Term
| What is the main problem caused by shock? |
|
Definition
| decreased tissue perfusion |
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Term
| What are the 4 main types of shock? |
|
Definition
| cardiogenic, hypovolemia, distributive, and obstructive |
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Term
| What are the 3 subtypes of distributive shock? |
|
Definition
| neurogenic, anaphylactic, and septic |
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Term
| What is the difference between absolute and relative hypovolemia? |
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Definition
| absolute is fluid lost outside the body, relative is fluid shifts or pooling in the body |
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Term
| This type of shock occurs when either systolic or diastolic dysfunction occurs resulting in decreased CO? |
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Definition
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Term
| The heart's inability to pump the blood forward is called? |
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Definition
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Term
| What is the only form of shock where bradycardia, not tachycardia is seen? |
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Definition
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Term
| What happens to the pulse pressure in all types of shock? |
|
Definition
|
|
Term
| What happens to the BP in all types of shock? |
|
Definition
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Term
| Which 2 types of shock does SVR increase? Which 2 types does SVR decrease? |
|
Definition
-increase cardiogenic and hypovolemic
-decrease distributive and obstructive |
|
|
Term
| What happens to CO in all types of shock? |
|
Definition
|
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Term
| What causes neurogenic shock? |
|
Definition
| spinal cord injury, spinal anesthesia |
|
|
Term
| What are S&S of cardiogenic shock? |
|
Definition
| tachycardia, hypotension, tachypneic, crackles, peripheral hypoperfusion |
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Term
| With hypovolemic shock at what percent of fluid loss will there be a SNS mediated response? |
|
Definition
|
|
Term
| With hypovolemic shock at what percent fluid loss will compensatory measures begin to fail and what is the immediate intervention that is needed? |
|
Definition
-greater than 30%
-immediate replacement with blood products and albumin |
|
|
Term
| With hypovolemic shock at what percent fluid loss does irreversible tissue damage take place? |
|
Definition
|
|
Term
| An injury above what level of the spine can result in neurogenic shock? |
|
Definition
|
|
Term
| How soon following a spinal cord injury can neurogenic shock occur? |
|
Definition
| with 30 minutes and lasts up to 6 weeks |
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Term
| What is the immediate reaction to vascularity that occurs in an anaphlyactic reaction? |
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Definition
|
|
Term
| What is a systemic inflammatory response to an infection? |
|
Definition
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|
Term
| What is sepsis complicated by organ dysfunction? |
|
Definition
|
|
Term
| What is sepsis with hypotension despite fluid resuscitation? |
|
Definition
|
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Term
| What are the 2 major cytokines released into circulation in septic shock? |
|
Definition
| Tumor necrosis factor (TNF) and interleukin-I (IL-I) |
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Term
| What are the 3 stages of shock? |
|
Definition
| compensatory, progressive, irreversible |
|
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Term
| What 3 things does the release of TNF and IL-1 lead to in septic shock? |
|
Definition
-myocardial depression
-endothelial damage
-microemboli |
|
|
Term
| What 3 problems to circulation are caused in septic shock? |
|
Definition
-endothelial damage (allows leakage of fluid 2nd/3rd spacing)
-microemboli (leads to blockages)
-peripheral vasodilation (fluid sets, decreased venous return, preload, and CO) |
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Term
| What are the 3 major processes that occur in the compensatory stage of shock that attempt to restore adequate tissue perfusion? |
|
Definition
-activation of alpha adrenergic receptors
-activation of beta adrenergic receptors
-activation of renin-angiotensin complex |
|
|
Term
| What effects does the activation of alpha adrenergic receptors have in the compensatory phase of shock? |
|
Definition
| causes selective vasoconstriction (blood flow is directed to vital organs) |
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|
Term
| What effects does the activation of beta adrenergic receptors have in the compensatory phase of shock? |
|
Definition
| causes dilation of coronary arteries, increase in HR and contractility |
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|
Term
| What effects does the activation of the renin-angiotensin complex have in the compensatory phase of shock? |
|
Definition
| increases osmolarity, ADH release, increased reabsorption of water, increased blood volume |
|
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Term
| What happens in the capillaries during the progressive phase of shock? |
|
Definition
| increased hydrostatic pressure causes a shift of fluid to the interstitual space and decrease in circulating volume |
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|
Term
| What happens in the lungs during the progressive phase of shock? |
|
Definition
| arteriovenous shunting leads to hypoxia and decreased oxygen availability |
|
|
Term
| What happens to the myocardium in the progressive phase of shock? |
|
Definition
| HR increases, contractility decreases, CO decreases |
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|
Term
| With the progressing tissue hypoxia of the progressive phase of shock, what follows? |
|
Definition
| anaerobic metabolism which leads to metabolic acidosis |
|
|
Term
| What are the 2 fatal outcomes of irreversible shock? |
|
Definition
| respiratory or cardiac arrest |
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|
Term
| Barorecptors respond to the decrease in CO and BP in the compensatory phase of shock by activating what? |
|
Definition
| the sympathetic nervous system; which releases epinephrine and norepinephrine |
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Term
| The physiologic dead space is increased during the compensatory stage of shock, how does this happen and what does it mean? |
|
Definition
| blood is shunted away from the lungs to preserve circulation to the heart and brain this causes the alveoli to be inadequately perfused which prevents gas exchange |
|
|
Term
| What happens to the GI tract in the compensatory stage of shock? |
|
Definition
| decrease in blood flow slows motility and can lead to ileus |
|
|
Term
| Why does the pt's skin feel cool and clammy in the compensatory stage of shock? What one type shock does the pt feel warm and why? |
|
Definition
-decreased blood flow to the skin
-septic shock pt's feel warm d/t hyperdynamic state |
|
|
Term
| What are the 2 distinguishing factors of the progressive stage of shock? What do they lead to? |
|
Definition
-decreased cellular perfusion and resulting altered capillary permeability
-profound edema |
|
|
Term
| Hypoperfusion of the heart during the progressive stage of shock can lead to what 3 things? |
|
Definition
-dsrhythmias
-myocardial ischemia
-AMI |
|
|
Term
| What clinical signs of the respiratory system will the pt show in the progressive stage of shock? |
|
Definition
-tachypnea
-crackles
-increased WOB
-pulmonary edema |
|
|
Term
| Aside from ileus what other GI problem can arise in the progressive stage of shock d/t prolonged hypoperfusion? |
|
Definition
|
|
Term
| What happens to the levels of liver enzymes as the liver fails? |
|
Definition
|
|
Term
| What condition contraindicates the use of Lactated Ringer's? |
|
Definition
|
|
Term
| In what two types of shock is the use of colloids contraindicated? |
|
Definition
| neurogenic and cardiogenic |
|
|
Term
| By what route can Dobutrex and dopamine be administered? |
|
Definition
central line
(infiltration will cause tissue sloughing) |
|
|
Term
| The goal of vasopressor therapy is to obtain a MAP of what? |
|
Definition
|
|
Term
| What is the mechanism of action of Nipride? |
|
Definition
| arterial and venous vasodilation |
|
|
Term
| What is the mechanism of action of nitroglycerin? |
|
Definition
| venodilation; dilates the coronary arteries |
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|
Term
| What are the treatments of cardiogenic shock? |
|
Definition
-to reduce the workload of the heart until a cardiac catheterization can be performed;
-nitrites (dilate coronary arteries)
-diuretics (reduce preload)
-vasodilators (reduce afterload)
-beta blockers (reduce HR and contractility) |
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|
Term
| What ratio is used to estimate the amount of fluid needed for replacement with a hypovolemic shock pt? |
|
Definition
| 3:1; (3mL fluid for every 1mL of fluid lost) |
|
|
Term
| What does the CVP need to be higher than before vasopressors can be used? |
|
Definition
| greater than or equal to 8 |
|
|
Term
| Dobutrex and dopamine do what to the CO? |
|
Definition
|
|
Term
| Why are fluids administered cautiously in the pt with neurogenic shock? |
|
Definition
| because the hypotension is not r/t fluid loss |
|
|
Term
| Why is the pt with neurogenic shock at risk for hypothermia? |
|
Definition
|
|
Term
| Which 2 meds are primarily used with anaphylactic shock? |
|
Definition
| epinephrine and IV benadryl |
|
|
Term
| How often should the nurse assess the pt's response to fluid resuscitation? |
|
Definition
| as often as every 10-15 mins |
|
|
Term
| If the pulse ox is not working for the pt in shock d/t poor circulation where should the probe be placed? |
|
Definition
|
|
Term
| UOP below what indicates inadequate renal perfusion? |
|
Definition
|
|
Term
|
Definition
multiple organ dysfunction syndrome
-2 or more failing organs in the acutely ill pt |
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