Shock

Question 1

What is the definition of shock?

Answer 1

Shock is a syndrome characterised by decreased tissue perfusion and impaired cellular response

Question 2

What are the 4 classifications of shock?

Answer 2

hypovolaemic
cardiogenic
distributive
obstructive

Question 3

Hypovolaemic shock is?

Answer 3

loss of fluid from circulation

Question 4

what is distributive shock?

Answer 4

diminished venous return due to arteriole and capillary dilation

Question 5

What is obstructive shock?

Answer 5

physical obstruction impeding flow

Question 6

What happens if shock is not treated?

Answer 6

MODS - multipule organ dysfunction

MOFS - multipule organ failure

Question 7

What are some causes of hypovolaemic shock?

Remembering that Hypovolaemic shock is loss of fluid not only blood

Answer 7

Haemorrhage
Dehydration
Plasma loss

Question 8

What are some examples of haemorrhage?

Answer 8

ruptured organs
fractures
surgery
postpartum haemorrhage

Question 9

What are some examples of dehydration?

Answer 9

vomiting
diarrhoea
NGT suctioning
diuresis
diaphoresis

Question 10

What are some examples of plasma loss?

Answer 10

burns
ascites
peritonitis
oedema

Question 11

How is the severity of hypovolaemic shock classified?

Answer 11

the percentage
volume lost
rate of volume lost
persons age
presence of other preexisting problems?

Question 12

what are the clinical signs of hypovolaemic shock?

Answer 12

resp rate increase
HR increase
BP decrease

Question 13

what are the 2 types of hypovolaemic shock?

Answer 13

relative and absolute

Question 14

explain relative hypovolaemic shock?

Give an example

Answer 14

Fluid volume moves out of the vascular space into the extravascular space eg. third spacing or increased capillary permeability like in burns

Question 15

explain absolute hypovolaemic shock?

Give an example

Answer 15

when fluid is lost through haemorrhage or gastrointestinal loss

(vomiting diarrhoea, fistula drainage, diabetes insipidus or diureses

Question 16

explain the course of hypovolaemic shock

Answer 16

decreased circulatory volume - decrease venous return - decreased stroke volume - decreased cellular oxygen supply - decreased tissue perfusion

Question 17

how do we diagnose hypovolaemic shock?

Answer 17

clinical picture/history
blood test
urine studies
chest x-ray

Question 18

what is the emergency care for hypovolaemic shock?

Answer 18

ABC - airway breathing circulation
assess for haemorrhage
assess for manifestations of shock
seek immediate medical help
O2 and IV fluid ASAP
Use of explanation and touch to reduce anxiety

Question 19

what is treatment for hypovolaemic shock?

Answer 19

if there is bleeding apply direct pressure
oxygen supplementation
fluid resuscitation
drug therapy

Question 20

what is required for fluid replacement therapy with hypovolaemic shock?

Answer 20

establish vascular access with at east 2 large
central line insertion
fluid resuscitation

Question 21

what fluids do we use for hypovolaemic shock?

Answer 21

crystalloids - isotonic (normal saline, hartmans) Hypertonic (1.8, 3, 5% saline)
colloids - Albumin (5 or 25%)
blood products -packed red blood cells, fresh frozen plasma, platelets

Question 22

what are the complications of hypovolaemic shock?

Answer 22

cardiac arrest
disseminated intravascular coagulation (DIC)
acute respiratory distress centre (ARDS)
multiple organ failure (MOFS)
death

Question 23

explain seagulling affect

Answer 23

happens when the heart rate dot is on top of the seagull

your seagull is being shat on

high HR and low BP

Question 24

what is cardiogenic shock?

Answer 24

caused when the heart pump fails

there is a decreased myocardial contractility which results in decreased cardiac output and impaired tissue perfusion

Question 25

who is at risk of cardiogenic shock?

Answer 25

Patients who currently have or have experienced: ``` Diseased coronary arteries Acute MI Greater than 40% damage to L) ventricle Cardiomyopathy Myocarditis Valvular disease Cardiac Tamponade (pressure on the heart itself) ```

Question 26

What are the signs and symptoms of cardiogenic shock?

Answer 26

* Tachycardia, hypotension * Narrow pulse pressure * Distended neck veins * Arrhythmias * Dyspnoea * Cool, pale, clammy skin * Oliguria * Decreased mental state, agitation, anxiety

Question 27

what is the goal of treatment and treatment options of cardiogenic shock?

Answer 27

Goal is to correct reversible problems, protect the myocardium, and improve tissue perfusion Oxygen therapy Vasodilators Antiarrhythmic agents Cardioversion

Question 28

name some vasodilators

Answer 28

Glyceryl triitrate - GTN - Dilates arterioles and veins of smooth muscle - Reduces peripheral resistance, cardiac output, and pulmonary wedge pressure - Decreases the oxygen requirements of heart - Decreases pulmonary congestion Frusemide (given to reduce preload)

Question 29

What are the 3 types of distributive shock?

Answer 29

Septic Anaphylactic Neurogenic

Question 30

distributive shock Septic shock is caused by?

Answer 30

Caused by a systemic inflammatory response syndrome (SIRS) as a result from an infection process * Often caused by gram-negative bacteria which release endotoxins into the blood stream. * Endotoxins cause the release of cytokines

Question 31

distributive shock Septic shock predisposing factors are?

Answer 31

* underlying chronic disease * alteration in host defenses * long hospitalisation * use of invasive catheters and devices * trauma and surgical wounds

Question 32

Distributive shock Septic shock EARLY signs and symptoms are?

Answer 32

Early (Warm) – Fever(>38oC) – BP: normal to hypotensive – Pulse: increased (tachycardia), thready – Respirations: rapid (tachypnoea) and deep – Skin: warm, flushed – MentalState: alert, orientated, anxious – Urine: normal – Other: weakness; nausea, vomiting, diarrhoea

Question 33

Distributive shock Septic shock PROGRESSIVE signs and symptoms are?

Answer 33

``` Progressive (cold) – severe hypotension – reduced perfusion – pulse: tachycardia, arrhythmias – respirations: rapid, shallow, dyspnoea – skin: cool, pale, oedematous – mental state: lethargy to comatose – oliguria/anuria – Other: normal to decreased body temperature, acidosis, progressing to multi-organ failure ```

Question 34

Distributive shock Septic shock treatments and preventions include?

Answer 34

– prevent through proper hand washing and good aseptic technique – need to restore vascular tone through vasopressor therapy – fluid resuscitation – antibiotic therapy

Question 35

Distributive shock Neurogenic shock is caused by?

Answer 35

– injury or disease to the upper spinal cord – spinal anaesthaesia – nervous system damage – vasomotor depression (e.g. drugs, severe pain, hypoglycaemia).

Question 36

Distributive shock Neurogenic shock signs and symptoms are?

Answer 36

* Spinal cord injury – paralysis * Hypotension * Bradycardia * Loss of temperature control – poikilothermia

Question 37

Distributive shock Neurogenic shock treatments

Answer 37

* Vasopressor therapy | * Spinal cord decompression and realignment

Question 38

Distributive shock Anaphylactic shock is? provide examples

Answer 38

• Severe allergic reaction due to antigen- antibody response – Medication administration – Contrast media – Blood transfusions – Ingestion – Bites/stings • Results in vasodilatation, increased capillary permeability and smooth muscle contraction

Question 39

Distributive shock Anaphylactic shock signs and symptoms are?

Answer 39

* Mental state: restless, anxious, lethargic to comatose * BP: hypotension * Pulse: increased, arrhythmias * Respirations: dyspnoea, stridor, wheezes, laryngospasm, bronchospasm, pulmonary oedema * Skin: warm, oedematous (lips, eyelids, tongue, hands, feet, genitals) * Other: abdominal cramps, vomiting, diarrhoea

Question 40

Distributive shock Anaphylactic shock treatments are?

Answer 40

* Stop drug or substance exposure * 100% oxygen & IV therapy ASAP * Maintain airway * Give adrenaline * Secondary management: antihistamine, corticosteroid, adrenaline infusion, treat acidosis as required, bronchodilators

Question 41

What is obstructive shock?

Answer 41

Develops when a physical obstruction to blood flow resulting in a decreased cardiac output

Question 42

What are some causes of obstructive shock?

Answer 42

Pulmonary embolism cardiac tamponade aortic stenosis

Question 43

What are the 3 stages of shock?

Answer 43

Compensatory stage Progressive stage Irreversible stage

Question 44

What signs and symptoms are in the compensatory stage?

Answer 44

BP: normal to slightly decreased Pulse: slightly increased from baseline Respirations: normal (baseline) Skin: cool, peripherally pale, moist (mild vasoconstriction) Mental state: alert and orientated Urine Output: slightly decreased Other: thirst, decreased capillary refill time

Question 45

in the compensatory stage what will happen to the body systems?

Answer 45

* as shock progresses, the prolonged reduced cardiac output initiates compensatory mechanisms involving the nervous and endocrine systems. * Symptoms become more apparent. * Shock may still be reversed if appropriate interventions are initiated.

Question 46

Explain the Progressive stage

Answer 46

* If the cause of shock is not corrected, or if compensatory mechanisms continue without reversing the shock, further patient deterioration occurs. * Eventually compensatory mechanisms begin to fail leading to a vicious cycle that can lead to death.

Question 47

What are the signs and symptoms of the progressive stage?

Answer 47

* agitated, confused, progressive decrease in activity * progressive thirst * pulse > 120 * BP decreased * tachypnoea (30 - 40), crackles * urine output 5 - 15 mls/hr * definite delay in capillary refilling * cold and moist skin

Question 48

what happens in the irreversible stage?

Answer 48

* Prolonged inadequate tissue perfusion that is unresponsive to therapy which causes multiple organ failure and death. * All compensatory mechanisms have failed. * Treatment is mostly unsuccessful.

Question 49

What are the signs and symptoms of the irreversible stage?

Answer 49

* confused, lethargic, unconscious * dilated pupils may be evident * pulse >140 weak and often irregular * severe hypotension (35) * negligible urine output (anuria) * no capillary refilling observed * cold, mottled and cyanotic skin * Other: loss of reflexes, decreased or absent peripheral pulses

Question 50

What are some nursing interventions to assess shock?

Answer 50

``` Nursing assessment – Neurological status – Cardiovascular status – Respiratory status – Renal status – Body temperature – Personal hygiene – Emotional support ```

Question 51

What is PAWP and what does it do?

Answer 51

Pulmonary artery wedge pressure pressure from the right side of the heart looks through the pulmonary capillary bed to the pressure in the left side of the heart Used to assess the function of the left side of the heart

Question 52

What needs to happen for the body to function normaly?`

Answer 52

adequate blood volume sufficient oxygen-saturated haemoglobin circulating adequate pump Arterioles need to have enough tone enough tone in the veins and functional valves Major vessels must be free of any kind of major obstruction

Question 53

What happens in cellular death?

Answer 53

Cells deprived of oxygen switch to anaerobic metabolism in order to function this makes blood more acidic damaging blood vessel walls

Question 54

How does shock progress?

Answer 54

Cause - inadequate tissue perfusion - impaired cellular metabolism - SHOCK!