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90 Cards in this Set
- Front
- Back
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anaphylactic shock
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Rapidly developing, systemic anaphylaxis that produces life-threatening acute airway obstruction followed by vascular collapse within minutes after exposure to an antigen.
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cardiogenic shock
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Failure of the heart to pump an adequate supply of blood and oxygen to body tissues
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crystalloids
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aqueous solutions of mineral salts or other water-soluble molecules
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hypovolemic shock
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Shock occurring when there is an insufficient amount of fluid in the circulatory system. Usually this is due to bleeding, diarrhea, or vomiting.
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colloids
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Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid
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circulatory shock
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Failure of the cardiovascular system to provide body tissues with enough blood for proper functioning
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neurogenic shock
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A form of distributive shock due to decreased peripheral vascular resistance.
Damage to either the brain or the spinal cord inhibits transmission of neural stimuli to the arteries and arterioles, which reduces vasomotor tone. The decreased peripheral resistance results in vasodilation and hypotension; cardiac output diminishes due to the altered distribution of blood volume. |
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septic shock
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Hypotension and inadequate blood flow to organs, as the result of sepsis (the presence of pathogens in the bloodstream). The most common organisms are gram-negative and gram-positive bacteria, but fungi and other organisms may also be responsible.
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SIRS
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A progressive state of systemic inflammation characterized by a white blood cell count greater than 12,000/mm3 or less than 4000/mm3, temperature greater than 38°C or less than 36°C, tachycardia, tachypnea, and decreased blood carbon dioxide levels. SIRS can begin with any serious illness or injury involving inflammation but is most often associated with systemic infection (sepsis) caused by gram-negative bacteria.
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shock is...
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life threatening response to alterations in circulation
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what 5 elements must be in place for adequate blood flow to occur?
C-POVV |
C ells healthy
P ump work O ragans healthy V asculature healthy V olume adequate |
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lack of C-POVV results in 2 impairments
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impaired:
1. tissue oxygenation 2. cellular metabolism |
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what 2 sets of receptors is our blood pressure controlled by?
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baro
chemo |
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what is the equation for cardiac output
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stroke volume x heart rate
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what is the stroke volume
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the amount of blood ejected during each contraction
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periphreal vascular resistance is related to what about the vessel?
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diameter of the vessel
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what is an optimum MAP?
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60+
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pulse pressure
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The difference between systolic and diastolic pressures.
The systolic pressure is normally about 40 points greater than the diastolic. A pulse pressure over 50 points or under 30 points is considered abnormal. |
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how do you determine the MAP?
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[systolic + 2(diastolic)] /3
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where are the baroreceptors located?
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carotid sinus and aortic arch
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how do the barorecptors work?
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bp drops
catecholamines released from adrenal ^heart rate + vasoconstrict bp^ |
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what are the three stages of shock
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compensatory
progressive irreversible (refractory) |
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3 ways to monitor tissue perfusion
Nurses Save Sons |
N ear-infrared spectroscopy
S ublingual capnometry S cv02 |
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which method of measuring tissue perfusion is most helpful in an acute situation
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Scv02
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sublingual capnometry does not measure 02.. it measures..
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c02
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NIRS monitoring is applied to the..
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palm and measures tissue perfussion
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bp normal
hr: 110 skin: cold urinary output: 20/hr mentation: confusion acid base: Ph 7.35, c02 18 what stage of shock? |
compensatory
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epinephrine's role is compesentory stage of shock
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baroreceptors cause release
^hr/contractility dilate: c arteries/bronchioles glycogen-->glucose sweating |
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norepinephrine role is compensatory shock
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baroreceptors cause release
vasoconstrict |
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endocrine compensatory stage of shock
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RAAS
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RAAS
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stimulate release
-angio 1/2 -aldosterone ^ h20/na+ retention ^ADH |
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chemicals in the compensatory stage of shock
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chemo-receptors control:
-^respirations (resp alk) pt becomes: restless, anxious, confused |
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pt:
bp: 80/50 hr: 176 resp: 28, shallow, crackles skin: mottled urine: 0.5ml/kg/hr mentation: lethargy acid base: ph 7.32 which stage of shock? |
progressive
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microciruclation dilation during progressive shock
4 parts |
cap leaks
sphincter relax metabolic acidosis impaired coronary perfusion |
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clinical manifestations of progressive shock
lungs heart circul neuro renal hepat gi |
L: crackles
<3: chest pain, ^ enzymes circ: ^BNP Neur: -lethargy - AMS renal: -map decrease renal fails -need foley -expect 30ml/hr |
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bp: requires heart machine to maintain perfussion
HR: erratic and asystole resp: intubated, mech ventilation + 100% non rebreather skin: jaudice urine: anuric, dialysis mentation: unconcious acid base: profound acidosis |
irreversible shock
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irreversible shock
1. blood in capillary beds 2. perfusion to organs 3. acid base |
1. blood pools
2. inadequate perfusion and organ failure 3. wildly acidodic |
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irreversible shock and the inflammatory process
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^cytokines
activate clotting mechanism leads to DIC |
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clinical indicators of irreversible shock
1. bp 2. hemodynamic |
1. bp may be misleading
2. hemodynamic measure are more useful |
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hemodynamic studies used during shock
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pulse pressure
map |
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compensatory shock involves which part of nervous system?
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sympathetic
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patients at risk for shock
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trauma
burns dehydrated surgical diuretic heart hx |
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medical management of compensatory shock (stage 1)
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identify/correct
improve perfusion fluid resusc med ^bp |
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nursing management of shock
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monitor
-LOC -v/s -urinary output -skin -cbc, electrolyte, abg promote safety reduce anxiety continuous pulse ox |
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medical management goals of progressive shock (stage 2)
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support resp
restore intravascular fluid improve cardiac contract improve vascular competence |
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complete
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yay
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cardiogenic shock
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cardiogenic shock
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obstructive shock
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circulatory shock define
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loss of peripheral resistance and vasodilation
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causes of circulatory shock
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septic
neurogenic anaphylactic |
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septic circulatory shock
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hypercoaguable state and infection
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neurogenic circulatory shock
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loss of sympathetic tone
imbalance between sympathetic/parasympathetic tone prolonged parasympathetic stimulation |
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anaphylacic shock circulatory shock
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antigen antibody reaction results in release in the release of vasoactive substancs causig vasodilation
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caues of septic shock
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infection
SIRS |
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risk factors for shock
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immunosupression
extremes of age malnourished chronic ilness invasive procedure |
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neurogenic shock: causes
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injury/disease upper spinal cord
spinal anestesia nervous system damage ganglionic/adrenergic blocking glucose deficiency |
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medication that cuase anaphylactic shock
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antibiotics
analgesics vaccine hormones |
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contrast media that causes anaphylactic shock
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iodine based radiological dye
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blood transfusions and anaphylactic shcok
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sensitivity to antigens in door blood
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high alert foods for anaphylactic shock
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milk
eggs shellfish peanuts seafood |
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bites and stings associated with anaphylactic shock
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venous snakes
wasps bees hornets |
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MODS
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multiple organ dysfunction syndrome
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MODS define
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results of direct tissue insult, complication of septic shcok or sirs
organ dysfunction |
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MODS goals
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prevention
control initiating event promote adequate organ perfusion provide nutrtional support |
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MODS medical management
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restrain activators
control mediators protect affected organs |
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MODS nursing management
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safety
fluid management meds support fam prevent complications |
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clinical eval of shock
what will you find? |
hypotension
tachycardia tachypnea cyanosis oliguria encephalopathy map<65-70 |
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lab tests for shock
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all of the standards +j
blood cultures INR/PTT ABG serum lactate cardiac enzymes EKG |
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imaging for shock
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CXR
CT scan echo ultrasound doppler (hypercoag) peritoneal lavage gastric tonometry |
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things to monitor in shock
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atrial pressure
CVP pulmonary artery cath pulse ox capnography ECG |
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desirable outcomes for shock patients
MENTATION |
alert/responsive
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desirable outcomes for shock patients
VS |
bp -/+ 20 mmHg compared to preshock
hr 6-100 resp 10-20 MAP>65 |
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desireable outcomes for shock patient
physical manifestations |
warm dry skin color with good turgor
capillary refill 2 seconds or better nondistended neck veins pink moist mucus membranes |
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desireable outcomes for shock patients
labs |
CVP at least 8
HgB >10 |
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desireable outcomes for shock patients
urine output |
0.5ml/kg/hr
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interventions for shock patients
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fluid resusc
blood products mechanical vent pharm tx -inotrope -vasopressor mechanical support |
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mechanical support for shock patients
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intra aortic balloon pump
ventricular assist device |
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inotrope used in shock patients
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dobutamine
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what position is this?
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modified trendelenburg
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medical management goals for patients in shcok
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restore/maintain adequate perfusion
vasoactive medications provide nutritional support |
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what fluid to use when replacing fluid volume in shock patients
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crystalloid/balanced salt solutions
colloid solutions blood albumin expanders hypertonic saline (sparingly) |
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vasoactive medications to use in treatment of shock patients
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vasoconstictors and dialtors
titrate them to maintain MAP and then wean off other meds to increase contractility |
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IV therapy for patients in shock
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0.9% NS
lactated ringers colloids |
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example of colloid sollutions
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albumin
dextran hetastarch |
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when picking a catheter for a shock patient, would you choose a 20 gage or 18 gage?
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20. it is larger.
start two IV's if possible |
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possible comlications related to medical interventions in patients with shock
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renal impairment
GI bleed stress response=^glucocorticoids |
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pharmacologic management
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antibiotics
monoclonal technology drotrecogin alpha (xigris) heparin steroids nalaxone epi diphenhydramine narcotics cardiotonic meds calciu |
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key factors in monitoring
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vitals (hyperthermia)
LOC urine output pulmoary status aseptic technique in all procedures |
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monitoring tissue perfusion
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narrowing or descreased pulse pressure is a better earlier indicator of shock that a decreases in SBP
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