1
Q
During shock Inadequate oxygen is delivered to____.
Poor oxygenation leads to _______.
____ products accumulate in _____.
_____ and _____ death occur
A
- Cells
- anaerobic cellular metabolism
- Waste/Cells
- Cell and organ
2
Q
Clinically, shock is defined by the following numbers: 1.\_\_\_\_ BP of < or = to \_\_\_\_\_ OR 2.\_\_\_\_ decrease from baseline OR 3.\_\_\_\_ of < or = \_\_\_\_\_ 4. Heart rate of greater than\_\_\_\_\_\_(less than \_\_\_ in neurogenic shock) 5. Signs of \_\_\_\_\_\_
A
- Systolic/90mmHg
- 40mmHg
- MAP/65
- 100/60
- Hypoperfusion
3
Q
What are signs of hypoperfusion that might be seen in shock?
A
- Oliguria
- Hyperlactemia
- Poor Peripheral perfusion
- altered mental status
4
Q
3 types of shock?
A
- Hypovolemic - most common
- Cardiogenic
- Distributive
5
Q
3 external causes of hypovolemic shock?
A
- Hemorrhage- Blood MOST COMMON CAUSE
- Burns - Plasma
- Dehydration - V/D/Diur/sweat
6
Q
3 internal causes of hypovolemic shock?
A
- Third-spacing
- Fluid leakage into the intestinal lumen
- Internal hemorrhage
7
Q
In a hemorrhage, shock develops after the loss of how much blood?
A
- Loss of 1/3 of normal amount of 5 liters.
* 15%
8
Q
S&S for hypovolemic shock? Fill in Blanks
- ___tension
- ___, Thready, ____ pulse
- ___pnea
- ___ urine output
- ___ CO
- ___PAP/CVP
- ___ SVR (900-1400)
- ___/___ skin
- __ ___/thermia
- ____ mucous membranes/ ___
- ____ neck veins
- ___ ___ ____ status
- ____esis
A
- Hypotension
- Weak, Thready, RAPID pulse
- Tachypnea
- Decreased urine output (less than 30 ml/hr)
- Decreased CO (normal is 4-8)
- Decreased PAP/CVP
- Increased SVR
- Cool/Pale Skin
- Mild hypothermia
- Dry mucous membranes/thirst
- Flat neck veins
- change in mental status
- diaphoresis
9
Q
1st line of Treatment for hypovolemic shock? 2nd line of treatment?
A
- FLUID VOLUME REPLACEMENT FIRST
2. Vasoconstrictive drugs (only if fluid doesnt work)
10
Q
fluids used for hypovolemic shock?
A
- Isotonic crystalloids ( NS/LR)
- Colloid (Albumin)
- Blood products (Plasma, RBC)
11
Q
When cardiac output is decreased due to failure of the heart to pump effectively, what is the result?
A
Fluid retention/pulmonary edema
12
Q
Clinical definition of cardiogenic shock?
A
- Low CO/CI
- Hypotension (systolic less than 90 or less)
- Clinical signs of inadequate blood flow to tissues
13
Q
Normal CI? Normal CO? what would a CI look like in cardiogenic shock?
A
- CI- 2-4 L/min (less than 1.8 in cardiogenic shock)
* CO- 4-8 L/min
14
Q
2 general conditions causing cardiogenic shock?
A
- Ineffective heart pumping
* Obstruction in cardiac system (Obstructive shock e.g. tamponade, embolism )
15
Q
Most common cause of Cardiogenic shock is _____. Occuring when ____ or more of ______ has been damaged.
A
- Myocardial infarction
- 40%
- Myocardium
16
Q
S&S for cardiogenic shock? Fill in Blanks
- ___tension
- ___, Thready, ____ pulse
- ___pnea
- ___ urine output
- ____ ____ ____ status
- ____esis
- ___/___ skin
- ____ neck veins
- ____ lungs
- ____/____ edema
- ______ CO
- ______ SVR (900-1400)
- _____ PA/CVP/Wedge pressures
A
- Hypotension
- Weak, thready, rapid
- Tachypnea
- decreased urine output
- change in mental status
- diaphresis
- Cool/pale skin
- Distended neck veins
- crackles in lungs
- pulmonary/peripheral
- decreased CO
- increased SVR
- Increased PA/CVP/Wedge pressures
17
Q
Normal range for CVP? What would it be in cardiogenic shock? what does it reflect?
A
- 2-6
- increased
- Fluid overload
18
Q
Normal range for PAWP/PCWP? What would it be in cardiogenic shock? What does this reflect?
A
- 6-12
- Increased above 18
- FIlling pressure in left atrium, increase means backflow (left ventricle failing -> increase in atrial pressure -> increase in PAWP
19
Q
Normal range for PAP? What would it be in cardiogenic shock? What does this reflect?
A
- 9 -18
- Increase
- Pressure in pulmonary artery increases due to back up from ineffective pump.
20
Q
Distributive shock is caused by massive ______. This causes what to happen? What happens to blood volume?
A
- vasodilation
- Blood volume stays the same
- Increase in vascular space decreasing blood return and C/O
21
Q
First line of treatment for distributive shock?
A
- Fluid volume replacement*
- Isotonic cyrstalloids
- Albumin (colloid)
22
Q
Second line of treatment for distributive shock?
A
- vasoacitve drugs (noreepi etc..) to increase afterload
* Use when fluids are not working
23
Q
What occurs in neurogenic shock?
A
*disturbances in nervous system (medula - vasomotor center) inhibiting sympathetic nervous system causing vasodilation. Vessels are relaxed and unable to constrict.
24
Q
some causes of neurogenic shock?
A
- upper spinal cord injury
- spinal anestheshia
- extreme emotional distress, fear, anxiety
25
S&S of neurogenic shock
* BRADYCARDIA AND HYPOTENSION*
* Decrease in CO, SVR, PA
* Dry/Warm skin
* Temp is same as room/low
26
Treatment for neurogenic shock with brain and spinal injuries?
Steroids
27
Patho of Anaphylactic shock?
* reexposure to allergen causes antigen to bind to IgE on mast cells
* Release of prostoglandins and histamine
28
What happens after chemical mediators are released prior to anaphylactic shock
* Major vasodilation*
* Laryngeal edema/bronchoconstiction
* Urticaria
* Cardiovascular collapse/Respiratory failure
29
Signs and Symptoms for Anaphylactic shock? fill in the blanks.
```
vitals
i. ____tension
ii. ____cardia
iii. _____pnea
iv. ____ _____changes
v. _____ U/O
Appearance
vi. ___ and _____ (on skin)
vii. E______ and Cy______
viii. Edema of eyelids, lips or tongue
Breathing
ix. W____and ___pnea
x. ____ness and _____
xi. R_____and R ____(lung sounds)
xiii. Rapid decrease _____
xiv. Decreased___, ___, ___ readings
```
i. Hypotension
ii. Tachycardia
iii. Tachypnea
iv. Mental status changes
v. Decreased U/O
vi. Urticaria and pruritis
vii. Erythema and Cyanosis
viii. Edema of eyelids, lips or tongue
ix. Wheezing and dyspnea
x. Hoarseness and stridor
xi. Rales and rhonchi
xiii. Rapid decrease in oxygen saturation
xiv. Decreased CO, SVR, PA readings
30
First and second line of treatment for anaphylactic shock?
* SQ epi
| * Diphenhydramine
31
systemic response to infection where fever, tachycardia, tachypnea or
leukocytosis is noted
sepsis
32
Patho of septic shock
* Massive infectious process - Bacteria spread faster than can kill
* As bacteria are killed, endotoxins and exotoxins enter into circulation causing release of chemical mediators from cells (histamines, prostagladins etc.)
* Massive vasodilation and increased capillary permeability occur.
33
Septic shock is Very _____. Mortality rate of _____
*Lethal - 40 -80%
34
Early stage signs and symptoms for septic shock..Fill in blanks.
1. ____cardia
2. ______pulse
3. ___ ____tension
4. ____pnea
5. ______U/O
6. ___/____ skin
7. ______thermia
8. _______ CO
9. ______ SVR
1. Tachycardia
2. Bounding pulse
3. Mild Hypotension
4. Tachypnea
5. Increased U/O
6. Hot/flushed skin
7. Hyperthermia
8. Increased CO
9. Decreased SVR
35
Late stage signs and symptoms for septic shock..Fill in blanks.
1. ____/____pulse
2. ______tension
3. ____pnea
4. ___,___,___skin
5. ____uria
6. ____thermia
7. ____ _____status
8. ____CO, SVR
9. _______PAP
1. Weak, rapid pulse
2. Hypotension
3. Bradypnea
4. Cool, clammy, pale skin
5. Oliguria
6. Hypothermia
7. Altered mental status
8. Decreased CO, SVR
9. Decreased PAP
36
Some treatments for septic shock?
* Antibiotics
| * Antipyretics
37
In compensatory shock..Stage____, The body is experiencing a state of ___ ____ ____ but is still able to maintain ____ ____ and ___ ___ by increasing the _____ ____ and _____ the blood vessels,
* STAGE 1*
* Low Blood Volume
* Blood Pressure and organ perfusion
* Heart rate
* constricting blood vessels
38
Signs & Symptoms: of compensatory shock. fill in blanks.
1. Slightly ______ BP
2. ___ _____cardia (or may be high normal)
3. ___ ____pnea (or may be high normal)
4. ___ ______urine output
5. Slight feelings of _____ or ______
6. Skin slightly ___,_____,____
1. Increased BP
2. Mild Tachycardia
3. Mild Tachypnea
4. Slightly Decreased
5. Anxiety or restlessness
6. Pale, cool, moist
39
In progressive shock...stage____ the compensatory mechanisms begin failing to meet ____ metabolic needs. Requires aggressive intervention to be ______.
* Stage 2
* Tissue
* Reversed
40
Signs and symptoms of progressive shock?
All the classic shock symptoms
41
in refractory shock...stage____, which is ______. _____ failure and _____ occur.
* Stage 3
* Irreversible
* Organ failure and death
42
What is the diagnostic for shock? What do they indicate when above ____? When/why is it done more than once?
* Lactate level (Lactic acid)
* Elevated levels (ABOVE 4), indicate anaerobic metabolism/poor tissue perfusion
* Serial draws to determine effectiveness of treatment
43
Prevention goal for hypovolemic shock?
Assess fluid balance, hemodynamic values, and vital signs
44
Prevention goal for Cardiogenic shock?
1. Decrease myocardial oxygen demand
| 2. Increase oxygen to myocardium
45
Prevention goal for Neurogenic shock?
Immobilization of spinal injuries
46
Prevention of Anaphylactic shock?
Know patients allergies
47
Prevention of sepctic shock
1. Wash hands/aseptic technique
| 2. Isolation precautions
48
Emergency positioning for severely hypotensive patients? When is this position not to be used?
Modified trendelenburg, HOB flat with extremities eleveated 30 to 45 degrees.
49
Nursing assessment for shock? FIll in blank.
a. _____ status
b. Frequent ____ ____
c. Arterial line.. Kee MAP ___
d. _____ _____ ____ with ____ ____ readings every ______
e. I/O _____
f. Level of consciousness
g. Tissue ____, _____, ____
a. Respiratory status
b. Frequent vital signs
c. Arterial line. Keep MAP > 65
d. Swan-Ganz catheter with hemodynamic pressure readings every 1-2 hours
e. Intake and output hourly
f. Level of consciousness
g. Tissue color, temp, capillary refill
FINAL EXAM 231
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