Nu 236 Exam 1 (Shock)

Front 1

DURING RESPIRATORY ALKALOSIS, PH WILL BE__ AND PCO2 WILL BE __?

Back 1

PH WILL BE HIGH
PCO2 WILL BE LOW

Front 2

SEPTIC SHOCK

Back 2

FORM OF DISTRIBUTIVE SHOCK
-COMPLICATION OF ANOTHER ILLNESS/INJURY
-USUALLY DUE TO INFECTION
-HIGH MORTALITY RATE !
-OFTEN DUE TO NOSOCOMIAL INFEC IMMUNOSUPP CLT

Front 3

WHAT ARE THE 3 TYPES OF SHOCK

Back 3

1.REDUCED INTRAVASCULAR VOLUME
2.IMPAIRED HEART PUMPING
3.WIDESPREAD ARTERIOLAR & VENOUS DILATION

Front 4

WHEN ACID IS IN CELLS,RESPIRATORY SYS __ AND __

Back 4

COMPENSATES AND BLOWS OFF CO2

Front 5

FOR SEPSIS,NURSE NEEDS TO MAINTAIN__FOR PT,GIVE__,PUT PT ON__,AND GIVE__ SUPPORT

Back 5

1.FLUID& ELECTROLYTES (SUPPORT CARDIAC OUTPUT,CORRECT ACIDOSIS0
2.CORTICOSTEROIDS/GLUCOCORTICOIDS OFTEN GIVEN
3.PUT PT ON VENTILATOR
4.NUTRITION-GIVE ENTERAL FEED,**PT MUST HAVE GOOD GI TRACT BEFORE GIVING

Front 6

IF 4 BODY SYSTEMS AFFECTED =

Back 6

MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)-100% MORTALITY
-OFTEN FROM NORMAL FLORA

Front 7

GOALS OF NURSE FOR PT W/ SEPTIC SHOCK:

Back 7

1.MAINTAIN ADEQUATE TISSUE PERFUSION & OXYGENATION
2.IDENTIFY & ELIMNATE CAUSE OF INFECTION
3.CULTURE ALL ASAP

Front 8

THE STAGES OF SHOCK ARE_?

Back 8

ON A CONTINUUM..YOU MUST GO FROM STAGE 1-TO STAGE 2-TO STAGE 3

Front 9

WHAT ARE THE 2 BLOOD VALUES TO BE LOOKED AT DURING SHOCK?

Back 9

1.SODIUM
2.GLUCOSE

Front 10

SYNDROME

Back 10

A COLLECTION OF SYMPTOMS

Front 11

LATE SHOCK/IRREVERSIBLE (LATE REFRACTORY)

Back 11

LEADS TO ORGAN FAILURE/DEATH
BP-WILL BE <70 OR NON PALPABLE
HEART-WILL FAIL
OVERWHELMING METABOLIC ACIDOSIS
-KIDNEY & LIVER FAIL
ALTERED BLEEDING-LEADS TO DIC
-BRAIN CEASES TO FCN (MULTIPLE SYS FAIL)

Front 12

PROGRESSIVE STAGE (MIDDLE STAGE)

Back 12

1.BODY UNABLE TO MAINTAIN COMPENSATION
2.BP DECREASES (CELLS HAVE BEEN DAMAGED
3.LACTIC ACID-METABOLIC ACIDOSIS.PH WILL BE LOW,BICARBONATE WILL BE LOW
4.3RD SPACE SHIFTING-EDEMA

Front 13

AS NURSE:WHAT IS ASSESSED FOR COMPENSATORY STAGE OF SHOCK?

Back 13

VS-GOOSEBUMPS,THIRST,BP (WNL)
LOC-INCREASED ALERTNESS,ANXIOUS,COMBATIVE,CONFUSED
U/O-WILL DECREASE
SKIN-WILL BE PALE,COOL
SODIUM-WILL INCREASE
GLUCOSE WILL INCREASE

Front 14

WHAT ARE THE 3 STAGES OF SHOCK?

Back 14

1.EARLY-COMPENSATORY STAGE
2.MIDDLE-PROGRESSIVE STAGE
3.LATE-IRREVERSIBLE STAGE OR REFRACTORY (DOESNT GET BETTER)..LEADS TO MUTIPLE ORGAN FAILURE

Front 15

WHAT SYSTEMS ARE 1ST AFFECTED BY SHOCK ?

Back 15

1.BRAIN
2.HEART
3.KIDNEY (30CC/L)
4.LIVER
5.SKIN-EARLY SIGN (PALE,WEAK CLAMY)LATE SIGN(CYANOSIS)

Front 16

S/S OF HYPERDYNAMIC SHOCK

Back 16

1.INCREASED CARIAC OUTPUT
2.BOUNDING PULSE
3.SKIN FLUSHED,WARM,DRY

Front 17

SHOCK

Back 17

ABNORMAL PHYSIOLOGICAL STATE IN WHICH THERE IS INSUFFICIENT BLD VOLUME RESULTING IN CIRCULATORY FAILURE & HAVE ANOXIA

Front 18

WHAT ARE THE 2 TYPES OF SEPTIC SHOCK?

Back 18

1.HYPERDYNAMIC "WARM"
2.HYPODYNAMIC "COLD"

Front 19

WHAT DO ALL TYPES OF DISTRIBUTIVE SHOCK CAUSE?

Back 19

A DECREASE IN VENOUSE RETURN:
-DECREASED BLD TO HEART
-DECREASED CARDIAC OUTPUT
-DECREASED TISSUE PERFUSION
-DECREASED STROKE VOLUMER

Front 20

WHAT ARE THE 3 TYPES OF DISTRIBUTIVE SHOCK ?

Back 20

1.NEUROGENIC-LOSS OF SYMPATHETIC T
ONE.OCCURS W/ SPINAL INJURY & SPINAL ANESTHETIC.
2.ANAPHYLAXIS-ALLERGIC SHOCK.AS NURSE:GIVE EPINEPHRINE..REMOVE ANTIGEN-GIVE ANTIHISTIMINE
3.SEPTIC SHOCK-RESULTS FROM OVERWHELMING INFECTION

Front 21

AS NURSE:WHAT IS ASSESSED/SUSPECTED FOR LATE SHOCK?

Back 21

1.PT TAKEN TO ICU & UNDERGOES HEMODYNAMIC MONITORING
-GOAL:MONTITOR TISSUE PERFUSION,RESTORE FLUID & ELECTROLYTES
-USE VASOMOTER MEDS,IMPROVE CARDIAC FCN,GIVEN IV
-NUTRITION SUPPORT-INC ENERGY
-PAIN RELIEF:GIVE PAIN MEDS & MONITOR SAFETY IF LOC DEC
-H2 BLOCKERS
-GIVE DRUGS THAT INHIBIT GASTRIC ACID & PREVENT TEMP EXTREMES

Front 22

SEPSIS

Back 22

BACTERIA CONTAMINATION

Front 23

AS NURSE,ASSESS: FOR HYPERDYNAMIC SHOCK

Back 23

VS-HR INCREASES,BOUNDING PULSE
SKIN-FLUSHED,WARM
LOC-AGITATED,RESTLESS
RESPIRATIONS-RAPID
**U/O-LOW (FIRST OVERT SIGN)*

Front 24

SYSTEMIC

Back 24

AN IMBALANCE BET OXYGEN SUPPLY & DEMAND

Front 25

S/S OF SHOCK CAN BE _ OR _?

Back 25

GRADUAL OR RAPID

Front 26

DURING THE PROGRESSIVE STAGE,A BP<90 =

Back 26

NARROW PULSE PRESSURE

Front 27

SHOCK RESULTS WHEN...?

Back 27

TOO LITTLE OXYGEN REACHES THE CELL

Front 28

S/S OF HYPODYNAMIC SHOCK

Back 28

1.DECREASED BP AND CO
2.SKIN-COOL,CLAMY,PALE
3.TEMP-CAN BE NORMAL OR LOW
4.HR-WILL BE ELEVATED BUT THREADY
5.RESPIRATIONS-ELEVATED
6.U/O-ABSENT
7.MULTIPLE ORGAN FAILURE

Front 29

NURSING DIAGNOSES FOR SEPTIC SHOCK:

Back 29

1.ALTERED TISSUE PERFUSION & OXYGENATION
2.DECREASED CARDIAC OUTPUT
3.ANXIETY

Front 30

AS NURSE: WHAT IS DONE FOR SHOCK?

Back 30

CHECK:
1.VS-CHECK PERIPHERAL PULSE
2.BP-NOT GOOD INDICATER CUZ DOESNT DECREASE UNTIL LATER IN SHOCK
3.PULSE INCREASE-LOOK FOR SUBTLE SIGNS
4.LOC-JUST ASK PT QUESTIONS
5.URINE OUTPUT
5.SKIN

Front 31

AS NURSE:WHATS TO BE DONE FOR REDUCED INTRAVASCULAR VOLUME?

Back 31

1.RESTORE FLUID AND CORRECT VOLUME
2.POSITION OF PT.-FEET ELEVATED AT 20 DEGREES

Front 32

WHAT HAPPENS TO SODIUM DURING SHOCK?

Back 32

DURING SHOCK, YOU BEGIN TO RETAIN WATER
-SODIUM LEVELS INCREASE DUE TO RELEASE OF ALDOSTERONE

Front 33

FOR SEPSIS,WHEN SHOULD ANTIBIOTIC BEGIN?

Back 33

W/IN 1 HR-GIVE BROAD SPECTRUM ANTIBIOTIC:CEPHALOSPORIN/AMINOGLYCOSIDE

Front 34

WHAT IS ASSOCIATED W/ REDUCED INTRAVASCULAR VOLUME?

Back 34

1.HYPOVOLEMIC SHOCK
2.EXTERNAL BLEEDING
3.3RD SPACE FLUID SHIFT

Front 35

PREVENTION:AS NURSE..WHAT IS TO BE DONE FOR SEPSIS?

Back 35

1.ASSESS VS,LISTEN TO LUNGS,SODIUM,GLUCOSE
2.ASEPTIC TECHNIQUE-HANDWASH
3.ENSURE PT HAS GOOD NUTRITION
4.MONITOR FOR LOCAL & SYSTEMIC SIGNS OF INFECTION
5.GIVE ANTIBIOTICS-CULTURE 1ST
6.QUESTION DELIRIUM/CONFUSION
INSOMNIA-ESP IN ELDERY

Front 36

POOR TISSUE PERFUSION CAUSES:

Back 36

1.LACK OF OXYGEN
2.GLUCOSE (ENERY=ATP)CANT POWER CELL
3.WASTES=ACIDS
4.ACIDS---ENZYME RELEASE,DESTROYS CELL MEMBRANE,DIGEST CELL CONTENTS
5.IRREVERSIBLE CELL CHANGES

Front 37

DURING SHOCK,CELLS DECREASE BEFORE__?

Back 37

S/S ARE NOTICED...AT THIS POINT,REVERSIBLE

Front 38

WHAT HAPPENS DURING SHOCK ?

Back 38

1.DECREASED BLD FLOW= LOW O2,LOW ELECTROLYTES,LOW NUTRIENTS
2.WASTES BUILD UP
3.CELLS DYSFUNCTION
4.IF THE CELL DIES,THE TISSUE DIES

Front 39

WHATS ASSOCIATED W/ IMPAIRED HEART PUMPING?

Back 39

1.CARDIOGENIC SHOCK
2.HEART ATTACK

Front 40

WHATS ASSOCIATED WITH WIDESPREAD ARTERIOLAR & VENOUS DILATION ?

Back 40

1.DISTRIBUTIVE SHOCK A.K.A. VASOGENIC SHOCK

Front 41

WHAT HAPPENS TO GLUCOSE DURING SHOCK?

Back 41

IT INCREASES DUE TO EPINEPHRINE AND GLYCOCORTICOID RELEASE "STRESS RESPONSE"

Front 42

COMPLICATIONS OF SEPIS:

Back 42

1.DIC-DISSEMINATED INTRAVASCULAR COAGULATION (NEW DRUG XIGRIS (DROTRECOGIN ALFA)
2.ARDS-ACUTE RESP DISTRESS SYN
3.MODS-MULTIPLE SYS ORGAN DYSFCN SYNDROME
...LONG TERM RECOVERY

Front 43

EARLY INDICATORS OF SEPSIS ARE:

Back 43

FEVER,CHILLS,HYPOTENSION

Front 44

PULSE PRESSURE

Back 44

THE DIFFERENCE BET SYSTOLIC AND DIASTOLIC

Front 45

WHAT OCCURS DURING THE COMPENSATORY (EARLY/INITIAL-NON PROGRESSIVE)STAGE?

Back 45

1.BODY TRIES TO COMPENSATE TO RETURN TO HOMEOSTASIS
2.CNS (NERVOUS SYS)FIGHT OR FLIGHT & ENDOCRINE SYS
S/S:INCREASED HR,NA,WATER,ADH (SAVES FLUID),BP,PUPILS DILATE,LOW U/O

Front 46

STRESS EPINEPHRINE & GLUCOCORTICOIDS __ GLUCOSE?

Back 46

INCREASE

Front 47

S/S OF PROGRESSIVE STAGE:

Back 47

HR INCREASES,MUSCLES BECOME WEAK,THREADY PULSE,DYSRYTHMIAS,HEART FAILS,PUPILS SLUGGISH
-RESPIRATIONS INCREASE
-PT GOES INTO PULMONARY EDEMA
-ARDS (ACUTE RESP DISTRESS SYN
-U/O DECREASES (DECREASED PERFUSION & HORMONES)
-LOC-DECREASED (LETHARGIC,DISORIENTED)
-LIVER(TOXINS BUILD UP)
-GI SYS (BLEEDING & STRESS ULCERS DEVELOP)
-BLEEDING ABNORMALITIES-LEAD TO DIC (DISSEMINATED INTRAVASCULAR COAGULATION)