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NRSG 327 > Week 5- hypovolemic, distributive > Flashcards

Week 5- hypovolemic, distributive Flashcards

(45 cards)

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1
Q

most common type of shock see in practice

A

hypovolemic

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2
Q

why hip fracture a concern

A

highly vascularized and can bleed

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3
Q

diagnostics for hypovolemia

6

A
  • ABGs
  • CBC
  • Lytes
  • type and cross match
  • lactate
  • coags
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4
Q

types of hypovolemia

A

relative
absolute

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5
Q

risk factors for hypovolemia

3

A
  • Age >65 (cant compensate as well, more at risk for dehydration, nutrition)
  • diseases (renal, cardiac, liver)
  • decreased body mass (break down fat when body needs energy)
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6
Q

pathophysiology

hypovolemic shock

A

decrease circulating volume
decrease venous return
decrease stroke volume
decrease output
decrease oxygen supply
tissue perfusion
impaired cellular metabolism

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7
Q

examples of absolute and relative
shock

A

A: external blood loss (gun shot wound)
body fluid loss (diuresis)
R: third spacing (ie, burns)
internal blood loss (ie. ruptured spleen)

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8
Q

complications for hemorrhage

3

A

hypoperfusion
lethal triad
Electrolyte imbalance

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9
Q

lethal triad

A

Hypothermia
Acidosis
Coagulopathy

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10
Q

hypovolemia treatment

A

treat the cause
- stop loss
- replace loss (PRBC, IV fluids)
improve CO
- increase O2 supply (preload, contractility & afterload)
- decrease O2 demand

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11
Q

Hypovolemia treatment
hemorrhage

2

A
  1. whole blood
    - 4 units of RBC
    - 4 units of plasma
    - 1 platelets (4 donors)

Ratio is 1 1 1

  1. Tranexamic acid (TXA)
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12
Q

hypovolemia non hemorrhage treatment

A

colloids
crystalloids

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13
Q

whole blood helps with

A

volume and clotting vs RBC alone

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14
Q

colloids contain
where do they go
what they do
require
watch for
examples

A
  • large molecules
  • remain in intravascular compartment
  • expand plasma by drawing fluid from the extravascular space (oncotic pressure)
  • require less volume than crystalloids
  • fld volume overload
  • FFP, Albumin, Hetastarch, pentastarch
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15
Q

colloids can be good if patient is already

A

fluid overloaded but need to increase pressure

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16
Q

crystalloids are (3)

A

Isotonic: osmolality matched plasma
hypertonic: higher concentration of electrolytes
hypotonic: lower concentration of electrolytes

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17
Q

examples of isotonic fluids
watch for

A

0.9% NS
ringers lactate

hypervolemia

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18
Q

examples of hypertonic fluids
watch for (2)

A

3% NS D10W D50

intravascular overload
pulmonary edema

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19
Q

examples of hypotonic
watch for (2)

Study These Flashcards
A

0.45% S, D5W once dextrose has been metabolized

changes in LOC/shock

20
Q

fluid we most commonly use

Study These Flashcards
A

NS but RL is the closest to blood composition but expensive

21
Q

some tests done in ICU to see if interventions are working

5

Study These Flashcards
A
  • CVP
  • Arterial pressure
  • PCWP
  • SVR
  • CO/cardiac index
22
Q

5 things to remember if interventions are working

Study These Flashcards
A
  • increase BP
  • HR decrease (RR will also decrease)
  • Increased UO
  • increased skin perfusion (decrease in Peripheral edema)
  • improved mental status
23
Q

distributive shock what happens

Study These Flashcards
A

tank gets bigger
- vessels dilate
- increased vessel capacity
- not enough fluid in the tank

24
Q

hypovolemia vs septic shock

Signs

type of problem

Study These Flashcards
A

H= preload problem, decrease in volume
S= afterload problem, vessel is getting bigger

septic= temperature increase, confirmed or suspected infection, flushed, warm

hypo= slight drop in temperature

25
Septic shock differs from hypovolemia shock in that it is frequently manifested by: fever and flushed face elevated blood pressure increased urinary output slow bounding pulse
a
26
who is at risk for septic shock | 3 CAN
- Age (babies and elderly - comorbidities - nutrition/hydration
27
lactic acid is
natural byproduct of cellular metabolism and is produced when body breaks down CHO for energy in low O2 conditions (impaired cellular metabolism)
28
the produces and uses ____ not _____
lactate nt lactic acid
29
key features of sepsis
- source of infection - S/S of infection (increase HR >90, RR >20) - temp >38 or less than 36 - increase WBC (>12 or less than 4) - SBP >90 - altered mental status
30
sepsis screening tool
2 f the following - HR > 90 - RR >20 - Temp greater than or equal to 38 or less than 36 - WBC > 12 or less than 4 - altered mental status AND confirmed of suspected source of infection or any of the symptoms below - cough/sputum/CP/SOB - Abdo pain, distension, vomiting, diarrhea - dysuria/frequency/indwelling cath - skin or joint (pain, swelling, redness) - Central line present - mottled skin, cold extremities
31
diagnostics for sepsis
lactate ABGs CBC Lytes Coags
32
septic shock treatment
- fluids - abx #1 - improve CO increase O2 supply (preload, contractility & afterload) - decrease 02 demand o2 intubation
33
Septic shock S&S
- temp dysregulation - increased WBC - hypoperfusion tachycardia tachypnea/hyperventilation hypotension ↓ UO Altered neuro GI dysfunction ARDS: DIC
34
What is the difference between anaphylaxis & anaphylactic SHOCK????
shock is more systemic, there is vasodilation
35
onset of anaphylaxis is
immediate and life threatening
36
anaphylactic shock is a
result of an immediate hypersensitivity reaction antigen/antibody response - massive histamine, chemical mediator release, vasoactive substances causing vasodilation
37
S&S of anaphylactic shock
- stridor (airway swelling) - rash - swelling - hypoperfusion Tachycardia Tachypnea/hyperventilation Hypotension ↓ urine output Altered neurological status GI dysfunction ARDS: Acute respiratory distress syndrome DIC: Disseminated Intravascular Coagulation
38
tx anaphylactic shock
- remove the cause - treat the cause improve CO increase O2 supply - afterload - preload - contractility Decrease O2 demand - intubation
39
how do we treat the cause | anaphylaxis
- Stop the vasodilation - stop bronchoconstriction - stop histamine Epinephrine Antihistamine (Benadryl) Ranitidine (also an antihistamine)
40
Alpha B1 B2
vasoconstriction increase HR, BP bronchodilation, increase RR
41
signs of anaphylactic shock | 3
bronchoconstriction hives or edema hypotension
42
neurogenic shock results of loss or suppresion
- of sympathetic tone - rare - SCI results in major vasodilation - drop and become super bradycardia
43
Neurogenic shock S&S
- bradycardia - dry, warm skin hypoperfusion Tachypnea/hyperventilation Hypotension ↓ urine output Altered neurological status GI dysfunction ARDS: Acute respiratory distress syndrome DIC: Disseminated Intravascular Coagulation
44
treatment of neurogenic shock
treat cause but if cant then maintain normal HR: atropine maintain normothermia increase O2 supply and decrease demand
45
take away for shock neurogenic anaphylaxis septic signs
- hypoperfusion septic= high temp, warm, flushed neurogenic= badycardic warm then cool ana= stridor, rash, swelling

NRSG 327 (5 decks)

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