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38 Cards in this Set
- Front
- Back
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Simply, what is shock?
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Lack of equilibrum between the cells need for O2 and the body's inability to provide that cellular O2
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What are the five types of shock?
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Cardiogenic, Hypovolemic, Neurogenic, Septic, Anaphylactic
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What happens with ATP and lactic acid when cells are in anaerobic state?
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decrease ATP and increased lactic acid
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What happens to BP and SVR when vessels are dilated?
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decreases both
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In shock what happens to fluid volume?
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- loss of fluid
- Shifting of fluid from vascular into the intersitital space |
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What happens to HR and PVR in shock?
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Increases
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What happens to BP, SVR, CVP, PAWP in shock?
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Decreases
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What happens to CO, PAP, SVO2/ScvO2 in shock?
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Can increases or decrease
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What is seen in the respiratory system with shock?
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- Hyperventilation
- Hypoxemia - Resp failure - Crackles - ARDS |
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Is change in LOC common in shock?
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Yes
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Is urine sodium low or high in shock?
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Low
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Is urine specific gravity low or high in shock?
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High
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What do lactate and glucose levels do in shock?
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Increase
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Cool and mottled skin would be an early or late sign in shock?
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Late
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What are the 4 stages of shock?
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- Initial
- Compensatory - Progressive - Irreversible |
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What happens in the inital stage?
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Decreases CO leads to impairment of tissue perfusion which leads to cells converting to anaerobic metabolism leading to increased lactic acid = cell death
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What happens in the compensatory stage?
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The body tries to compensate
- Increased HR - Vasocontriction - Retains sodium and water - Increased BG and RR to blow off effects of lactic acidosis |
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What happens in the progressive stage?
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- 3rd spacing
- change in LOC, high ammonia and lactate levels - Decreased CO causing decreased BP - Decreased perfusion - Decreased urine output - DIC, MODS, SIRS |
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What happens in irreversible stage?
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Nothing can be done, patient will die
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What do they look at to indicate the cause of shock?
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Client history
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What specific test can be given to dx shock?
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There is no test
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What are the main treatments for shock?
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- Oxygen and respiratory support
- Fluid support - Drug support |
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How do we increase O2 on a patient in shock?
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- O2 mask or NC
- Ventilator - Percussion |
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How do we increase perfusion?
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- Cardiac drugs
- Fluids |
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Where do you want a patients PaO2?
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>60
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In fluid resuscitation, what is given first?
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NS is first, unless large amt of blood loss then blood given
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What will you be monitoring on a patient in shock?
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- Neuro checks q1 hr
- Urine output - Accuchecks - daily weights - lactic acid level - ABGs |
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What is the diet for a patient in shock?
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- High protein
- High calorie |
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What are some examples of care bundles/ EBP guidelines?
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- turn q2hrs
- HOB up 30-45 TPN feedings - DVT prevention |
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What is one thing you can do to make it easier on your patient?
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Cluster your work
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To reverse the volume deficit and restore organ perfusion, what will you be giving the patient?
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- Large volume of crystolloids- 6-10 L, 2-4 L in first few hrs
- Vasopressors, IV corticosteriods, antibiotics |
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How often should you monitor the patients temp?
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q4 hrs
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What fluids should you not give a shock patient? why?
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Lactated ringers, b/c lactate is already high
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What vasopressors are used first? second?
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First: Levophed, dopamine (Intropin)
Second: Vasopressin (Pitressin) |
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What is the goal of admin vasopressors?
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Get BP in normal range and MAP 65 or higher
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If you have an order for antibiotics and to take cultures, which would you do first?
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Cultures
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Why would dobutamine be given?
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To increase CO and contractility of the heart
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What is septic shock?
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Sepsis plus hypotension in spite of fluid resuscitation
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