Home > Flashcards > Print Preview

The flashcards below were created by user Braddk1 on FreezingBlue Flashcards. What would you like to do?

  1. two criterian that must be met before shock can be diagnosed is
    • a reduction in mean systemic b/p
    • clinical evidence of hypoperfusion of vital organs
    • earliest sighn is agitation and restlessness
    • decreased uop and mentation and b/p
    • cool clammy skin
    • increased pulse
  2. what is the formula for map
  3. what happens in the initial stage of shock
    • increased sns stim
    • mild vasoconstriction and increase in hr
  4. what happens in the compensated or nonprogressive stage of shock
    • organs still adequately perfused because of compensatory mech
    • decrease in map 10-15 degress from baseline continued decrease in bp
    • activation of raas and resulting decreased uop

    • moderate vasoconstriction with still increase in hr
    • blood shunted to heart and vital organs
  5. what happens in the decompensated or progressive stage of shock
    • underperfusion of organs and compensatory mech fail
    • map decreased by over 20 from baseline
    • anoxia
    • hypoxia
  6. what happens in the irreversible or refratory shock stage
    • severe hypoxia and ischemia
    • mods
    • death
  7. wha is hypovolemic shock
    volume loss
  8. compare and contrast absolute vs relative volume loss
    absolute is going outside the body

    ie: frank bleeding,diarrhea or vomiting,diuresis,loss of plasma through skin (burns)

    • relative is staying inside
    • as in third spacing, internal volume loss and fluid shifting
  9. what is the order of the cascade of hypovolemic shock
    • decreased
    • circulating volume --preload(venous return)-- stroke volume--co--cellular 02 supply--tissue perfusion
  10. what is the classification system of hypovolemic shock
    class I-IV
  11. what is class I
    volume loss up to 15% or 750ml

    • charecterized by
    • anxiety
    • restlessness
    • poss be asymptomatic
  12. what is class II
    • beginning of changes in vs
    • blood loss of 15-30% or 750-1500ml
    • characterized by
    • decreased preload
    • apprehension/ restlessness
    • pallor/diaphoresis
    • delayed cap refill
    • decreased uop
    • increased hr >100and rr 20-30
  13. what is class III
    • volume loss of 30-40% or 1500-2000 ml
    • characterized by
    • decreased b/p, and increased hr and rr and uop
    • delayed cap refill
    • anxious and confused
  14. what is class IV
    • hemorrahage
    • volume loss of greater than 40% and 2000ml
    • mods
    • irreversible shock
  15. how do you tx hypovolemic shock
    • blood - prefer prbc
    • (can use whole blood but rarely used due to allergic reactions)
  16. what is cardiogenic shock
    • pump failure
    • low co and hypotension
    • low uop
    • decreased peripheral pulses
    • cool clammy skin
    • ms changes
  17. causes of cardiogenic shock
    • ischemia, structural problems and dysrhythmias
    • MI
    • will hear crackles
    • likely within 48 hours of MI
  18. what is the cascade cycle in cardiogenic shock
    decreased heart fnxn--decreased co--decreaded b/p and hypoperfusion with hypoxemia--decreased in blood supply and further dysfunction--compensatory mech increase b/p--creates increased oxygen demand and work of the heart
  19. s/s of cardiogenic shock
    pulmonary edema, peripheral edema and jvd, mottlling of skin
  20. assesment findings with cardiogenic shock
    • L ventricle ejection fraction <30%
    • hypotension
    • increased rr
    • crackles resulting from pulmonary congestion
    • decreased uop
    • restlessness, agitation, confusion
  21. what needs to be done to reach the goal of restoring blood flow in cardiogenic shock
    • thrombolytics
    • angioplasty
    • coronary revascularization
    • iabc to increase perfusion and decrease afterload (inflates durin diastole and deflates during systole)
  22. what drugs are given with cardiogenic shock
    • pos inotrope
    • dobutamine (preferred because no much chrono effect)
    • dopamine
    • vasoactive
    • nitro - decrease preload (blood coming back to heart)
  23. distributive shock develops as a result of...
    vasodilation without an increase in intravascular volume
  24. 3 types of distributive shock
    septic, anaphlatic and neurogenic
  25. what is the differing charecteristic in septic shock
  26. 2 of the following assesment vitals and or labs must be met to be declared in sepsis
    icreased b/p, hr, rr, wbc
  27. what is sepsis with hypotension
    • b/p<90 despite fluid resuscitaion
    • scant urination
    • change in ms
  28. what is the cascade of events in septic shock
    microbes invade--endotoxins release cytokines initiating inflamm response--damages vessel triggering coag cascade and thrombi--fibrinolysis is interupted blocking blood flow--also increased cap perm creating edema
  29. what are the 2 states of septic shock
    early-hyper and late-hypo dynamic state
  30. what assesment findings during early-hyperdynamic state
    • normal to high co
    • high temp
    • tachypnea
    • hypotension to normotension
    • vasodilation and b/p is barely maintained
  31. what assesment findings during late hypodynamic state
    • low perfusion, co,
    • ms changes
    • clammy pale skin
    • tachycardia
    • pulmonary congestion
    • central cyanosis
  32. what is the overall goal with septic shock
    • filling the tank and constricting the vessels 1st
    • eliminating hte source of infection
  33. filling the tank and constricting the vessels in septic shock is done with
    • iv fluids ie
    • ns,lr
    • vasoconstrictors
    • dopamine
  34. what is the cascade of events from anaphylactic shock
    allergic reaction--mast cells and histamine--increased vasc perm--edema and bronchoconstriction
  35. clinical manifes of anaphlactic shock
    • priurtis, sneezing/coughing, wheezing uticaria, angioedema,restlessness
    • BAD - stidor, bronchospasm and laryngeal edema
  36. more resulting from anaphlactic shock
    increased cap perm--pooling of blood in periphery-- decrease co and b/p--decrease in svr
  37. management of anaphlactic shock
    • abc'c
    • epi
    • volume expansion
    • vasoconstrictor agents
    • antihistamines
    • bronchodilators
    • corticosteriods
  38. pathophys of neurogenic shock
    • loss of sympathetic tone--massive vasodilation--
    • decreased venous return,sv,co, oxygen supply, tissue perfusion
  39. what is the differing characteristic with neurogenic shock
  40. poikilothermia happens in neurogenic shock as a result of loss of vasomotor tone, define this
    pt assumes temp of environment
  41. presenting s/s with neurogenic shock include
    hypotension, hypothermia, decreased uop, ms changes, increased cap refill time
  42. tx of neurogenic shock
    • stabilize spine
    • abc's
    • fluid resusitation
    • vasoconstrictors
    • atropine for bradycardia
    • warming blankets for hypothermia

Card Set Information

2012-04-03 08:49:57

shock exam 3
Show Answers:

What would you like to do?

Home > Flashcards > Print Preview