Card Set Information
Care Patients Shock
widespread abnormal cellular metabolism that occurs when
oxygenation and tissue perfusion
needs are not met to the level necessary to maintain cell function
factors that influence MAP
total blood volume
size of the vascular bed
Overall cause of hypovolemic shock
total body fluid decreased (when too little circulating blood volume causes a MAP decrease, resulting in inadequate total body oxygenation)
Specific causes of risk factors for hypovolemic shock
overall cause of Cardiogenic shock
direct pump failure
specific cause of risk factors for cardiogenic shock
overall cause of distributive shock
fluid shifted from central vascular space (blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot circulate and deliver oxygen)
specific cause or risk factors for distributive shock
Neural-induced (pain, anesthesia, stress, spinal cord injury)
chemical induced (anaphylaxis, sepsis, capillary leak (burns))
overall cause of Obstructive shock
cardian function decreased by noncardiac factor
specific cause or risk factors of obstructive shock
pulmonary embolus, pulmonary hypertension, thoracic tumors, tension pneumothorax
4 stages of shock
Cardiac output = ______ x _______
Heart rate x stroke volume
normal= 4-7 L/min
how to calculate MAP
(Systolic - Diastolic) / 3 = X
X + Diastolic = MAP
Initial Stage of shock
is present when the patient's baseline MAP is decreased by less than ___ mm Hg. Total loss of ___ mL of circulating volume.
10 mm Hg. total loss of 750 mL.
Nonprogressive (compensatory) stage of shock
is present occurs when MAP decreases by ___ to ___ mm Hg from baseline. Total loss of ___ mL to ____ mL of circulating volume.
10-15 mm Hg. total loss of 750-1500 mL.
what happens in the nonprogressive state of shock
Kidneys and baroreceptors react- trigger the release of renin, ADH, aldosterone, epinephrine, and norepinephrine to start kidney compensation.
acidosis occurs (low blood pH)
hyperkalemia (k+ increases)
what does renin do?
causes decreased urine output, increased sodium reabsorption, and widespread blood vessel constriction.
what does ADH do?
increases water reabsorption in the kidney, further reducing urine output and also causes blood vessel constriction in the skin and other less vital tissue areas
Clinical manifestations for nonprogressive state of shock
decreased urine output
decreased systolic, increased diastolic
2%-5% decrease in O2 saturation
Progressive (intermediate) state of shock
occurs when there is a sustained decrease in MAP of more than ___ mm Hg from baseline. Total loss of ___ mL to ____ mL of circulating volume.
20 mm Hg. total loss of 1500-2000 mL.
what happens in progressive stage of shock
vital organs develop hypoxia
less vital organs become anoxic and ischemic
low blood pH
rising lactic acid and potassium levels
clinical manifestations for progressive stage of shock
restlessness and anxiety
feeling of impending doom
pale, cool moist skin
refractory (irreversible) stage of shock occurs when ________.
too much cell death and tissue damage result from too little oxygen reaching the tissues.
clinical manifestations for refractory stage of shock
rapid loss of conciousness
cold, dusky extremities
slow, shallow respirations
unmeasurable oxygen saturation
dopamine (intropin, revimine)
improve contractility of heart