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Shock

Shock and Nursing Management

QuestionAnswer
Shock syndrome characterized by decreased tissue perfusion and impaired cellular metabolism.
Shock results in what? Imbalance between the supply of and demand for oxyen and nurients.
What are the three types of shock? Hypovolemic, Cardiogenic, Distributive
Which types of shock are classified as low blood flow? Cardiogenic and hyovolemic shock
Which type of shock is classified as maldistribution of blood flow? Distributive
Distributive shock consists of what? Septic, anphylactic, and neurogenic shock
What is cardiogenic shock? The inability of the heart muscle to function adequately.
Cardiogenic shock is also what? Mechanical obtruction of blood flow.
If it's not corrected, cardiogenic shock can lead to what? Hypovolemic shock.
What is systolic dysfunction? It is the heart's inability to pupmp the blood forward.
Systolic function primarily affects which part of the heart and why? The left ventricle. Systolic pressure and tension are greater on the left side of the heart.
What happens if systolic dysfunction affects the right side of the heart? Blood flow through the pulmonary circulation is compromised.
What are the precipitating causes of systolic dysfunction? MI, cardiomyopathies, severe systemic or pulmonary hypertension, blunt cardiac injury, andmyocardial depression from sepsis.
What is diastolic dysfunction? It is an impaired ability of the right or left ventricle to fill during diastole.
Decreased filling of the ventricle will result in what? Decreased stroke volume.
What is stroke volume? Amount of blood ejected from the heart with each contraction.
The cause and initial presentation of various types of shock differ, but what about their physiologic responses? The physiologic responses of cell to hypoperfusion are similar.
The early clinical presentation of a patient with cardiogenic shock is similar to that of a patient with what? Acute heart failure.
In a patient with cardiogenic shock, what will they have? Tachycardia, hypotension, and narrowed pulse pressure.
How does the myocardial oxygen increase its consmption in cardiogenic shock? The systemic vascular resistance (SVR) increase, which in turn increases the workload of the heart.
What will result in the heart's inability to pump blood forward? Low cardiac index (less than 2.1 L/min/m2)
Cardiogenic Shock Clinical Presentation: Cardiovascular Decrease capillary refill time. Increase MVO2. Cardiac index <2.1 L/min/m2. Pulmonary artery wedge pressure (PAWP)is >20 mmHg. Chest pain may or may not be present.
Cardiogenic Shock Clinical Presentation: Pulmonary Tachypnea, cyanosis, crackles, rhonchi.
Cardiogenic Shock Clinical Presentation: Renal Increse sodium and water retention. Decrease renal blood flow. Decrease urine output.
Cardiogenic Shock Clinical Presentation: Skin Pallor. Cool, clammy.
Cardiogenic Shock Clinical Presentation: Neurologic Decrease cerebral perfusion: anxiety, confusion, agitation.
Cardiogenic Shock Clinical Presentation: Gastrointestinal Decrease bowel sounds. Nausea/vomiting.
Cardiogenic Shock Clinical Presentation: Diagnostic findings Increase cardiac markers. Increase blood glucose. Increase BUN. ECG (arrhythmias). Echocardiogram (left ventricular dysfunction). Chest x-ray (pulmonary infiltrates.
Hypovolemic Shock Clinical Presentation: Cardiovascular Decrease preload. Decrease stroke volume. Decrease capillary refill time.
Hypovolemic Shock Clinical Presentation: Pulmonary Tachypnea --> bradypnea (late)
Hypovolemic Shock Clinical Presentation: Renal Decrease urine output.
Hypovolemic Shock Clinical Presentation: Skin Pallor. Cool, clammy.
Hypovolemic Shock Clinical Presentation: Neurologic Anxiety, confusion, agitation.
Hypovolemic Shock Clinical Presentation: Gastrointestinal Absent bowel sounds.
Hypovolemic Shock Clinical Presentation: Diagnostic findings Decrease hematocrit. Increase lactate. Increase urine specific graviy. Changes in electrolytes.
Neurogenic Shock Clinical Presentation: Cardiovascular Decrease/Increase temperature.
Neurogenic Shock Clinical Presentation: Pulmonary Dysfunction related to level of injury.
Neurogenic Shock Clinical Presentation: Skin Decrease skin perfusion. Cool or warm. Dry.
Neurogenic Shock Clinical Presentation: Neurologic Flaccid paralysis below the level of hte lesion. Loss of reflex activity, bowel and bladder function.
Anaphylactic Shock Clinical Presentation: Cardiovascular Chest pain. Third spacing of fluid.
Anaphylactic Shock Clinical Presentation: Pulmonary Swelling of lips and tongue. Shortness of breath. Edema of larynx and epiglottis. Wheezing. Rhinitis. Stridor.
Anaphylactic Shock Clinical Presentation: Skin Flushing, pruritus, urticaria, angioedema.
Anaphylactic Shock Clinical Presentation: Neurologic Anxiety. Feeling of impending doom. Confusion. Decrease level of consciousness. Metallic taste.
Anaphylactic Shock Clinical Presentation: Gasrointestinal Cramping. Abdominal pain Nausea. Vomiting. Diarrhea. Sudden onset. History of allergies. Exposure to contrast media.
Septic Shock Clinical Presentation: Cardiovascular (Early) Decrease/increase temperature; increase heart rate; decrease systemic vascular resistance (SVR), Increase CO; Decrease BP; Biventricular dilation (decrease ejection fraction); Increase SvO2.
Septic Shock Clinical Presentation: Cardiovascular (Late) Decrease/increase temperature; Decrease CO/Increase SVR; decrease SvO2.
Septic Shock Clinical Presentation: Pulmonary Hyperventilation. Respiratory alkalosis --> resiratory acidosis. Hypoxemia. Respiratory failure. ARDS. Pulmonary hypertension. Crackles.
Septic Shock Clinical Presentation:Renal Decrease urine output.
Septic Shock Clinical Presentation: Skin (Early) Warm and flushed.
Septic Shock Clinical Presentation: Skin (Late) Cool and mottled.
Septic Shock Clinical Presentation: Neuologic (Early) Alteration in mental status. Agitation.
Septic Shock Clinical Presentation: Neurologic (Late) Coma.
Septic Shock Clinical Presentation: Gastrointestinal GI bleeding. Paralytic ileus.
Septic Shock Clinical Presentation: Diagnostic findings Increase/decrease WBC. Decrease platelets. Increase lactate. Increase urine specific gravity. Decrease urine sodium. Positive blood cultures.
What is hypovolemic shock? It occurs when there is a loss of intravascular fluid volume. Large decrease in circulating volume and metabolic needs are not me.
Absolute hypovolemia Results when fluid is lost through hemorrhage, GI loss (vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis.
Relative hypovolemia Fluid volume moves out of the vascular space into extravascular space interstitial or intracavit
Created by: LeidiSwts on 2005-04-22



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