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59 Cards in this Set
- Front
- Back
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what are the two forms of shock?
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low blood flow ( cardiogentic & hypovolemic) and maldistribution of blood (septic, anaphalactic, and neurogenic)
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name the precipitating causes of cadiogenic shock.
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heart issues:
pumping heart forward problem filling during dyastole dysrthmias structural heart issue |
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name the precipitating causes of anaphylactic shock.
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any allergic reactions:
blood, bug bite, anesthetic, latex |
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name the precipitating causes of hypovolemic shock.
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external loss of whole blood
loss of body fluids (vomiting, diarrhea, excessive diuresis, diabetes insipidus/mellitus) |
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name the precipitating causes of neurogenic shock.
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MVA, or any injury and orr disease to the spinal cord at T5 or above
spinal anesthesia vasomotor depression (sever pain, drugs, hypoglycemia, injury) |
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name the precipitating factors of septic shock.
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infection (uti, respiratory tract, invasive procedure, indwelling lines and catheter
at risk patients: those receiving immunosuppressive agents and with chronic diseases gram negative bacteria, positive aswell |
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name the precipitating factors of relative hypovolemia.
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pooling of blood and fluids,fluid shift into 3rd space because of burns,internal bleeding, massive vasodilation (sepsis)
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which laboratory result is a better indicator of impaired kidney functions BUN of creatinine?
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creatinine
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explain the role of glucose in the progression of shock.
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initially you will see an INCREASE in glucose as teh body releases glycogen store in response to the SNS activiation.
As shock progresses glucose levels will decrease b/c glycogen store will be used up. |
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why would NA increase in a patient with shock?
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because of the decrease renal perfusion the body will try to increase BP by releasing aldasterone which will increase fluid retention by keeping NA.
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explain the role of K in shock.
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potassium will increase in the late stage of shock because cell death would release the intracellular potassium. early in shock the potassium level will decrease because of increase secretion of aldasterone
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which shock will cause bradycardia?
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neurogenic shock
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while giving an head to toe assessment what finding will be present in a patient with cardiogenic shock?
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head- confused, diaphoresis, agitated
heart- tachy, 3rd and 4th heart sounds, decrease capillary refill lungs- crackles skin- cool and clammy GI/renal - fluid retention decrease urine output, decrease bowel sounds hemodynamic changes - increase wedge pressure (PAWP) and PVR |
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while giving an head to toe assessment what findings will be expected in a pt with hypovolemic shock?
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head-confused, agitated
heart-decrease capillary refill, stroke volume, preload lungs- tacypnea (early)...bradypnea (late) renal - decrease urine output skin - cool and clammy GI- absent bowel sounds |
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while giving an head to toe assessment what findings will be expected in a pt with neurogenic shock?
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head - flaccid paralysis, loss of relex
heart - brady lungs - dysfunction related to injury renal - bladder dysfunction skin - warm, dry skin GI - bowel dysfunction |
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what are the two forms of shock?
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low blood flow ( cardiogentic & hypovolemic) and maldistribution of blood (septic, anaphalactic, and neurogenic)
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name the precipitating causes of cadiogenic shock.
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heart issues:
pumping heart forward problem filling during dyastole dysrthmias structural heart issue |
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name the precipitating causes of anaphylactic shock.
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any allergic reactions:
blood, bug bite, anesthetic, latex |
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name the precipitating causes of hypovolemic shock.
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external loss of whole blood
loss of body fluids (vomiting, diarrhea, excessive diuresis, diabetes insipidus/mellitus) |
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name the precipitating causes of neurogenic shock.
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MVA, or any injury and orr disease to the spinal cord at T5 or above
spinal anesthesia vasomotor depression (sever pain, drugs, hypoglycemia, injury) |
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while giving an head to toe assessment what findings will be expected in a pt with anaphylactic shock?
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head - anxiety, doom
heart - chest pain, third spacing of fluid lungs - SOB, edema oflarynx and epiglottis wheezing, strider, rhinitis skin - flushing, hives GI - metallic taste, cramping, NVD, abdominal pain |
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while giving an head to toe assessment what findings will be expected in a pt with septic shock?
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head - alteration in mental status
heart - decrease ejection fracture lungs - hyperventilation and alkalosis leads to hypo and acidosis, resp failure, decrease urine output, crackles skin - warm and flushed then goes to cool and mottled GI - bleeding labs - increase/decrease WBC decrease platletts, increase glucose, increase urine specific gravity |
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what is one of the first clinical signs of shock?
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decrease in BP, which occurs because of decrease on CO and narrowing pulse pressure.
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what clinical manifestations will you see in the patients lung during the compensatory phase?
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the blood from the lungs will be shunted to the heart and head. the decrease perfusion to the lungs causes ventilation-perfusion mismatch. arterial o2 will decrease and rate and depth of respiration will increase
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what is the hallmark sign of the progressive stage
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continued decrease cellular perfusion and resulting capillary permeability
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what subjective signs in the lungs will let you know that a patient is in the progressive stage of shock?
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The pt will be tachypnea, crackles, and overall increase work of breathing.
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what objective signs in the heart will let you know that a pt is in the progressive stage of shock?
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decrease in CO, BP, coronary artery, cerebral, and peripheral perfusion. dysrhythmias, myocardial ischemia, and potential MI.
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what is Disseminated intravascular Coagulation?
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DIC is there is a consumption of platelets and clotting factors with secondary fibrinolysis. will manifest in bleeding from many orifices. decrease platelet, increase pt and ptt time.
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what clinical manifestations will you see in a pt in the refractory stage of shock?
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the pt will have profound hypo-tension and hypoxemia. will have MOF and build up of bodily waste (urea, CO2, lactate, ammonia)
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what is an important finding during the compensatory stage?
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changes in mental status
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what us the first line of defense for a pt with shock?
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increase oxygen and ventilation, fluid resuscitation ( isotonic saline, ringers lactate, and colloids e.g. albumin)
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what is the role of Ringer's lactate in fluid resuscitation?
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important in fluid resuscitation. helps deal with acidosis caused by liver failure
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name 2 examples of vasopressors.
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epi, norepiepherine
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what is the indications to use vasopressors and the effect?
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they are used as a last resort and the patient must have adequate fluid resuscitation first. it mimics the SNS and causes sever peripheral vasoconstriction and increases SVR, which increases the workload of the heart. goal is to maintain MAP above 65.
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what is the indications to use vasodilators and the effect?
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its for pt who show excessive vasoconstriction even after fluid replacement and normal/high systemic BP.
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what are the different types of drugs you can give for a pt with cardiogenic shock?
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nitrates - increase blood supply by dilating coronary arteries
diuretics - decrease preload vasodilators - decrease after load by decreasing SVR B-adrenergic blockers - reduce HR and contractility |
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what is the drug of choice for anaphylactic shock?
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erpinephrine - it causes peripheral vasoconstriction and bronchodilation and opposes the effect of histamine.
benadryl - is used for excessive histamine. |
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what is the initial assessment as well as subsequent assessments for a nurse?
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initial is A, B, C (airway, breathing, circulation)
then vital signs, level of consciousnesses, peripheral pulse, capillary refill, skin, and urine output. |
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which pt is at risk for hypothermia?
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a pt with nuerogenic shock. extreme vasodilation makes the skin warm and promotes heat loss in addition to inability to regulate heat.
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define poikilothermia
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when pt takes on the temp of the environment. normally found in neurogenic shock.
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which shock is associated with a hyperdynamic state?
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increase CO and decrease SVR is linked to septic shock
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what is anasarca and what stage of shock does it appear in?
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it is when fluid leakage affects solid organs and peripheral tissue. also decrease blood flow to pulmonary capillaries
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what happens when the liver fails to metabolize drugs and waste?
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jaundice, elevated enzymes, loss of immune function, and risk of DIC.
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if a pt is not responding to 2 to 3L of fluids, what is the next intervention?
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blood administration and central venous monitoring.
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what are two complications of fluid resuscitation?
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hypothermia and coagulopathy
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when should enteral nutrition be initiated?
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within the first 24 hours
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what are the 6 important interventions for a pt with cardiogenic shock?
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1.restore blood flow by restoring the balance between 02 demand and supply
2.thombolytic therapy 3.surgery (stenting, vavle replacement, revascularization 4.hemodynamic monitoring 5.drug therapy. diuretics to reduce preload 6.circulatory assist device (intr-aortic balloon pump, ventricular assist device) |
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what is the important intervention for a pt with hypovolemic shock? what rule should they follow?
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Stopping the fluid loss and restoring circulating volume. follow 3:1 rule. 3 ml of isotonic crystalloid (NS) for every 1 ml of estimated blood loss.
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what are the 8 important intervention for a pt with septic shock?
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1. fluid replacement, part isotonic crystalloids (NS) and colloids.
2. vasopressor drug therapy 3. IV corticosteroids for pts who require vasopressor 4. antiobiotics 5. xigris (side fx is bleeding) 6. monitor glucose levels. keep below 150 mg/dl 7. h2 receptor blockers to prevent stress ulcers 8. deep vein thrombosis prophylaxis. |
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what are the 3 important interventions for a pt with neurogenic shock?
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1. treat hypo-tension and bradycardia with vasopressors and atropine
2. give fluids cautiously because hypo-tension not related to fluid loss 3. monitor hypothermia |
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what are the 4 important interventions for a pt with anaphylactic shock?
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1. epinephrine, diphenhydramine
2. maintain a patent airway -nebulizer -entubation 3. aggressive fluid replacement 4. IV corticosteroids if significant hypo-tension persist after 1 to 2 hours of aggressive therapy |
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which pts are at an increase risk for sepsis?
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1. elderly
2. those with debilitating illnesses 3. immunocompromised 4. surgical/accident or trauma pt |
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what is nociceptive pain?
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it reults from tissue damage. it is subdivided into somatic and visceral (gut). can be sharp, dull, aching, or radiate.
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what medications would you suggest for nociceptive pain?
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NSAID'S and Opiods.
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what is neuropathic pain?
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damage to or dysfunction to nerves in the peripheral of CNS. faulty signals are sent and the pt experiences pain.
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what medications would you suggest for nueropathic pain?
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tricyclic antidepressants, anticonvulsants, and sodium channel blockers
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what warning would you give a pt that wants to take aspirin for their pain?
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1. that it has a analgesic ceiling
2. can cause GI upset, bleeding, and platelet dysfunction |
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why would you suggest Tylenol over aspirin?
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1. it doesn't cause anitplatelet and anti inflammatory effects
but watch out cause its metabolized by the liver so more than 3/4 g a day can cause liver damage. |
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what common side effects are associated with opiod use?
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constipation, NV, sedation, respiratory depression, hallucinations, confusion, and urinary retention
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