypnea
  • Persistent hypotension
  • Evidence of poor peripheral perfusion
62
Q

What actions must be completed w/in the first 3hrs of septic shock?

A
  • Obtain the lactate level
  • Obtain blood cultures before administering antibiotics
  • Administer broad-spectrum antibiotics
  • Administer 30 mL/kg of crystalloid solution for hypotension or for lactate levels of 4 mmol/L or higher
  • Goal is to achieve normal CVP @ 8-12 mm Hg
63
Q

What should be done within 6 hours if septic shock hypotension has not responded to initial fluid resuscitation?

A

Admin vasopressors to maintain a Map of ≥ 65mm Hg

64
Q

Why might a pt in septic shock experience massive diuresis?

A

The body is trying to get rid of the dead and dying bacteria

65
Q

Petechiae and mottling of legs and feet is a sign that…

A

Clotting factors are being used up and the pt is at risk of DIC

66
Q

How do we control temperature when treating shock?

A

Antipyretics

Sponging or cooling blankets

67
Q

_____ use is preferred to dopamine for managing septic shock

A

Norepinephrine

68
Q

If hemoglobin levels fall below ____, red blood cell (RBC) transfusion is recommended to a target hemoglobin range of ___.

A
  • 7 g/dL
  • 7-9 g/dL
69
Q

True or False

Albumin should be used only when substantial amounts of crystalloid solution are required.

A

True

MS_Primers for Exam 3 Content (13 decks)

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