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80 Cards in this Set
- Front
- Back
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what is shock
5 |
clinical syndrome
characterized by impaired tissue perfusion pts low blood pressure not pushing blood to tissues or organs |
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what can shock lead to
5 |
SIR systemic inflammatory response
syndrome MODS multiple organ dysfunction syndrome |
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what are the types of shock
5 |
neurogenic
septic hypovolemic cardiogenic |
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what is neurogenic shock
5 |
loss of autonomic nervous system
=loss of sympathetic vasoconstrictor tone =massive vasodilation =massive drop in blood pressure increasing fluids will not help to raise bp |
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what are some causes of
neurogenic shock 5 |
spinal cord injury
spinal cord disease epidural block severe pain drugs |
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what is the time frame for neurogenic
shock 5 |
hours or weeks
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what is pt presentation for
neurogenic shock 5 |
hypotension
bradycardia-oddball symptom usually with hypotension the HR will increast to make up for low bp but in neurogenic shock the sympathetic nervous system does not work so the parasympathetic nervous system takes over and slows the HR |
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what are the clinical manifestations
neurogenic shock 5 |
low HR-parasympathetic ns
low CO low cellular O2 supple low tissue perfusion=impaired cellular metabolism venous and arterial vasodilation loss of sympathetic tone low venous return low stroke volume |
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what is septic shock aka SIRS
5 |
sepsis with hypotension
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what effect does fluid resuscitation
have on septic shock 5 |
increasing fluids do not help to increase the bp
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what can septic shock be
accompanied by 5 |
MODS multiple organ
dysfunction syndrome |
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what causes septic shock
5 |
gram negative bacteria which releases an endotoxin
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what does the endotoxin that is
releases in septic shock do 5 |
triggers the inflammatory response
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what are risk factors for septic
shock 5 |
anything that releases gram negative
bacteria into the blood stream trauma to GI tract perforation of small intestine GI surgery chronic debilitation diseases invasive procedures and devices pts treated with immunosuppressive drugs |
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what are the effects of endotoxin on the body
5 |
widespread vasodilation-very relaxed
blood vessels increased capillary permeability microemboli/selective vasoconstriction decreased SVR increased CO/dilated aorta hypermetabolic state from fever= increased O2 needs |
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what is pt presentation in septic
shock 5 |
presence of infection
hypotension skin warm and dry increase HR due to hypotension decrease SVR dilated aorta increased CO without tissue perfusion |
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what is the prognosis in septic
shock 5 |
the mortality rate increases with
every system that fails |
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what is hypovolemic shock
5 |
inadequate volume to fill the vascular
space (blood vessels) |
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what are the two types of
hypovolemic shock 5 |
absolute hypovolemia
relative hypovolemia |
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what is absolute hypovolemia
5 |
shock where fluid is lost outside of
the body ie dehydration hemorrhage diarrhea |
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what is relative hypovolemia
5 |
shock where fluid is shifted out of
the intravascular space within the body due to increased capillary permeability aka third spacing |
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what are the spaces within the
body relative to hypovolemic shock 5 |
intravascular space-within blood vessel
interstitial-tissue space extra fluid=edema third spacing-area not normally filled with fluids due to severe burns or edema |
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what are the clinical manifestations
of hypovolemic shock 5 |
decreased venous return
decreased stroke volume decrease CO all leading to decreased tissue perfusion and impaired cellular metabolism |
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what causes hypovolemic shock
5 |
hemorrhage
burns GI losses with vomiting diarrhea diuresis in DM or DI |
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who is more at risk of developing
hypovolemic shock 5 |
persons with decreased compensatory
mechanisms infants elderly |
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what is cardiogenic shock
5 |
pump failure of the left ventricle that
results in decreased CO=low blood flow to kidney=RAAS=increased SVR=further compromises tissue perfusion |
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what is the most common cause of
cardiogenic shock 5 |
anterior wall MI
this effects the left ventricle |
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what are some results of cardiogenic
shock that can lead to systolic dysfuntion (problems with the left ventricle) 5 |
ventricle ischemia
structural problems with blood flow out of the heart arrhythmias |
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what are the clinical manifestations
of cardiogenic shock 5 |
low stroke volume
low CO increased pulmonary pressure and pulmonary edema all leading to decreased tissue perfusion and impaired cellular metabolism |
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what are the stages of shock
5 |
compensated
progressive irreversible or refractory |
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what is the compensatory stage in
shock 5 |
body shunts blood to vital organs
(ie heart and brain) decreased blood flow to non-vital organs (ie skin, GI) Renin-AldosteroneAngiotension System activated=increased BP and venous return to heart=increased CO |
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what is progressive stage of
shock 5 |
body's compensatory mechanisms
fail sympathetic ns causes vasoconstriction in non critical organs |
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what are some of the system failures in the progressive stage of shock
5 |
renal ischemia causes RAAS
activation=decreased CO leading to tissue hypoxia, anaerobic metabolism and lactic acid in body =acidosis and meds stop working |
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what is the irreversible/refractory
stage of shock 5 |
death imminent
increase in acidosis severe cerebral ischemia |
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what assessment data is looked
at in shock 5 |
hypotension
change in LOC tachycardia ( not in neurogenic shock) arrhythmias (r/t cardiac ischemia) narrowing pulse pressure less CO systolic and diastolic closer |
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how can change in LOC in shock
be manifested 5 |
due decrease perfusion to brain will
have decreased response to pain restlessness confusion lethargic unresponsiveness |
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what other assessment data will be looked at in shock
5 |
tachypnea
pulmonary edema decrease urine output dry mucous membranes cool, pale , clammy skin-cyanotic slow capillary refill decreased platelet count |
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what causes tachypnea in shock
5 |
pt is in metabolic acidosis and
is blowing off CO2 |
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what causes pulmonary edema in
shock 5 |
extra fluid given to correct low bp backing up in the heart
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what causes low urinary output
in shock 5 |
low perfusion to kidney leads to
acute tubular necrosis or kidney failure creatinine (over 1.0) and BUN increase |
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what does a low platelet count lead
to in shock 5 |
may decrease to 80,000 or 50%
over 3 days DIC may develop with causes small clots inside blood vessels in body leading to abnormal bleeding leading to organ failure or death |
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what is the normal platelet count
5 |
150,000-400,000
below 150,000 =bleeding risk platelets help with clotting, they clump together during clotting |
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what is the purpose of hemodynamic catheter
5 |
aka Swanz Ganz
aka pulmonary artery flow directed catheter measures fluid balances monitors vascular tone monitors myocardial contractility |
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how is the pulmonary artery flow directed catheter inserted
5 |
a cardiologist threads the catheter thru a cordis line thru the rt artium to the rt ventricule to the pulmonary
artery |
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why is it important to measure the
left heart pressures 5 |
70% of the CO for the body comes out of the left ventricle
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what pressures are measured by
the pulmonary artery flow directed catheter 5 |
PA pressures
PCWP CVP |
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what is the PA pressures
5 |
pulmonary artery pressures
measures rt and lf sided heart pressures rt 20-30 (higher on right) lf 10-20 |
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what is PCWP
5 |
pulmonary capillary wedge pressure
truest measure of left ventricular pressure 4-12 mmHg |
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what is CVP
5 |
central venous pressure
pressures in great vessels on right side of the heart monitors blood volume 2-6 mmHg |
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why are pts who go into shock at
risk for bleeding 5 |
they develop DIC that leads to small
blood clots inside blood vessels all over the body leading to abnormal bleeding and organ failure or death |
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what needs to be assessed frequently
on pts who are getting fluid resuscitation to correct hypotension 5 |
lungs
ausculated to assess for crackles as evidence of fluid overload in lungs |
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what drugs are given to pts in
shock 5 |
sympathomimetic drugs
vasodilators corticosteroids antibiotics |
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what are sympathomimetic drugs
5 |
mimic the sympathetic nervous system
causes peripheral vasoconstriction helps to keep the MAP at 70-80 to improve perfusion to the key organs |
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what are the two types of sympathomimetic drugs
5 |
vasopressors
inotropes |
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what do vasopressors do
5 |
cause vasocontrictions of the blood vessels
DOC: dopamine dobutamine norepinephrine epinephrine phenylephring |
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what do inotropes do
5 |
causes increased force of contraction
IV DOC:dobutamine |
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what could be a potential problem with
sympathomimetic drugs 5 |
overuse of drugs could cause too
much vasoconstriction causing damage to fingers, toes and organs need to do frequent assessments |
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why are vasodilators used with shock
pts 5 |
to correct excessive vasoconstriction and poor tissue perfusion especially in toes,
fingers and coronary arteries to maintain MAP of 70-80mmHg |
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what are some vasodilators used for
shock 5 |
Nitroglycerin-specific for coronary
arteries Nitroprusside Morphine Sulfate |
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why are corticosteroids used
in shock 5 |
only for neurogenic shock or where
have adrenal insufficiency not for other types of shock because causes secondary infections |
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what are the corticosteroids used for neurogenic shock or adrenal
insufficiency 5 |
hydrocortisone
methylprednisolone |
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why are antibiotics used in shock
5 |
as treatment for septic shock due
to infectious process as prophylaxis in other shocks to prevent nosocomial infections |
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what is the DOC antibiotic in
shock 5 |
Xigris
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what is most important nursing care for shock
5 |
prevention
id pts at risk debilitated pt elderly pts with chronic illness pts with chronic infections getting worst |
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what is good infection control in
shock 5 |
hand hygiene
get invasive lines out fast CDC: foleys out 24 hrs after surgery big source of urosepsis guidelines to avoid antibiotic resistance |
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why should sedation be avoided in
shock 5 |
need to be able to assess mental
status and assess for cerebral edema |
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how are patent airways maintained
in shock 5 |
no trachs
only ET tubes for short term use disease progression last only few days |
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why do you monitor lactate levels in
shock 5 |
high levels over 4 mean hypoperfusion
of organs even thought BP may still by stable need to be able to raise BP |
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what are neuro assessments of
pts in shock 5 |
may sure unsedated
neuro checks q hr check for S/S of cerebral edema re-orient pt to PPand T |
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how is volume expansion done in shock
5 |
use large bore needle, smaller the
number the bigger the gauge, the faster the fluid goes in use crystalloids.9NSS collioids-SPA |
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what do you have to be careful of
in volume expansion with cardiogenic shock 5 |
volume expansion can lead to CHF in
pts with cardiogenic shock |
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what is respiratory care for pts
in shock 5 |
intubate and vent if needed
head and ft horizontal may raise ft freq lung assessments freq ABGs to correct acid-base imbal continous pulse ox O2 sat greater than 90% PaO2 greater than 60 |
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what is nutritional care for pts
in shock 5 |
start enteral or TPN early
enteral route of choice to use gut, contraindicated due to pt positioning monitor glucose levels for enteral or TPN and keep under 150 monitor labs to assess nutritional status |
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what is psycho-social care for
shock 5 |
talk to pt
do not discuss condition in front of pt provide emotional support to family be honest pastoral care if needed |
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what determines adequate tissue
perfusion in shock 5 |
LOC
urine output skin color temperature |
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how can tell kidneys being perfused
5 |
minimum of 30 cc/hr
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what is renal care in shock
5 |
monitor I and O q hr via catheter
BUN 10-30 mg/dl creatine (less than 1.0) |
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what is cardio care in shock
5 |
if hct less than 30%-transfusion
hemodynamic monitoring of heart pressures MAP over 65 CVP monitor VS heart sounds Arrhythmias (tele-monitors) adjust meds based on CV assessments |
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what is mouth care when intubated
5 |
mouth care q 2 hrs
use antiseptic |
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what is some additional nursing
care for shock 5 |
daily wts
repostition judiciously to prevent hypotension monitor temp and treat fever evaluate response to therapy |
