Term
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Definition
- Early identification and timely treatment is very important for a better prognosis
- identify and treat the underlying cause, bc if don't treat the underlying cause shock will progress to irrev stage then to death
- sequence of events for different types of shock will vary so mgmt of pt will depend on type of shock
-fluid replacement to restore intravascular volume
- vasoactive meds to restore vasomotor tone, improve cardiac fct
- nutritional support to address metabolic requirements |
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Term
| Mean Systolic Pressure (MAP) |
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Definition
Systolic + 2(Diastolic)/3
ex. BP 125/75
125 + 2(75) / 3 = 275/3=91.6=92 |
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Term
| General Management Strategies in Shock |
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Definition
Fluid Replacement
- must be initiated early to maximize intravascular volume, improves cardiac and tissue oxygenation
- rate of admin varies based on type of shock
- crystalloid or colloid solutions; also vary for diff types of shock
- albumin-plasma protein 9for hypovolemic shock)
Vasoactive Medication Therapy
- used along with fluid therapy
- improves hemodynamic instability
- improves myocardial contractility, regulates heart rate, reduces myocardial resistance, initiates myocardial vasoconstriction
- Used when fluid therapy alone cannot maintain MAP
- Mon q 15 mins, titrate based on vitals and MAP, wean down as stable
Nutritional Support
- inc met rate occurs during shock inc energy req bc catecholamine release
- deple of glyco occurs in 8-10 hrs, body begins to break down muscle and fat stores
- May req 3000 cal/day, init TPN asap
WILL ALWAYS USE PLASMA EXPANDERS FOR ALL TYPES OF SHOCK! |
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Term
| Biggest Complications of Shock Tx |
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Definition
Fluid Volume Overload
AEB: Pulmonary Edema
Monitor fluid boluses carefully
Hypothermia
AEB: rapid drop in body temp
Monitor body temperature carefully |
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Term
| Causes of Hypovolemic Shock |
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Definition
External:
- Trauma, surgery, vomiting, diarrhea, rapid duresis, diabetes insipidus
Internal:
- Hemorrhage, burns (fluid shifting), ascites, peritonitis, dehydration
15-25% intravascular fluid has to be gone to be classified as shock, in 150 lbs person this is 750-1400 cc fluid.
HV Shock: Dec BV, dec venous rtn, dec sys rtn, dec co, dec tiss perf |
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Term
| Medical Management of Hypovolemic Shock |
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Definition
-Treatment of Underlying Cause:
ex. emesis - give antiemetic
ext. bleeding - apply pressure
-Fluid, blood replacement
use blood products sparingly but will use PRBC if O2 carrying capacity is altered.
LR most commonly used, NS also used, but in an emergency will use the closest available fluid.
redistribution of fluid - want to position the pt to assist c fluid distribution; modified trendelenberg.
pharmacological tx. |
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Term
| Medical Management of Cardiogenic Shock |
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Definition
- Treatment of Underlying Cause - Angio, CABG
- Initiation of 1st line tx:
- Oxygenation: 2-6 l/min, keep >90%
- Pain control: IV morphine
decreases cardiac workload
dilates blood vessels
decreases anxiety
- Hemodynamic Monitoring:
arterial line, in the ICU, CO, pulm artery pressure, pulm & sys resist
- Lab marker Monitoring:
BNP - monit ventricular dysrhythmias, CHF
cardiac enzymes - CPK, troponins
EKG
- Fluid Therapy:
never admin rapidly bc CO shock isn't d/t a massive loss of fluid rapid infus will lead to fluid vol overload.
incremental fluid bolus only
- Mechanical assistive devices
intraartic ballon temp circ assistive device |
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Term
| Causes and Risks of Cardiogenic Shock |
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Definition
Usually happens after impairment of heart to pump blood to tissues and heart, such as: MI, dmg to LV, cardiomyopathies, valve dmg, dysrhythmias
Other Risks:
Acidosis
Hypocalcemia
Pneumothorax
Hypoglycemia |
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Term
| Pharmacological Therapy of Cardiogenic Shock |
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Definition
- Dobutamine:
Stimulates myocardial beta receptors
Increases myocardial activity
Improves cardiac output
- IV Nitrogylcerine: (Common)
Venous vasodilator
Used in combination c Dobutamine to inc CO while minimizing cardiac workload
Enhances bloodflow to the myocardium
Improves oxygenation to the myocardium
- Dopamine:
Vasoactive action depends on the dosage
Low dose - enhances renal perfusion and is not sufficient for CO shock
Medium dose - improves contractility and slightly inc HR and improves perfusion to kidneys
High dose - do not use in pts with CO shock bc inc cardiac workload
READ LABELS CAREFULLY FOR NITRO & DOPAMINE BEFORE HANGING!!! |
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Term
| Nursing Mgmt for Cardiogenic Shock |
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Definition
- Preventing CO shock esp in pts c dysrhythmias
- Monitoring hemodynamic status: low BP, inc HR, inc O2 demand
- Admin meds, IV fluids
- Ensuring safety, comfort, reducing pt anxiety |
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Term
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Definition
- Most common in critically ill pts
- Usually originates in resp and urinary tracts
- HR in immune comp pts, elderly, CA pts
- Tx
identify cause: often gram - bac, but can be gram + bacteria
remove invasive lines and replace in other areas
antibiotic coated lines
debridement of wounds, abcesses
- Pharm
broad spec antibiotics until c/s, then give specific a/b based on results |
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Term
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Definition
- Tx
- large volumes of fluid may be needed to restore nl hemodynamics
- dopamine (intropin) is often used either alone or in combination with other inotropic agents
- vasopressors: phenylephrine should be avoided as it can worsen bradycardia often seen in neurogenic shock
- atropine: speeds up HR and increases CO
ONLY NEUROGENIC SHOCK IS TREATED WITH ATROPINE B/C NEED TO INCREASE HR |
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Term
| Neurogenic Shock Causes and S/Sx |
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Definition
- Caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls. This can result from severe brain and spinal cord damage.
-S/SX
Low BP, Low HR, Dec CO, Warm and Dry skin (other shocks have cool, clammy skin) |
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Term
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Definition
- An acute multi system severe hypersensitivity reaction
- Anaphylactic shock is anaphylaxis associated with systemic vasodilation which results in low blood pressure
- also associated with severe bronchoconstriction to the point where pt is unable to breath
- can occur in response to any allergen
-S/SX:
Low BP due to vasodilation, bronchoconstriction |
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Term
| Treatment of Anaphylactic Shock |
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Definition
-Tx
Epinephrine: opens airways and raises BP by tightening blood vessels
Antihistamines: diphenhydramine, benadryl and corticosteriods, such as prednisone to further reduce symptoms |
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