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90 Cards in this Set

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anaphylactic shock
Rapidly developing, systemic anaphylaxis that produces life-threatening acute airway obstruction followed by vascular collapse within minutes after exposure to an antigen.
cardiogenic shock
Failure of the heart to pump an adequate supply of blood and oxygen to body tissues
crystalloids
aqueous solutions of mineral salts or other water-soluble molecules
hypovolemic shock
Shock occurring when there is an insufficient amount of fluid in the circulatory system. Usually this is due to bleeding, diarrhea, or vomiting.
colloids
Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid
circulatory shock
Failure of the cardiovascular system to provide body tissues with enough blood for proper functioning
neurogenic shock
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.
septic shock
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.
SIRS
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.
shock is...
life threatening response to alterations in circulation
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
lack of C-POVV results in 2 impairments
impaired:

1. tissue oxygenation
2. cellular metabolism
what 2 sets of receptors is our blood pressure controlled by?
baro
chemo
what is the equation for cardiac output
stroke volume x heart rate
what is the stroke volume
the amount of blood ejected during each contraction
periphreal vascular resistance is related to what about the vessel?
diameter of the vessel
what is an optimum MAP?
60+
pulse pressure
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.
how do you determine the MAP?
[systolic + 2(diastolic)] /3
where are the baroreceptors located?
carotid sinus and aortic arch
how do the barorecptors work?
bp drops
catecholamines released from adrenal
^heart rate + vasoconstrict
bp^
what are the three stages of shock
compensatory
progressive
irreversible (refractory)
3 ways to monitor tissue perfusion

Nurses
Save
Sons
N ear-infrared spectroscopy
S ublingual capnometry
S cv02
which method of measuring tissue perfusion is most helpful in an acute situation
Scv02
sublingual capnometry does not measure 02.. it measures..
c02
NIRS monitoring is applied to the..
palm and measures tissue perfussion
bp normal
hr: 110
skin: cold
urinary output: 20/hr
mentation: confusion
acid base: Ph 7.35, c02 18

what stage of shock?
compensatory
epinephrine's role is compesentory stage of shock
baroreceptors cause release
^hr/contractility
dilate: c arteries/bronchioles
glycogen-->glucose
sweating
norepinephrine role is compensatory shock
baroreceptors cause release
vasoconstrict
endocrine compensatory stage of shock
RAAS
RAAS
stimulate release
-angio 1/2
-aldosterone

^ h20/na+ retention
^ADH
chemicals in the compensatory stage of shock
chemo-receptors control:
-^respirations (resp alk)

pt becomes: restless, anxious, confused
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
microciruclation dilation during progressive shock

4 parts
cap leaks
sphincter relax
metabolic acidosis
impaired coronary perfusion
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
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
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
irreversible shock and the inflammatory process
^cytokines
activate clotting mechanism
leads to DIC
clinical indicators of irreversible shock

1. bp
2. hemodynamic
1. bp may be misleading
2. hemodynamic measure are more useful
hemodynamic studies used during shock
pulse pressure
map
compensatory shock involves which part of nervous system?
sympathetic
patients at risk for shock
trauma
burns
dehydrated
surgical
diuretic
heart hx
medical management of compensatory shock (stage 1)
identify/correct
improve perfusion
fluid resusc
med ^bp
nursing management of shock
monitor
-LOC
-v/s
-urinary output
-skin
-cbc, electrolyte, abg

promote safety
reduce anxiety
continuous pulse ox
medical management goals of progressive shock (stage 2)
support resp
restore intravascular fluid
improve cardiac contract
improve vascular competence
complete
yay
cardiogenic shock
cardiogenic shock
obstructive shock
circulatory shock define
loss of peripheral resistance and vasodilation
causes of circulatory shock
septic
neurogenic
anaphylactic
septic circulatory shock
hypercoaguable state and infection
neurogenic circulatory shock
loss of sympathetic tone
imbalance between sympathetic/parasympathetic tone
prolonged parasympathetic stimulation
anaphylacic shock circulatory shock
antigen antibody reaction results in release in the release of vasoactive substancs causig vasodilation
caues of septic shock
infection
SIRS
risk factors for shock
immunosupression
extremes of age
malnourished
chronic ilness
invasive procedure
neurogenic shock: causes
injury/disease upper spinal cord
spinal anestesia
nervous system damage
ganglionic/adrenergic blocking
glucose deficiency
medication that cuase anaphylactic shock
antibiotics
analgesics
vaccine
hormones
contrast media that causes anaphylactic shock
iodine based radiological dye
blood transfusions and anaphylactic shcok
sensitivity to antigens in door blood
high alert foods for anaphylactic shock
milk
eggs
shellfish
peanuts
seafood
bites and stings associated with anaphylactic shock
venous snakes
wasps
bees
hornets
MODS
multiple organ dysfunction syndrome
MODS define
results of direct tissue insult, complication of septic shcok or sirs

organ dysfunction
MODS goals
prevention
control initiating event
promote adequate organ perfusion
provide nutrtional support
MODS medical management
restrain activators
control mediators
protect affected organs
MODS nursing management
safety
fluid management
meds
support fam
prevent complications
clinical eval of shock

what will you find?
hypotension
tachycardia
tachypnea
cyanosis
oliguria
encephalopathy
map<65-70
lab tests for shock
all of the standards +j

blood cultures
INR/PTT
ABG
serum lactate
cardiac enzymes
EKG
imaging for shock
CXR
CT scan
echo
ultrasound
doppler (hypercoag)
peritoneal lavage
gastric tonometry
things to monitor in shock
atrial pressure
CVP
pulmonary artery cath
pulse ox
capnography
ECG
desirable outcomes for shock patients

MENTATION
alert/responsive
desirable outcomes for shock patients

VS
bp -/+ 20 mmHg compared to preshock

hr 6-100

resp 10-20

MAP>65
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
desireable outcomes for shock patients

labs
CVP at least 8
HgB >10
desireable outcomes for shock patients

urine output
0.5ml/kg/hr
interventions for shock patients
fluid resusc
blood products
mechanical vent
pharm tx
-inotrope
-vasopressor
mechanical support
mechanical support for shock patients
intra aortic balloon pump
ventricular assist device
inotrope used in shock patients
dobutamine
what position is this?
modified trendelenburg
medical management goals for patients in shcok
restore/maintain adequate perfusion
vasoactive medications
provide nutritional support
what fluid to use when replacing fluid volume in shock patients
crystalloid/balanced salt solutions
colloid solutions
blood
albumin
expanders
hypertonic saline (sparingly)
vasoactive medications to use in treatment of shock patients
vasoconstictors and dialtors

titrate them to maintain MAP and then wean off

other meds to increase contractility
IV therapy for patients in shock
0.9% NS
lactated ringers
colloids
example of colloid sollutions
albumin
dextran
hetastarch
when picking a catheter for a shock patient, would you choose a 20 gage or 18 gage?
20. it is larger.

start two IV's if possible
possible comlications related to medical interventions in patients with shock
renal impairment
GI bleed
stress response=^glucocorticoids
pharmacologic management
antibiotics
monoclonal technology
drotrecogin alpha (xigris)
heparin
steroids
nalaxone
epi
diphenhydramine
narcotics
cardiotonic meds
calciu
key factors in monitoring
vitals (hyperthermia)
LOC
urine output
pulmoary status
aseptic technique in all procedures
monitoring tissue perfusion
narrowing or descreased pulse pressure is a better earlier indicator of shock that a decreases in SBP