Term
| a syndrome characterized by inadequate tissu perufsion resulting in impaired cellular metabolism |
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Definition
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Term
| inadequate tissue perfusion deprives cells of essential oxygen and nutrients, forcing cells to rely on _ |
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Definition
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Term
| shock has been classified into ofne of four types based on the etiolog or cause |
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Definition
| hypovolemic, cardiogenic, obstructive and vasogenic/distrubitive shock |
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Term
| distributive shock further encompassesL |
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Definition
| anaphlactic, septic, neurogenic shock |
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Term
| the most common type of shock |
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Definition
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Term
| occurs when the circulating blood volume is inadequate to maintain the supply of oxygen and nutrients to body tissues |
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Definition
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Term
| the most frequent cause of hypovolemic shock |
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Definition
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Term
| causes of hypovolemic shock from fluid loss include |
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Definition
| gastrointestinal losses from sever diarrhea or vomiting, excesisve diuressis from diabetes insipidus or diuretics, excessive diaphoresis, diabetic ketoacidosis or aggressive fluid remvoal during dialysis |
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Term
| excessive hsift of plasma out of the vascular compartment can result in hypovolemic shock and is associated with conditions shuch as |
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Definition
| burns, pancreatitis and intestinal obstruction |
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Term
| occurs when the heart fails as a pump |
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Definition
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Term
| a decrease in myocadial ocntractility results in decreased cardiac output and impaired tissue perfusion |
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Definition
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Term
| blood lfow is reduced and prevented from entering or leaving the heart by a mechanical obstruction |
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Definition
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Term
| the problem is not loss of blood but rather excessive dilation of blood vessels or decreased vacsular resistance causing the blood to be improperly distributed |
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Definition
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Term
| fluid pools in the dependent areas of the body and is not returned ot the arterial circulation to supply cricial cellular metabolic needs |
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Definition
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Term
| distributive shock can be complicated by _ which permits plasma to leak inot the interstitial compartment, therby decreasing intravascular blood volume |
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Definition
| increase capilary permeability, |
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Term
| three types of distrubtive shock are |
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Definition
| anaphylactic, septic, neruogenic shock |
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Term
| occurs when a person ahs a severe allergic reaction that results in the release of chemicals that dilate blood vessels and increas capillary permeability |
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Definition
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Term
| people can be allergic to many substances including |
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Definition
| drugs, vaccines, contrast media, insect bites and stings foods and food additives, pet dander, molds and pollens |
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Term
| a systemic inflmmatory response to a documented or suspected infection |
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Definition
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Term
| sepsis can progress to _ which is hypotensio unresponsive to _ along with signs of inadequate tissue perfusion such as |
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Definition
septic shock
fluid resuscitaiton,
metabolic acidosis, acute encphalopathy, oliguria, coagulation disorders |
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Term
| develops when pathogenic organisms release toxic substances that cause blood vessles to tilate, therby decreasing vascular resistance and increasing capillary permiability |
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Definition
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Term
| intreased permiability caused by septic shock results in _ that contributes to inadequate tissue perfusion and oxygenation as in other shock states |
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Definition
| leakage of plams proteins, reduced intravascular volume, preload and cardiac output |
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Term
| occurs when a disruption in the nervous system affects the vasomotor center in the medulla |
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Definition
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Term
| in neurogenic shock, disruption of sympathetic nerve impulses results in |
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Definition
| vasodilatio or loss of vascular resistance |
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Term
| most common cause of neurogenic shock is |
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Definition
| spinal cord injury from traum or regional anesthesia |
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Term
| other causes of neurogenic shock are |
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Definition
| disease of the upper spinal cord, depression of the vasomotor center from certain drugs and adrenal insufficiency |
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Term
| effects of shock on resp system |
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Definition
| tissue hypoxia nad noxia, respiratory failure, acute respiratory distress syndrom |
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Term
| effects of shock on acid base balance |
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Definition
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Term
| the effects of shock on the cardiovascular system |
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Definition
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Term
| effects of shock on the neuroendocrine system |
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Definition
release of catecholamines, mineralocorticoids, glucocorticoids, and antidiuretic hormone
decreased level of consciousness when cererbral blood flow falls |
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Term
| effects of shock onthe hematologic system |
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Definition
| DIC, multiple organ dysfunction, depletion of clotting factors with a predesposition to bleeding, peripheral ischemia and necrosis of digits and extremities |
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Term
| effects of shock on the integumentary system |
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Definition
| cyanosis may be present but is a late unreliable sign,k central cyanosis of mucous membranes, nose, cayanosis of nails and earlobes |
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Term
| effects of shock on the immune system |
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Definition
| depressed immune response |
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Term
| effects of shock on gastrointestinal system |
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Definition
| decreased peristalsis, ischemia of intestinal submucosa, impaired liver function |
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Term
| effects of shock on the renal system |
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Definition
| reduced glomerular filtration, inadequate renal perfusion, tubular necrosis, renal ischemia |
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Term
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Definition
| preshock, shock and end organ dysfunction |
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Term
| compensatory mechanisms respond to decreased deliver of oxygen, inadequate extraction of oxygen or both depending on type of shock |
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Definition
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Term
| signs and symptoms of organ dysfucntion become apparent as compensatory mechanisms become overwhelmed |
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Definition
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Term
| if the cause of shock is not corrected or if compensatory mechanisms continue without reversing the shock _ ensue |
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Definition
| irreversible organ damage, multiple organ failure and death |
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Term
| the decrease in perpheral blood flow r/t shock leads to weak or absent pulses and _ of the extremities |
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Definition
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Term
| deprived of adequate oxygen oxygen cells resort to _ whcih produces lactic acid and results in _ which as a depressant effect on _ cells |
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Definition
| anaerobic metabolism, metabolic acidosis, myocardial |
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Term
| typical assessment findings of mental status in end organ dysfunction |
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Definition
| listlessness, confusion, loss of consciousness |
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Term
| typical assessment findings of blood pressure in end organ dysfunction |
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Definition
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Term
| typical assessment findings of pulse in end organ dysfunction |
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Definition
| weak and trheady, tahcycardia, dyrhthmias |
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Term
| typical assessment findings of respirations in end organ dysfunction |
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Definition
| increased, deep, chrackles on auscultation |
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Term
| the overall goal of treatment of shock is |
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Definition
| restoration and maintenacne of o2 delivery to tissues |
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Term
| low tidal volume breaths on the ventilator are extablished at _ and palteau pressure with each breath are kept at or below _ water to prevent damage ot the lungs until mechanical ventilation is no longer needed |
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Definition
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Term
| In general _ is not routinely indicated for patients in cardiogenic shock |
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Definition
| aggressive fluid administration |
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Term
| Fluids admintered initially to treat shock |
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Definition
| isotonic solutions such as normal salin, isolyte, plasmolyte or lactated ringers |
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Term
| provide replacement water and electrolytes for all fluid compartments |
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Definition
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Term
| colloids such as _ remain in the vascular system and draw fluid into the bloodstream thereby increasing _ but are more expensive |
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Definition
| albumin, circulatory volume |
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Term
| fluid replacemnt is best determined by |
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Definition
| monitoring pulmonary artery wedge pressure, cardiac output, lactic acid levels and urine output |
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Term
| notify the physician if urin output falls below |
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Definition
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Term
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Definition
| depress cardiact activity |
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Term
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Definition
| permit excessive bleeding and extravasation of vasopressors can cause tissue necrosis |
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Term
| generalized inflammation that thereatens vital organs |
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Definition
| systemic inflammatory response syndrome |
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Term
| some of the conditions that can lead ot SIRS are |
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Definition
| multiple transfusions, trauma, burns, pancreatitis and infection |
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Term
| the effects of SIRS includ damage ot the |
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Definition
| endothelium of blood vessels and a hypermetabolic state |
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Term
| damaged endothelium r/t to SIRS increases _ allowing fluid to leak inot the body tissues |
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Definition
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Term
| _ compromis organ perfusion |
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Definition
| hypotension, microemboli and shunting of blood flow |
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Term
| the hypermetabolic state is characterized by |
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Definition
| increased serum glucose which eventually delpetes carbohydrate, fat and protein stores |
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Term
| a diagnosis of SIRS is made when a patient exhibitis two or more of the following symptoms |
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Definition
temp less than 97f
HR >90bpm
resp rate .20 or arterial pressure of co2 <32 mm Hg
wbc count <4000 or >12000 or > 10% immature neutrophils |
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Term
| when more than one organ begins to fial as a result of SIRS the patient is said eo have |
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Definition
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Term
| life threatening organ dysfunction caused by a dysregulated host respons to infection |
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Definition
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Term
| patients who have deteriorated from a state of sepsis to septic shock can be identified by having a vasopressor requirement to maintain a mean arterial pressure of _ or greater and serum lactate level greater than _ in the absence of hypovolemia |
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Definition
| 65 mm Hg, 2 mmol/L(>18mg/dL) |
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Term
| condtions that cause blood loss r/t shock |
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Definition
massive trauma, gi bleeding, ruptured aortic aneurysm, surgery,
erosion of vessel form lesion, tubes or other devices,
DIC |
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Term
| interventions for blood loss r/t shock |
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Definition
stop exter bleeding w/direct pressure, pressure dressing or turniquet(last resort),
reduce intraabdominal or retroperitoneal bleeding or prepare for emergency surgery,
administer lactated ringer solution or NS,
transfuse with fresh whole blood, packed cellls, fresh frozen plasma, plts. or other clotting facotrs,
conduct autotransfusion of appropriate, |
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Term
| use of nonblood plasma expanders or colloids to treat blood loss r/t shock remains |
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Definition
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Term
| causes of plasma loss r/t shock |
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Definition
| burns, accumulation of intraabdominal fluid, malnutrition, sever dermatitis, DIC |
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Term
| interventions to treat plasma loss r/t shock |
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Definition
administer low dose cardiotonics( dopamin,e dobutamin),
administer LR or plasma lyte
use of 5% albumin, fresh frozen plasma, dextran are possible |
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Term
| improvement of blood loss r/t shock does not occur with _ formation |
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Definition
| crystalloid administration |
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Term
| cause of shock r/t myocardial disease or injury |
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Definition
| acute myocardial infarction, myocardial contusion, cardiomyopathies |
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Term
| interventions to treat myocardial disea or injury r/t shock |
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Definition
vasodilators, diuretics, cardiotonics,b eta blockers,
intraaortic ballom pumpm, ventricular assist device, or extracorporeal life support may be used ,
reperfusion interventions including percutaneous transluminal angioplasty or coronary artery bypass graft, throbolysis for treatment of myocardial infarction depends on timely drug deliver to the clot |
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Term
| an intervention for myocardial disease or injury is a fluid challange with up to _ of NS or LR solution to rule out _ unless HF or _ are present |
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Definition
| 300 mL, hypovolemia, hypovolemia, pulmonary edema |
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Term
| cause of valvular disease or injury r/t shock |
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Definition
| ruptured aortic cusp, ruptured papillary muscle, ball thrombus |
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Term
| interventions for vavlular disease or injury r/t shock |
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Definition
same as myocardial disease or injury,
if rapid response does not occur, prepare for prompt cardiac surgery |
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Term
| Cause of external pressure on heart that interferes with heart filling or emptying r/t shock |
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Definition
pericardial tamponade caused by trauma, aneurysm, cardiac surgery, pericarditis
massive pulmonary embolus,
tension pneumothorax,
hemoperitoneum,
mechanical ventilation |
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Term
| interventions to treat external pressure on heart that interferes wiht heart filling or emptying |
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Definition
relieve tamponade with ECG assisted percardiocentesis,
surgical repari if it recurs,
throbolytic or anticoagulat therapy,
relieve air accumulation with needle throacostomy or chest tube insertion
relieve fluid accumlation with paracentesis,
reduce inspiratory rpessure |
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Term
| cause of cardiac dysrhthmias r/t shock |
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Definition
| tachydysrhthmias, bradydysrhythmias, pulseless electrical activity |
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Term
| interventions to treat cardiac dysrhtmias |
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Definition
| treat dysrhtymias, be prepared to initiate cpr, cardiac pacing |
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Term
| vasodilators used to treat myocardial diseas or injury |
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Definition
| sodium nitroprusside, nitroglycering, calcium channel blockers, morphine |
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Term
| diuretics used to treat myocardial disease or injury |
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Definition
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Term
| cardiotonics used to treat myocardial disease or injury |
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Definition
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Term
| betablockers used to treat myocardial disease or injury |
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Definition
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