Week 4- Shock cardio/obst

Question 1

what is shock

Answer 1

syndrome

1. decreased tissue perfusion
2. impaired cellular metabolism

results in imbalance between supply and demand of 02 and nutrients

Question 2

how do we classify shock

Answer 2

based on what caused it

Question 3

Regardless of the type of shock or what caused it – the end result is

Answer 3

inadequate tissue perfusion due to decreased CO

Question 4

when cells die…

Answer 4

tissue dies…
when tissues die
organs die
people die

Question 5

CO=

Answer 5

SV x HR

Question 6

When we think about shock, we need to think about….

Answer 6

CO

Question 7

SV includes

Answer 7

preload, afterload and contractility
the amount of blood ejected from the heart with each contraction measured in ml/beat

Question 8

average normal CO

Answer 8

5000ml/min

Question 9

how to increase CO

Answer 9

increase HR or SV

Question 10

shock is an imbalance in

Answer 10

CO

Question 11

Type of shock impacting preload

Answer 11

Hypovolemic= deals with the loss of volume, from intravascular fluid volume as well as blood loss.

Question 12

Type of shock impacting Contractility

Answer 12

cardiogenic & obstructive
- ineffective pumping of the heart and insufficient perfusion and delivery of O2 to cells

Question 13

type of shock impacting afterload (pipes)

Answer 13

Distributive: ineffective distribution of blood volume in the vessels because of vessel dilation and inadequate delivery of oxygen. i.e. sepsis, anaphylaxis, and neurogenic.

Question 14

Initial phase of shock

Answer 14

• little or no s/s
• lactic acid

Question 15

compensated stage of shock

classic sign

Answer 15

• fairly normal
• hypotension classic sign late in this stage e

Question 16

uncompensated (progressive) stage of shock

Answer 16

s/s are obvious
really bad need them out

Question 17

irreversable or refractory stage of shock

Answer 17

it is over

Question 18

3 compensatory stage mechanisms

Answer 18

neural: activate SNS epinephrine= increase HR, BP, RR, dilate pupils, broncho dilate, decrease blood flow to kidneys at first

Biochemical: (when acid base comes into play): activated by H+, O2, C02 concentrations. stimulated by HR and RR increase

Hormonal: RAAS, ADH (try to increase BP)

still have adequate CO

Question 19

neural response

activated by

Answer 19

baroreceptors sense
low pressure and blood flow

Question 20

biochemical response

Answer 20

chemoreceptors sense: decrease pH, decrease O2 and increase CO2

Question 21

Angiotensin 2=
Aldosterone=
ADH=

Answer 21

increase afterload and BP
increase preload
increase afterload and BP

Question 22

S/S of compensated shock

Answer 22

• skin normal or slightly pale, cool peripherly
• ↑ resp. rate; normal WOB, normal SpO2
• thirst
• Slightly restless; possibly mild confusion; decreased concentration, ↑glucose
• mild tachycardia, strong pulse centrally, possibly slightly weaker periphery, normal to low BP
• decreased urine output, urine concentration

Question 23

what do you want as an order in compensatory shock

3

Answer 23

blood work, lactate, ABG

Question 24

A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client’s vital signs frequently during the compensatory stage of shock?

a) Arteriolar constriction occurs.
b) The cardiac workload decreases.
c) Contractility of the heart decreases.
d) The parasympathetic nervous system is triggered.

Answer 24

a

Question 25

progressive shock | 4

Answer 25

- compensatory mechanisms fail - decreased CO - Decreased end organ perfusion - MODS

Question 26

MODS - CVS - Resp - GI - Liver - CNS - Renal - skin

Answer 26

- decrease BP, increase HR until gets to tired - rise in RR, increase WOB, O2 will drop - nothing, hypoactive bowels - increase enzymes - obvious confusion now - drop in blood flow, decrease UO, increase BUN, Cr - cold clammy, grey, decreased tissue perfusion, increased cap refill, look sick, green, gross

Question 27

progressive shock neuro CVS Reps GI renal

Answer 27

- confusion obvious, restless, decrease LOC - pale, cld, clammy, prolonged cap refill, BP, HR decrease - increase wOB, increase RR, O2 decrease, crackles from shift in fluids - nothing, nausea/vom (creates pressure to raise BP) decreased bowel sounds - decreases UO

Question 28

During the progressive stage of shock, anaerobic metabolism occurs. The nurse expects that initially the anaerobic metabolism causes:

Answer 28

metabolic acidosis lactate is put out and breakdown is very acidic

Question 29

refractory shock

Answer 29

loss of compensatory mechanisms profound cell destruction organ failure and death

Question 30

refractory shock neuro: CVS: RESP: GI: GU: DIC

Answer 30

- GCS 4 or 5, not responding, comatose, cerebral edema, extreme decrease in LOC, - severe decrease CO, major dysrhythmias - ARDS mixed acidosis, metabolic acidosis because resp is trying to compensate so our resp is pooping out. - necrotic guts - anuria - disseminated intravascular coagulation bleeding and clotting at the same time

Question 31

how to intervene refractory stage

Answer 31

- early recognition - early intervention

Question 32

systolic dysfunction=

Answer 32

cardiogenic (inability to pump bld fwd)

Question 33

diastolic dysfunction=

Answer 33

obstructive (↓ RV or LV filling)

Question 34

obstructive shock usually affects cardiogenic shock usually affects

Answer 34

Obstructive shock typically just diastole affected Cardiogenic usually systole and diastole affected

Question 35

diastolic dysfunction = ineffective filling

Answer 35

increase pulmonary pressures pulmonary edema decreased oxygenation

Question 36

anterior STEMI complications | 4

Answer 36

v fib arrest (dysrhythmia) HF or decreased CO (systole problem) pericarditis cardiogenic shock

Question 37

risk factors for cardiogenic shock from MI | 5

Answer 37

age HTN DM Multivessel CAD Prior MI or Angina

Question 38

why check BP in both arms

Answer 38

in case of aortic dissection

Question 39

investigation and management Orders: management: Improve CO:

Answer 39

Orders: - blood tests: lactate*, CBC, Coags, renal, liver - ABGs - Scans M: - treat underlying cause (revascularization) CO: - increase O2 supply - decrease O2 demand - drugs - LV support - O2 intubation

Question 40

drugs for cardiogenic shock | examples and what they do

Answer 40

inotropes* - (dobutamine (mcg/kg/min) - milrione - levophed (norepi) work more on CO than BP

Question 41

LV support

Answer 41

reduce myocardial demand - intra aortic balloon pump (IABP) increase coronary perfusion - left ventricular assist device (LVAD) - helps bring blood to aorta

Question 42

pH 7.47 PaCO2 30 HCO3 22 PaO2 98

Answer 42

uncompensated resp alkalosis

Question 43

Uncompensated is when Partially compensated is when Full compensated is when

Answer 43

- CO2 or HCO3 is normal & the other is abnormal - all 3 are abnormal - pH is normal

Question 44

CVP

Answer 44

pressure recorded from the right atrium or superior vena cava and is representative of the filling pressure of the right side of the heart. High= fluid retention low=volume depletion, decreased venous tone

Question 45

pH 7.25 PCO2 30 HCO3 17 PaO2 70

Answer 45

partially compensated metabolic acidosis hypoxia

Question 46

pH 7.05 PCO2 56 HCO3 14 PaO2 38

Answer 46

partially compensated mixed acidosis

Question 47

principles of treatment of shock

Answer 47

1) Treat the underlying cause 2) Increase Supply: ABC’s Optimize O2 Optimize CO Optimize Hgb 3) Decrease Demand: Normothermia Decrease Activity Sedation/analgesia

Question 48

text book tables

Question 49

when CO2 high= When HCO3 high=

Answer 49

acidic basic CO2 = acid when high Bicarb = base when high