NURS216 > Shock II > Flashcards

Shock II Flashcards

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1
Q

define circulatory shock

A

hypoperfusion of organs and tissues leading to insufficient supply of nutrients and oxygen to meet demands

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2
Q

what are the outcomes of circulatory shock if left untreated?

A
  • Ischemia
  • Anaerobic metabolism
  • Tissue necrosis
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3
Q

name some examples of circulatory shock

A
  • Distributive shocks
  • Hypovolemic
  • Cardiogenic
  • Obstructive
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4
Q

define histamine

A

Main mediator of allergic inflammation, binding to H1 receptors on endothelial cells and smooth muscle cells

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5
Q

what are the primary consequences of histamine release?

A
  • increased vascular permeability
  • risk of clotting
  • bronchoconstriction
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6
Q

name some common allergens

A
  • drugs
  • foods
  • venom
  • latex
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7
Q

what occurs during 1st exposure to an allergen?

A

specific IgE synthesis in response to allergen

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8
Q

what occurs during 2nd (+ onward) exposures to allergens?

A

IgE modulated immune response occurs within 15 minutes of exposure, triggering histamine release

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9
Q

what are the s&s of an allergic reaction?

A
  • Pruritis
  • Urticaria (itchy, hive-like rash)
  • Watery eyes (lacrimation)
  • Runny nose
  • Swelling + loss of function
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10
Q

T or F: mild or localized allergens typically compromise ABCs

A

FALSE

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11
Q

what is the first line tx for allergic reactions?

A

H1 receptor antagonists (antihistamines)

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12
Q

define anaphylaxis

A

life-threatening state caused by systemic response to allergen

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13
Q

what are the primary consequenses of anaphylaxis?

A

vasodilation and bronchoconstriction -> compromised ABCs

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14
Q

what are the s&s of anaphylaxis?

A

2 system involvement between skin or mucosal, CVS, respiratory and GI systems

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15
Q

what is the first line treatment for anaphylaxis?

A

epinephrine IM in the thigh

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16
Q

what is the dosage of epi used to rescue anaphylaxis?

A

0.01mg/kg

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17
Q

what are some second line tx we can use to rescue anaphylaxis?

A
  • antihistamine
  • glucocorticoids
  • stop the cause
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18
Q

what drugs do we discharge a pt with once the anaphylaxis resolves?

A
  • Prednisone, PO (x3 days)
  • EpiPen x2
  • Antihistamines, 2nd gen
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19
Q

define anaphylactic shock

A

life-threatening condition in response to an allergen characterized by hypoperfusion and fluid shift out of circulation→ circulatory collapse

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20
Q

what is the tx for anaphylactic shock?

A
  • Support ABCs
  • Epinephrine IV
  • Fluid resuscitation with NS boluses
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21
Q

define hypovolemic shock

A

a significant decrease in blood or plasma volume leads to inadequate filling of the vascular compartment and decreased cardiac output (CO)

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22
Q

what are the possible causes of hypovolemic shock?

A
  • blood loss
  • low extracellular fluid
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23
Q

what can cause blood loss that leads to hypovolemic shock?

A
  • Trauma
  • Surgery
  • Burns
  • Internal blood loss
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24
Q

what can cause low extracellular fluid that leads to hypovolemic shock?

A
  • Low intake
  • Vomiting
  • Diarrhea
  • Ascites
  • Excessive diuretic use
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25
what compensatory mechanisms are triggered upon initial fluid loss leading to hypovolemic shock?
* Heart increases heart rate and contractility * Hypothalamus stimulates ADH release + RAAS system stimulates release of aldosterone = sodium and water retention
26
what are the effects of low blood volume on CO and MAP?
* Low blood volume → decreased preload → decreased SV and increased HR → decreased CO * Decreased CO → decreased MAP and increased SVR
27
what are the initial s&s of hypovolemic shock? | presentation while compensation occurs
* Normal BP * Increased HR * Vasoconstriction (especially to end organs) * Pale, cool, clammy * Oliguria * Thirst
28
what are the progressive s&s of hypovolemic shock? | presentation during decompensation
* Hypotension (SBP <90 mmHg) * Thready pulse * Decreased RR * Irritability, restlessness, altered LOC * Signs of cellular dysfunction (lectrolyte imbalances, hyperglycemia)
29
what are important labs to assess if suspecting hypovolemic shock?
* Lactate value * CBC * ABG
30
how do we treat hypovolemic shock?
- treat cause - replace fluid loss with IV fluids - support BP with pressors
31
what is the like-for-like rule?
when replacing fluid loss, replace with similar fluid (i.e. blood loss is replaced with blood products)
32
what crystalloid fluids can we use to treat fluid loss in hypovolemic shock?
NS, LR
33
what is a risk to administering crystalloids during hypovolemic shock?
clotting difficulties with high volumes
34
what colloid fluids can we use to treat fluid loss in hypovolemic shock?
* Albumin 5%/25% * Dextran * Heptastarch
35
what is a risk to using colloids when treating hypovolemic shock?
allergic reactions
36
what blood products can we use to treat fluid loss in hypovolemic shock?
* PRBCs * Whole blood * FFP
37
what is a risk to using blood products when treating hypovolemic shock?
allergic reactions
38
what are the primary complications of hypovolemic shock?
* Metabolic acidosis * Renal failure * GI ischemia * DIC * Lung injury (ARDS) * Multiple organ dysfunction (MODS)
39
what drug to we use to treat acid/base imbalance in renal failure d/t hypovolemic shock?
sodium bicarb
40
what drug to we use to treat hypernatremia in renal failure d/t hypovolemic shock?
excrete sodium with diuretics
41
what drug to we use to treat hyponatremia in renal failure d/t hypovolemic shock?
saline
42
what drug to we use to treat hyperkalemia in renal failure d/t hypovolemic shock?
Kayexalate
43
what drug to we use to treat hypokalemia in renal failure d/t hypovolemic shock?
KCl
44
what drug to we use to treat hypocalcemia in renal failure d/t hypovolemic shock?
administer Calcium Gluconate
45
how do we treat water retention in renal failure d/t hypovolemic shock?
IV fluids and diuretics
46
what effect does renal failure have on RBC production?
decreased EPO production → low RBCs → hypoxemia
47
what effect does renal failure have on the skeletal system?
- decreased activation of vitamin D, which maintains calcium balance - decreased stimulation of GI and renal absorption of calcium
48
what are risk factors for ARDS?
* Metabolic acidosis * DIC * Lung disease (e.g. asthma)
49
what is ARDS?
**injury to the lungs** characterized by pulmonary hypoperfusion, triggering inflammation that leads to dysfunction of surfactant and thickening of the alveolar membranes, **ultimately causing low gas exchange**
50
define cardiogenic shock
ineffective cardiac function to meet body demands e.g.: low CO | Adequate total blood volume, but ineffective myocardium
51
what conditions/events can cause cardiogenic shock?
* Myocardial infarction (e.g. STEMI) * Arrhythmias * Cardiac insufficiency (valves, anatomy, surgical injury) * Cardiac depression due to other shocks * Any event which causes heart failure
52
state Starling's Law
the greater the heart muscle is stretched during filling, the greater the force of contraction and the greater the quantity of blood pumped into the aorta
53
define preload
the degree of stretch in ventricles during diastole
54
define afterload
the pressure that the heart must pump against; the tension needed in the ventricle to open the semilunar valves and push blood out
55
what are the s&s of cardiogenic shock?
* Hypotension (compared to pt baseline) * SOB or rapid breathing * Fast or weak pulse * **Cold**, clammy, mottled extremities * Differentiates from septic shock * Decreased LOC
56
how do we treat cardiogenic shock?
- reduce volume - vasodilate - assist ventilation - improve contractility
57
what drugs can we use to vasodilate during cardiogenic shock?
* Direct acting vasodilators (e.g. nitroprusside) * Nitroglycerine (high affinity for coronary circulation) * Synergy: ACE inhibitors, Adrenergic antagonists, Calcium channel antagonists
58
what drugs can we use to improve contractility during cardiogenic shock?
* Phosphodiasterase inhibitors (e.g. Milrinone) * Catecholamines (high beta 1 affinity, e.g. Dobutamine)
59
what is the mechanism in which an intra-aortic balloon pump treats cardiogenic shock?
* Decrease myocardial oxygen demand by decreasing afterload * Improve coronary blood flow
60
define obstrutive shock
Caused by a mechanical obstruction to blood flow through central circulation
61
what are the probable causes (etiology) of obstructive shock?
* Large embolism (e.g. PE) * Cardiac tamponade
62
how do we treat cardiac tamponade?
pericardiocentesis
63
how do we treat PE?
- anticoagulant - thrombolytic - aspirate obstruction
64
define aspiration thrombectomy
invasive catheterization via femoral venous access (inferior vena cava to pulmonary circulation) for aspiration of life threatening PE
65
what inflammatory mediators are released upon mast cell degranulation?
- histamine - bradykinin - cytokines - PAF - NO - leukotrienes - activation of complement system
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