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2013-03-15 15:56:48

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  1. What are the classifications of shock?
    hypovolemic-decreased body fluid (hemorrhage, dehydration)

    cardiovascular-direct pump failure (MI)

    distributive- Fluid shift from central vascular space; increase in fluid (pain, anesthesia, sepsis)

    Obstructive-indirect pump failure; cardiac function decreased (pulmonary embolus)
  2. Cardivascular manifestations
    • decreased cardiac output
    • increased pulse; thready
    • decreased BP
    • slow cap. refill
    • diminshed peripheral pulse
  3. Respiratory Manifestations
    • Icreased resp. rate; shallow depth
    • Cyanosis, around lips and nail beds
    • increased Paco2
    • decreased Pao2
  4. Neuromuscular Manifestation
    • Eearly:
    • anxiety
    • restlessness
    • increased thirst

    • Late:
    • lethargy
    • muscle weakness
    • absent deep tendo reflex
    • sluggish pupillary response to light
  5. Kidney Manifestations
    • decreased urine output
    • increased specific gravity
    • sugar present in urine
  6. Integumentary manifestations
    • cool/cold
    • pale, mottled to cyanotic
    • moist, clammy
    • mouth dry
  7. Gastrointestinal Manifestations
    • decreased motility
    • diminished bowel sounds
    • n/v
    • constipation
  8. What are some risk factors for hypovolemic Shock?
    • Diuretic therapy
    • Diminished thirst reflex
    • immobility
    • use of aspirin
    • use of compilmentary therapies
    • anticoagulant therapy
  9. What factors influence Mean Arterial Pressure(MAP)?
    • Total blood volume
    • Cardiac Output
    • Size of vascular bed

    *these are related to oxygenation and tissue perfusion
  10. How is total blood volume and cardiac output diresctly related to MAP?

    How is the vascular bed indirectly related to MAP?
    *Increases in total blood volume or cardiac  output raise MAP. Decreases lower MAP.

    *Increase in bed size lower MAP and decreases raise MAP
  11. What is anaphylaxis?
    *allergic reaction, happens in seconds to minutes

    *loss of blood vessel tone; decreased cardiac output
  12. What is sepsis?
    *widespread infection that triggers a whole body inflammatory response (distributive shock); infection in blood
  13. What is Capillary Leak Syndrome? 
    • response of capillaries that change blood vessel intergrity and allow fluid to shift from te blood vessels into interstitial tissue. Once in tissue can no longer supply O2 or remove waste
    • (burns, peritonitis, large wounds, malnutrition)
  14. what is hypovolemic shock?
    loss of blood volume from vascular space, resulting in decreased MAP, and a loss of O2 carrying capacity from the loss of curculating RBC's
  15. What are the stages of hypovolemic shock?
    • intitial
    • nonprogressive
    • progressive
    • reactory
  16. Initial stage of hypovolemic shock (Early)
    *patients baseline MAP is 5-10mm Hg less

    *compensatory mechanisms are so effective at returning systolic pressure to  normal that O2 blood flow to vital organs is maintained

    *may notice an increase in pt's heart and RR from baseline or slight increase in diastolic bp
  17. Nonprogressive Stage of hypovolemic shock (compensatory)
    *MAP decreases 10-15mm Hg

    *this activates kidney and hormonal compensatory mechanisms b/c cardiovascular are no longer to maitain supply of O2 to organs on own

    *kidneys release renin (ADH) which maintains fluid volume by fluid constriction; ie decreased urine output and blood vessel constriction in skin

    *pt will be thirsty and anxious, restless, tachycardia, increased RR, decreased urine output, decreased systolic, increased dystolic, 2-5% decrease in O2, pt cold 
  18. Progressive Stage of Shock (intermediate)
    *sustained decrease in MAP of more than 20 mm Hg

    *O2 not being delivered to vital organs, severe cell damage and death

    *pt feels impending doom, confused, rapid weak pulse, low bp, cyanosis, anuria, rising latic acid and postassium level

    *this needs to be corrected in less than 1 hour for pt to survive
  19. Refractory stage of hypovolemic shock
    *too much cell deat has occurred, therapy no longer effective
  20. What is MODS?
    Multiple Organ Dysfunction Syndrome- one organ dies and contiues to the next
  21. Risk factors for shock
    • age
    • GI ulcers
    • surgery
    • hemophilia
    • liver diorders
    • vomiting and diarrhea
    • asparin, diuretics and NSAIDS
  22. Lab Values: Ph, Latic Acid, Hematocrit, Hemoglobin, Potassium
    PH < 7.35 = decreased tissue O2

    Latic acid > 7= decreased tissue O2, buildup metabolites

    • Hematocrit > 47% (F), 52% (M)=
    •                     Dehydration
    •                  < 37% (F), 42% (M)=
    •                     Hemorrhage
    • Hemoglobin > 16 (F), 18(M)= dehydration
    •                   < 12 (F), 14(M)= hemorrhage

    Potassium> 5= dehydration
  23. what does normal saline and ringers lactate do for pt in hypovolemic shock?
    *fluid replacement, increase plasma volume

    *cotains sodium, chlorde, calcium, potassium, and lactate dissolved in water-expands vlume, and buffers acidosis
  24. what is best practice to maintain pt safety and quality of care during hypovolemic shock
    • ensure airway
    • start IV
    • administer O2
    • Elevate feet, head flat <30 degrees
    • examinefor overt bleedng (apply pressure if necessary)
    • administer drugs
    • icrease iv flow
    • do not leave pt
  25. what vitals should be monitored in hypovolemic shock
    pulse, BP, Pulse pressure, Central Venous pressure (monitors rt atrium), RR, skin and mucosal color, O2 saturation, mental status, urine output

    *every 15 minutes
  26. what vasoconstricting drugs are used to increase MAP?
    • dopamine
    • norepinephrine
  27. what inotropic drugs are used to help improve heart muscle contraction?
    • dobutamine
    • milrinone
  28. Which drugs improve myocardial perfusion?
    sodium nitroprusside
  29. what are some treatment goals?
    • maintain tissue perfusion
    • replace loss fluid
    • control fluid loss
    • treat cause of hypovolemia
    • support compensatory mechaisms