Integrated Clinical (Complex) > Mod 3 - Multisystem Disorders > Flashcards

Mod 3 - Multisystem Disorders Flashcards

(49 cards)

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1
Q

What is shock? (3)

A
  • O2 demands exceeds delivery
  • body is unable to compensate to meet this demand
  • if untreated, leads to death
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2
Q

SvO2 measures amount of _____ in the ______ from ________.

A
  • O2
  • blood
  • upper and lower body
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3
Q

ScvO2 measures the amount of ____ in the ______ from ______.

A
  • O2
  • blood
  • upper body
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4
Q

How is preload measured?

A

central venous (right atrial) pressure

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5
Q

How is afterload measured?

A
  • pulmonary artery cath
  • hemodynamic devices
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6
Q

How is contractility measured?

A
  • Echo (EF%)
  • Ultrasound
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7
Q

What is Cardiogenic Shock? What are some causes?

A

the heart is unable to pump, leading to inadequate blood delivery to tissues
- MI, heart injury d/t trauma or post-op, HF

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8
Q

What is Obstructive Shock? What are some causes?

A

a blockage creates barrier to blood entering and/or exiting the heart
- Tension pneumothorax, cardiac tamponade, pulmonary embolism

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9
Q

What is Distributive Shock? What are the different types? (3)

A

“Relative hypovolelmia” – massive peripheral vasodilation impedes venous return
- Anaphylactic (allergen), Neurogenic (brain or spinal cord injury), Septic (uncontrolled infection)

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10
Q

What is Hypovolemic Shock? What are some causes?

A

decreased blood and/or fluid volume leading to inadequate perfusion
- blood loss, internal bleeding, dehydration, fluid loss (excessive vomiting)

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11
Q

What are the stages of Shock?

A
  1. Initial - subtle changes in assessment and VS
  2. Compensatory - tachypnea and tachycardia, decreasing BP and urine output
  3. Progressive - blood shunted to vital organs (compensation failed)
  4. Refractory - prolonged tissue hypoperfusion, MODS, irreversible
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12
Q

What assessments will you see in the compensatory stage of shock? (7)

A
  • subtle mental status changes (restless and confused)
  • tachycardia
  • weak pulses
  • decreasing BP
  • tachypnea
  • decreasing urine output
  • cool, moist skin
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13
Q

What assessments are seen in the progressive stage of shock? (8)

A
  • lethargy or coma
  • hypotension
  • dysrhythmias
  • anuria
  • absent bowel sounds
  • metabolic/resp acidosis (or both)
  • cold extremities
  • weak/absent pulses
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14
Q

What assessments are seen in the refractory stage of shock? (3)

A
  • coma
  • hepatic, renal failure
  • peripheral ischemia and necrosis
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15
Q

What is DIC?

A

Disseminated intravascular coagulopathy
- overwhelming inflammatory response leads to excessive clotting
- excessive clotting exhausts clotting factors
- depletion of clotting factors leads to excessive bleedings

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16
Q

What will the labs show for DIC? (4)

A
  • elevated d-dimer r/t clots
  • decreased clotting factors (platelets and fibrinogen)
  • increased clotting times (PTT/INR)
  • increased fibrin degradation products
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17
Q

What is the treatment for DIC? (5)

A
  • supportive care (optimize O2, pH/lytes, etc)
  • TREAT THE CAUSE
  • volume replacement
  • replacement of clotting factors
  • bleeding precautions
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18
Q

Which organs typically go first in MODS?

A

lungs and kidneys

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19
Q

What is the identifications for MODS?

A
  • failing system
  • resp failure
  • anuria
  • absent bowel sounds
  • etc
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20
Q

What is the mortality rate once 3 organs are involved in MODS?

21
Q

Describe the pathway of Anaphylactic Shock (4)

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A
  • exposure to allergen
  • histamine response
  • venous dilation, increased capillary permeability, smooth muscle contraction
  • airway compromised, angioedema, profound hypotension
22
Q

What kind of breath sounds will you hear in a patient experiencing Anaphylactic Shock?

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A

wheezing and stridor

23
Q

T/F: A patient with anaphylactic shock will experience hypertension

Study These Flashcards
A

False - they experience hypotension due to vasodilation

24
Q

T/F: a patient with anaphylactic shock will experience peripheral edema

Study These Flashcards
A

true - due to vasodilation there is also capillary leakage causing the edema

25
What are the hemodynamic findings of Anaphylactic Shock? (5) What happens to HR, BP, Preload, Afterload, and Contractility?
- Increased HR d/t compensation - Decreased BP d/t vasodilation, capillary leak - Decreased preload d/t decreased venous return - Decreased afterload/SVR d/t vasodilation - Decreased contractility d/t coronary hypoperfusion, damage
26
What are the hemodynamic findings for Hypovolemic Shock? (5) What happens to HR, BP, Preload, Afterload, and Contractility?
- Increased HR d/t compensation - Decreased BP d/t deficient intravascular volume - Decreased preload d/t intravascular volume - Increased afterload/SVR d/t compensation - Increased contractility d/t compensation
27
In hypovolemic shock is SpO2, PaO2, ScO2 normal?
yes until late stages
28
In hypovolemic shock, is the patient hyperventilating pr hypoventilating during the compensatory stage?
hyperventilating
29
If the hypovolemic shock patient is hyperventilating, what is their pH and CO2 going to look like?
pH is high and CO2 is low
30
What will the BUN and Creatinine look like in a patient with hypovolemic shock?
BUN and Creatinine will look high d/t dehydration and kidney injury
31
What will the lactate levels look like in a patient with hypovolemic shock?
lactate will be elevated when the pt transitions to anaerobic metabolism
32
What are the hemodynamic findings in a patient with obstructive shock? (5) What happens to HR, BP, Preload, Afterload/SVR, and Contractility?
- HR increases d/t compensation - BP decreases d/t deficient cardiac output - Preload decreases d/t too many variables - Afterload/SVR increases d/t compensation - Contractility has no changes
33
What cardiac rhythm would the patient be in with obstructive shock?
PEA
34
Early sepsis is warm or cold?
warm
35
What are the hemodynamic findings in a patient with septic shock? (5) What happens to HR, BP, Preload, Afterload/SVR, and Contractility?
- HR increases d/t compensation - BP decreases d/t decreased venous return - Preload decreases d/t decreased venous return - Afterload/SVR decreases d/t vasodilation - Contractility increases in early stages d/t compensation
36
What ABG diagnostic findings would you see in a septic shock patient?
- Respiratory alkalosis in early stage - Metabolic acidosis in later stage
37
What clotting studies would you see in a patient with septic shock?
DIC - decrease in clotting factors (platelets and fibrin) and increased clotting time (PTT/INR)
38
What are the risk factors for Cardiogenic Shock? (4)
- Co-morbidities: decompensated HF - Trauma: blunt chest trauma - Post-op: CABG - Direct tissue injury: STEMI
39
What are the clinical manifestations of Cardiogenic Shock?
- decreased LOC, altered mental status - SOB - Tachypnea - tachycardia - Hypotension (narrow pulse pressure) - Diaphoresis, pallor - N/V - decreased CO, decreased SV
40
What are the medical managements of Cardiogenic Shock? (3)
- Vasoactive medications to increase MAP and perfusion - Inotropes to increase contractility and CO - Diuretics to decrease preload and fluid overload
41
What are the three Mechanical Circulatory Support systems?
- Intra-aortic Balloon Pump - Ventricular assist device (LVAD/RVAD) - Extracorporeal membrane oxygenation (ECMO)
42
What does an Intra-Aortic Balloon Pump do?
increase coronary perfusion by improving filling and decreases afterload
43
What are the nursing interventions for Cardiogenic Shock patients?
- apply O2 - anticipate intubation - prepare for invasive hemodynamic monitoring - administer medications - administer fluid replacement - restrict activity - maintain MCS (mechanical circulatory system)
44
T/F: You want limb movement restrictions for a patient who underwent an Intra-Aortic Balloon Pump surgery
true
45
What is the pathophysiology of Neurogenic Shock? Sympathetic disruption vs Unopposed parasympathetic response?
injury to the nervous system caused by spinal cord or brain injury - Sympathetic disruption: loss of vascular tone (SVR) leading to vasodilation, decreased venous return, and relative hypovolemia - Unopposed Parasympathetic Response: bradycardia leading to low CO d/t low Hr and low SV and loss of compensatory tachycardia
46
What are the clinical manifestations of Neurogenic Shock?
- warm, dry, flushed skin (d/t vasodilation) - hypotension (d/t decreased vascular tone) - bradycardia (d/t unopposed parasympathetic response) - decreased venous return - decreased CO (d/t bradycardia and decreased SV) - LOC changes (d/t acidosis and hypoperfusion) - elevated lactate, metabolic acidosis (d/t anaerobic metabolism from decreased perfusion)
47
What is the priority medical management of Neurogenic Shock?
(rescue) maintain vital functions - hypotension: fluid admin and vasopressor infusion - bradycardia: atropine, pacing - resp compromise: intubation with mechanical device
48
What are the nursing assessments for a patient with Neurogenic Shock?
- frequent vital signs and hemodynamics - focused cardiac, resp, skin continuous cardiac monitoring - strict I&O - frequent physical assessment to monitor for progression to MODS
49
What are the nursing interventions for a patient with Neurogenic Shock?
- maintain IV access and hemodynamic access (via arterial line) - be prepared for emergency interventions (intubation, pacing) - DVT prophylaxis (pt esp at risk d/t spinal cord injury and immobility) - Raise patient's head of bed slowly (pt at risk for orthostatic hypo d/t loss of vasomotor tone) - skin care
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