Shock For Uca Nursing

Front 1

What happens to the blood pressure in the compensatory stage?

Back 1

BP remains within normal limits.

Front 2

Medical management of compensatory stage shock.

Back 2

Fluid replacement and medication therapy must be initiated to maintain an adequate blood pressure and maintain adequate tissue perfusion.

Front 3

What are the signs and symptoms of shock in the compensatory stage?

Back 3

Fight or flight response. Body shunts blood from organ such as skin, kidneys, and gastrointestinal tract to the brain and heart to ensure adequate blood supply to the vital organs. Patient has cool clammy skin, bowel sounds are hypoactive, urine output decreases in response to the release of aldosterone and ADH.

Front 4

What. The actions are taken in the compensatory stage of shock to maintain adequate cardiac output?

Back 4

First: vasoconstriction. Second: increased heart rate. Third: increased contractility of the heart.

Front 5

In the compensatory stage of shock serum sodium in blood glucose levels are elevated? True or false?

Back 5

True. They are elevated in response to the release aldosterone and catecholamines.

Front 6

What is the nurses job in the compensatory stage of shock?

Back 6

Monitor patients hemodynamic status, promptly report deviations to the physician, assist in identifying and treating the underlying disorder by continuous in-depth assessment of the patient, administer prescribed fluids and medications, promote patient safety.

Front 7

A nurse should report a systolic blood pressure lower than_____or a drop in systolic blood pressure of___.

Back 7

90 mmHg, 40 mmHg.

Front 8

Pulse pressure correlates well with what?

Back 8

Stroke volume, amount of blood ejected from the heart with systole.

Front 9

What is normal pulse pressure?

Back 9

30 to 40 mmHg.

Front 10

What is an earlier indicator of shock than a drop in systolic blood pressure?

Back 10

Narrowing or decreased pulse pressure (also an early indication of decreased stroke volume).

Front 11

Damage has already been occurring at the cellular and tissue levels by the time blood pressure drops. True or false?

Back 11

True

Front 12

What are the technologies that allow clinicians to detect changes in tissue perfusion before changes in classic signs indicate hypo perfusion?

Back 12

Sublingual carbon dioxide, tonometry, and central venous or mixed venous blood oxygen saturation.

Front 13

What is capnography?

Back 13

CO2 monitoring measures exhaled level of CO2 through a device on exhalation arm of the ventilator.

Front 14

What is capnography?

Back 14

CO2 monitoring measures exhaled level of CO2 through a device on exhalation arm of the ventilator.

Front 15

What to assess for when recognizing shock in older patients.

Back 15

Beta blocking agents used to treat hypertension may mask tachycardia, increasing trend in body temperature should be addressed, heart may respond to decrease myocardial oxygenation with this dysrhythmias may be misinterpreted as a normal part of aging, sudden change in mental status should be aggressively treated the presence of infection and organ hypo perfusion.

Front 16

What to assess for when recognizing shock in older patients.

Back 16

Beta blocking agents used to treat hypertension may mask tachycardia, increasing trend in body temperature should be addressed, heart may respond to decrease myocardial oxygenation with this dysrhythmias may be misinterpreted as a normal part of aging, sudden change in mental status should be aggressively treated the presence of infection and organ hypo perfusion.

Front 17

What happens to the blood pressure and mean arterial pressure (MAP) during the progressive stage of shock (second stage).

Back 17

Blood pressure can no longer compensate mean arterial pressure falls below normal limits.

Front 18

Pathophysiology of the progressive stage of shock.

Back 18

First, Hypo perfusion at this stage, overworked heart becomes dysfunctional, this causes ischemia. Biochemical mediators cause myocardial depression, these lead failure of the cardiac. Second, auto regulatory function the microcirculation fails in response to numerous biochemical cytokines and mediators released by the cells resulting in increased capillary permeability. Inflammatory response to injury is activated, and pro-inflammatory and anti-inflammatory cytokines and mediators are released which in turn activate coagulation system effort to reestablish homeostasis. Oxygen consumption increases.

Front 19

Respiratory effects during progressive stage of shock.

Back 19

Respirations are rapid and shallow, crackles, decreased pulmonary blood flow causes arterial oxygen levels to decrease in carbon dioxide levels to increase, leaky capillaries cause pulmonary edema, diffusion abnormalities (shunting), interstitial inflammation and fibrosis are common as the pulmonary damage progresses.

Front 20

Cardiovascular effects during the progressive stage of shock.

Back 20

Lack of blood supply leads to dysrhythmias and ischemia levels of cardiac enzymes increase, myocardial depression in particular dilation may further impair the heart's ability to pump enough blood to the tissues to meet oxygen requirements.

Front 21

What is a new laboratory marker used to assess the function of the heart?

Back 21

natriuretic peptide (BNP), this increases when the ventricle is over distended.

Front 22

Neurologic effects during the progressive stage of shock.

Back 22

Mental status deteriorates because the cerebral perfusion hypoxia.

Front 23

Renal effects during the progressive stage of shock.

Back 23

MAP falls below 70 mmHg, glomerular filtration rate of the kidneys cannot be maintained, drastic changes in renal function occur. Acute renal failure may develop. Urinary output decreases to <0.5 mL per kilogram per hour or less than 30 mL per hour.

Front 24

Acute renal failure is characterized by what?

Back 24

Increase in blood urea nitrogen (BUN) and serum creatinine levels, Flynn lecture like she is, acid-base and balances, loss of the renal hormonal regulation of BP.

Front 25

Acute renal failure is characterized by what?

Back 25

Increase in blood urea nitrogen (BUN) and serum creatinine levels, Flynn lecture like she is, acid-base and balances, loss of the renal hormonal regulation of BP.

Front 26

Hepatic effects during the progressive stage of shock.

Back 26

Less ability to metabolize medications and metabolic waste products, such as ammonia and lactic acid. Gluconeogenesis glycogenolysis, are impaired, liver enzymes and bilirubin levels are elevated and patient appears jaundiced.

Front 27

Gastrointestinal effects during the progressive stage of shock.

Back 27

Increased risk for gastrointestinal bleeding mucosa can become necrotic slough off causing bloody diarrhea, gastrointestinal ischemia leaps to bacterial toxin translocation (this is when bacterial toxins enter the bloodstream through the lymph system).

Front 28

What can bacterial toxins cause?

Back 28

Vasodilation increased capillary permeability intense inflammatory response with activation of additional biochemical mediators.

Front 29

Hematologic effects during the progressive stage of shock.

Back 29

Inflammatory cytokines activate the clotting cascade, causing deposition of microthrombi in multiple areas of the body and consumption of clotting factors. This can lead to disseminated intravascular coagulation (DIC) may occur either as a cause or a complication of shock.

Front 30

Define disseminated intravascular coagulation.

Back 30

Widespread clotting and bleeding occur simultaneously, bruises and bleeding appear in the skin, prothrombin time impartial thromboplastin time or prolonged. Clotting factors and platelets are consumed and require replacement therapy to achieve homeostasis.

Front 31

Medical management for all types of shock.

Back 31

Optimizing intravascular volume, supporting the pump action of the heart, improving the competence of vascular system, supporting the respiratory system, enteral nutritional support, aggressive hyperglycemic controlled with IV insulin, and the use of ant acids histamine 2 blockers, or anti-peptic agents to reduce the risk of gastrointestinal ulceration and bleeding.

Front 32

What has been shown to reduce morbidity and mortality of acutely ill patients?

Back 32

Tight glycemic control with a blood glucose of 80 to 110 mg per deciliter

Front 33

Preventing complications during the progressive stage of shock.

Back 33

Evaluate blood levels of medication, observing invasive vascular lines for signs of infection, checking neurovascular status of arterial lines are inserted (especially in lower extremities), ensure aseptic technique are used for punctures.

Front 34

Promoting resting comfort during the progressive stage of shock.

Back 34

Promoting patient resting comfort is a priority, perform only essential nursing activities, protect patient from extreme temperatures, do not warm patient to quickly or use a warming blanket because they can cause they so dilation and the subsequent drop in BP.

Front 35

What is the?

Back 35

Point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.

Front 36

What is the irreversible stage also known as?

Back 36

Refractory

Front 37

Medical management of the irreversible stage.

Back 37

Usually the same as for the progressive stage, but defined because the patient fails to respond to treatment.

Front 38

Nursing management for the irreversible stage of shock.

Back 38

Same as progressive stage, such as, carry out prescribed treatments, on during the patient, preventing complications, protecting the patient from injury, and providing comfort.

Front 39

During the irreversible stage of shock what must the nurse do if it becomes obvious that the patient is unlikely to survive?

Back 39

Family must be informed about the prognosis and likely outcome.

Front 40

When patient is likely to die because the irreversible shock what must be explained to the family about the treatment being given?

Back 40

Equipment and treatments being provided are intended for patient comfort and do not suggest that the patient will recover.

Front 41

Why are fluid replacements administered during shock?

Back 41

To improve cardiac tissue oxygenation.

Front 42

What type of fluid replacement is used in shock?

Back 42

crystalloids (electrolyte solutions that move freely between intravascular in interstitial spaces), colloids (large molecule IV solutions), and blood components.

Front 43

In emergencies dealing with shock what is the best type of fluid to be used?

Back 43

Fluid that is readily available.

Front 44

Why is fluid resuscitation initiated early in shock?

Back 44

To maximize intravascular volume.

Front 45

When giving crystalloids what must you be aware of?

Back 45

More fluid is necessary to restore intravascular volume.

Front 46

Hypovolemic shock that is caused by blood loss is usually treated how?

Back 46

Blood component therapy.

Front 47

During shock isotonic crystalloids solutions are often selected why?

Back 47

They contain the same concentration of electrolytes as the extra cellular fluid and therefore can be given without altering the concentrations of electrolytes in the plasma.

Front 48

Common IV fluids used for resuscitation in hypovolemic shock include what?

Back 48

Normal saline and lactic ringers solution.

Front 49

In ringers lactate the lactate ion is converted into what and what does it help?

Back 49

Bicarbonate, helps buffer the overall acidosis that occurs in shock.

Front 50

When rapidly administering isotonic crystalloids, what is sometimes given and why?

Back 50

Hypertonic crystalloids solution such as 3% sodium chloride. The osmotic effect of hypertonic solution results in fewer fluids being administered to restore intravascular volume.

Front 51

Complications associated with the use of hypertonic saline solution include?

Back 51

Excessive serum osmolality, hypernatremia, hypokalemia, and altered thermoregulation..

Front 52

Colloidal solutions are considered to be what?

Back 52

Plasma proteins

Front 53

How the colloids extended intravascular volume?

Back 53

By exerting oncotic pressure, thereby pulling fluid into the intravascular space. These have the same effect as hypertonic solutions.

Front 54

Albumin solution is commonly used to treat what type of shock?

Back 54

Hypovolemic shock.

Front 55

With all colloidal solutions, side effects include the rare occurrence of?

Back 55

Anaphylactic reactions. Nurses must monitor patients closely.

Front 56

Common complications of fluid administration?

Back 56

Cardiovascular overload and pulmonary edema.

Front 57

Patients receiving fluid replacement must be monitored frequently for what?

Back 57

Adequate urinary output, changes in mental status, skin perfusion, changes in vital signs.

Front 58

Crackles in the patient receiving fluids may mean what?

Back 58

Pulmonary edema.

Front 59

What is a normal right atrial pressure valve or CVP?

Back 59

4 to 12 mmHg.

Front 60

Vasoactive medications help increased what?

Back 60

Strength of myocardial contractility, regulate the heart rate, reduce myocardial resistance, and initiate vasoconstriction.

Front 61

Vasoactive medications work on what types of receptors?

Back 61

alpha-adrenergic, beta-adrenergic receptors.

Front 62

When alpha-adrenergic receptors are stimulated what occurs?

Back 62

Blood vessels constrict in the cardiorespiratory gastrointestinal systems, skin, and kidneys.

Front 63

When beta-I adrenergic receptors are stimulated what occurs?

Back 63

heart rate lowers and myocardial contraction increases.

Front 64

When beta-2 adrenergic receptors are stimulated what occurs?

Back 64

Vasodilation occurs in the heart and skeletal muscles in the bronchioles relax.

Front 65

When vasoactive medications are administered how often should vital signs be assessed?

Back 65

Every 15 minutes until stable or more often.

Front 66

Vasoactive medications should be administered through what?

Back 66

A central venous line, because infiltration in extravasation of some vasoactive medications can cause tissue necrosis and sloughing.

Front 67

IV pump or controller should be used to ensure that the medications are delivered safely and accurately when giving vasoactive medications. True or false?

Back 67

True

Front 68

Dosages are changed to maintain their MAP at a physiologic level that ensures adequate tissue perfusion, this is usually greater than what?

Back 68

65 mmHg.

Front 69

Why must vasoactive medications never be stopped abruptly?

Back 69

This can cause severe hemodynamic instability, perpetuating the shock state.

Front 70

What happens to metabolic rates during shock?

Back 70

Increases, patients in shock may require more than 3000 calories per day.

Front 71

The release of catecholamines early in shock caused depletion of glycogen stores in about____hours?

Back 71

8 to 10 hours.

Front 72

What is the most common type of shock and how is it characterize?

Back 72

Hypovolemic shock, characterized by decreased intravascular volume.

Front 73

Hypovolemic shock occurs when there is a reduction in intravascular volume by what percent?

Back 73

15 to 25%. This represents a loss of 750 to 1300 mL of blood in the 70 kg (154 pound) person.

Front 74

Which type of fluid accounts for the most total body water?

Back 74

Intracellular fluid.

Front 75

Intravascular means what?

Back 75

Inside the blood vessels

Front 76

Interstitial means what?

Back 76

Surrounding tissues

Front 77

The volume of interstitial fluid is about 3 to 4 times that of intravascular fluid. True or false?

Back 77

True

Front 78

Causes of hypovolemic shock.

Back 78

External fluid losses, internal fluid shifts, as in severe dehydration, severe edema, or ascites.

Front 79

Hypovolemic shock begins with a decrease in what?

Back 79

Intravascular volume.

Front 80

Major goals in the treatment of hypovolemic shock include?

Back 80

Restore intravascular volume, redistribute fluid volume, to create the underlying cause of the fluid loss as quickly as possible.

Front 81

Fluid replacement is also referred to as?

Back 81

Fluid resuscitation

Front 82

Colloids include what types of drugs?

Back 82

Albumin, hetastarch, and dextran

Front 83

If hypovolemic shock is caused by hemorrhage what type of colloids is not indicated?

Back 83

dextran, because it interferes with platelet aggregation.

Front 84

If hypovolemic shock which type of position is preferred and why?

Back 84

Modified Trendelenburg position, elevation of the legs promotes the return of venous blood. It is not recommended to put patients in full Trendelenburg position, because this makes breathing difficult.

Front 85

When does cardiogenic shock occur?

Back 85

When the heart's ability to contract into, blood is impaired and the supply of oxygen is inadequate for the heart and tissues.

Front 86

The causes of cardiogenic shock are known as two types, what are they?

Back 86

Coronary or non-coronary.

Front 87

Which type of cardiogenic shock is more common and seen most often in patients with myocardial infarction?

Back 87

Coronary cardiogenic shock.

Front 88

Coronary cardiogenic shock occurs when a significant amount of_____has been damaged?

Back 88

Left ventricular myocardium.

Front 89

Non-coronary causes of cardiogenic shock related to conditions that?

Back 89

Stressed the myocardium (severe hypoxemia, acidosis, hypoglycemia, hypocalcemia, tension pneumothorax) as well as conditions that resulted in ineffective and myocardial function (cardiomyopathy's, valvular damage, cardiac tamponade, dysrhythmias).

Front 90

What is compromised in cardiogenic shock?

Back 90

Cardiac output.

Front 91

Clinical manifestations of cardiogenic shock include?

Back 91

Pain of angina and develop dysrhythmias and hemodynamic instability.

Front 92

Overall management strategies in shock.

Back 92

Fluid replacement, vasoactive, nutritional support.

Front 93

Goals of medical management in cardiogenic shock include?

Back 93

Limit further myocardial damage in preserve healthy myocardium, improve the cardiac function by decreasing cardiac contractility, decreasing ventricular after load, or both.