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54 Cards in this Set
- Front
- Back
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What causes shock?
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inadequate perfusion; or imbalance between oxygen supply and demand
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What is shunting?
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moving oxygenated blood into selected areas while bypassing others
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When is the initial stage of shock present?
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when client's MAP is decreased by less than 10mmHg
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What are the characteristics of Stage 1 or compensatory shock?
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MAP decrease 10-15mmHg, RAAS increases; patient looks right but vitals are unstable
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What labs might indicate shock?
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signs of metabolic acidosis, decreased bicarbonate, increased potassium and lactic acid
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What occurs during Stage 2?
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MAP is decreased 20mmHg, O2 not sufficient, hypoxia, hyperkalemia, lactic acid accumulation, hypotensive
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How is hypotension corrected?
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fluid resuscitation and or vasopressors
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What are the characteristics of Stage 3?
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mega cell death, shock is irreversible due to prolonged damage
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What are the cardiac manifestations of shock?
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myocardial cells become hypoxic, HR increases, nonpalpable pulses, dysrhymthmias due to potassium
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What are the respiratory manifestations of shock?
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increased RR, CO2 increases causing respiratory acidosis, ARDS can occur
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What are the GI manifestations of shock?
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organs become ischemic, stress uclers, paralytic ileus
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What are the liver manifestations of shock?
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gluconeogenesis leading to hypoglycemia, fat metabolism impaired
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What are the mental manifestations of shock?
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changes in mental status and orientation, lethargic
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What are the renal manifestations of shock?
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blood is shunted to brain and heart, oliguria, renal failure
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What are the types of shock?
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hypovolemic, cardiogenic, obstructive, distributive, septic, neurogenic, anaphlactic
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When does hypovolemic shock occur?
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when too little circulating blood volume causes a decreased MAP
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What are the clinical manifestations of hypovolemic shock?
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increased HR, absent PP, decreased O2, skin pallor, decreased systolic BP
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What is the Rx for hypovolemic shock?
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oxygen, fluids, crystalloid fluids, LR, isotonic
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What does LR contain?
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sodium, chloride, calcium, potassium, and lactate dissolved in H20
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What is isotonic fluid?
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helps expand volume and the lactate helps buffer any acidosis
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What are vasoconstricting drugs used to treat hypovolemic shock?
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dopamine, NE
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Which drug enhances myocardial perfusion?
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sodium nitroprusside
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What is cardiogenic shock?
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the heart cannot maintain cardiac output
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What is the most common cause of cardiogenic shock?
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acute MI
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What are the manifestations of cardiogenic shock?
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visible distress, dyspnea, tachycardia, hypotension, JVD, murmurs
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What is the Rx for cardiogenic shock?
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fluids, vasopressors, dopamine (increases BP), morphine for pain,
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What is obstructive shock?
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flow of blood is obstructed; impedes perfusion and can cause cardiac arrest
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What is distributive shock caused by?
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decreased systemic vascular tone characterized by a decreased systemic vascular resistance; hypotension
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What is the most common type of vasodilatory shock?
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septic shock
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What is septic shock associated with?
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severe infection and the release of inflammatory mediators
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What is often released during septic shock?
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endotoxins
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Which type of bacteria most often causes septic shock?
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gram-negative
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What is the criteria for septic shock?
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temp >38C, HR >90bpm, RR>20,
WBC >12,000 |
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What are cytokines?
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promote endothelial leukocyte adhesion, cell damage proteases, prostaglandins and activation of clotting cascade
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What is the result of too many cytokines in septic shock?
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major cap permeability and vasodilation....fluid shifts
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Why does the skin become flushed and warm in the early stages of septic shock?
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because of the vasodilation
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What are some of the late signs of septic shock?
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tachycardia, rapid respirations, cool, pale skin, lethargic to comatose, oliguria, decreased CVP
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What lab MUST be checked for septic shock?
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lactate levels (if >4mmol/dl) indicates hypo-perfusion
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Which increased lab value is associated with low rates of survival?
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WBC > 50,000
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What is the Rx for septic shock?
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control the causative agent (right ABX), PA cath, oxygen, fluid resuscitation, dopamine, NE
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What is recombinant human activated protein C?
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an endogenous protein that not only promotes fibrinolysis and thrombosis and inflammation but also shows signs of modulating the coagulating and inflammatory mediators in severe sepsis
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Why is tight glycemic control important for the Rx of septic shock?
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shown to decrease mortality rates; blood sugar should be maintained from 80-110mg/dL
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What is used only in severe sepsis and is indicated for the reduction of mortality in adults with high risk?
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Xigris
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What is neurogenic shock?
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occurs when a condition increases parasympathetic stimulation or inhibits sympathetic stimulation of smooth muscle
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How is neurogenic shock characterized?
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loss of vascular tone and reflexes
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What is the most severe systemic allergic reaction?
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anaphylactic shock
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What is distributed into the blood stream in anaphylactic shock?
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histamine and other vasoactive amines
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What is the treatment for anaphylaxis?
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Epi for severe, Benadryl, O2, steroids, bronchodilators
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This is the formation of fibrin clots and thrombotic occlusion of small and mid-sized vessels caused by endotoxins and inflammation?
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Disseminated Intravascular Coagulation
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How is DIC characterized?
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widespread clotting and bleeding
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What are the manifestations of DIC?
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hemorrhage, oozing of bleeding, purpura, petechiae, bruising, GI bleeding, blood sputum
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This indicates the presence of abnormally high levels of fibrin degredation products in the body.
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D-dimer/FDPs
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This inhibits further thrombogenesis?
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heparin
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This inhibits fibrinolysis through the inhibition of plasminogen activator substances
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Aminocapric acid (Amicar)
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