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M6 Shock
| Question | Answer |
|---|---|
| Shock Define | A life-threatening response to alterations in circulation that results in inadequate delivery of oxygen to tissues and cells, and their subsequent dysfunction and death |
| Patho of shock | Shock involves one or more of these events Blood volume decreases (volume problem) Heart failure as an effective pump (pump problem) Peripheral vessel dilation (tank problem) |
| Shock is classified according to its cause. Four main types of shock: | Four main types of shock: Hypovolemic. Distributive. Obstructive. Cardiogenic. |
| Hypovolemic Most common cause. Decrease in fluid volume from: | Hemorrhage. Prolonged vomiting or diarrhea. Burns. Large, draining wounds. Reduced fluid intake. Diabetes insipidus, DKA |
| Shock:Distributive | Volume is adequate, but perfusion is inadequate. Vascular beds are dilated. Blood flow is not sufficient. |
| Distributive: Three types: | Neurogenic. Septic. Anaphylactic |
| Distributive-Neurogenic= Causes | Injury or disease to upper spinal cord Spinal anesthesia Drugs that vasodilate |
| Distributive-Neurogenic Leads to: | vasodilation hypvolemia bradycardia |
| Distributive-Anaphylactic Causes | Anitgen-antibody response Histamine |
| Distributive-Anaphylactic Leads to | Capillary hyperpermeability – causes the release of plasma through the capillary walls. Hypovolemia |
| Distributive-Septic Causes | Systemic inflammatory response syndrome to toxins Multiple organ dysfunction syndrome Simular vascular response as in anaphylactic shock |
| Distributive-Septic: Leads to | Fluid shift Hypotension Coagulation |
| Obstructive | Compression of the heart or great vessels. Compression reduces blood that can enter and leave the heart. Heart is unable to fill. Cardiac output is reduced. |
| Obstructive Caused by any condition that fills the thoracic cavity with fluid, air or tissue: | Cardiac tamponade Tension pneumothorax Pericarditis Pulmonary emboli Abdominal distention Ascites Positive end expiratory pressure (PEEP) Aortic stenosis |
| Cardiogenic shock | Heart fails Mortality is 50-80% Causes Myocardial infarction Dysrhythmias Cardiomyopathy Myocarditis Valvular disease and structural disorders |
| Cardiogenic shock damage | Damage to myocardium Reduced contractility Reduced stroke volume Ventricular pressure increases Reduced cardiac output Reflex peripheral vasoconstriction |
| Identify the four types of shock: | 1. Hypovolemic 2. Distributive 3. Obstructive 4. Cardiogenic mnemonic: DOC H |
| Four Stages of Shock: | Initiation Compensatory Progressive Refractory (Irreversible) |
| Stage 1: Initiation | subclinical hypoperfusion Physiological events Clinical presentation |
| subclinical hypoperfusion | subclinical hypoperfusion Inadequate dissolved oxygen Inadequate extraction of oxygen |
| Physiological events | Decreased intravascular volume Decreased myocardial contractility Decreased vascular tone (distributive) |
| Clinical presentation: | No obvious clinical indications of hypoperfusion |
| Stage 2: Compensatory | Activation of compensatory mechanisms to maintain homeostasis |
| Stage 2: Compensatory:Three specific compensatory mechanisms begin to work independently | Neural Endocrine Chemical |
| Neural Compensation | Baroreceptors Chemoreceptors Activation of the Sympathetic Nervous System (SNS) |
| Identify the 3 compensatory mechanisms in the second stage of shock | Neural Endocrine Chemical |
| Assessment: CNS | Agitation Anxiety Nervousness Restlessness Drowsiness Disorientation Lethargy Syncope |
| Assessment: Cardiovascular | Systolic pressure of 90 to 100 mmHg indicates impending shock. Systolic pressure of 80 mmHg indicates shock. |
| Assessment: Cardiovascular.Shock pressure | Changes in BP indicating pending or actual shock: BP below 100 mmHg. Any fall of > 20 mmHg below patient's normal systolic BP. Trend in progressively lower BP. |
| Cardiovascular shock: objective signs | Weak and thready pulse Tachycardia Very late stage-slows Neck veins Distended : cardiogenic/obstructive Flat : hypovolemic/distributive Delayed capillary refill Right atrial pressure Pulmonary artery pressure Abnormal heart sounds |
| Assessment: Respiratory | Rapid and deep initially Progress to slow and shallow Pulse oximetry Arterial blood gas |
| Assessment: Renal | Urine output less than 0.5 ml/kg/hr |
| Assessment: Hematologic | Enhanced clotting Inihibits fibrinolysis Low platelet count Prolonged clotting time |
| Assessment: Gastrointestinal | Thirst Nausea Vomiting Decreased bowel sounds |
| What is a sensitive indicator of systemic perfusion? | Urine output: >30ml/hr |
| Nursing Management | Intravenous therapy Fluid therapy Restore intravascular volume Maintain oxygen carrying capacity Maintain hemodynamic stability |
| Nursing Management Types of fluids | Crystalloids-LR, NS Colloid-albumin, dextran, hetastarch |
| Fluid Resuscitation | Fluid challenge Patient’s response MAP > 60; UO>30 ml/hr Increased LOC Peripheral perfusion |
| Blood products | Transfuse if Hct is less than 30% Whole blood Packed red blood cells Fresh frozen plasma Platelets |
| Pharmacologic Therapy | affects contractility Positive inotropic agents Increases heart’s force of contraction Improves stroke volume and blood pressure Increases workload of heart |
| Pharmacologic Therapy:Pharmacologic Therapy | epinephrine and norepinephrine Reduces preload: nitroprusside |
| Pharmacologic Therapy Affects afterload | Vasopressin Epinephrine Nitroprusside |
| Pharmacologic Therapy | Pharmacologic Therapy Heart rate Chronotropic Antidysrhythmic Oxygen Antibiotics Steroids Sodium bicarbonate Insulin |
| Mechanical Management Intra-aortic balloon pump | Cardiogenic balloon pump Reduces afterload Improves coronary artery perfusion Improves perfusion to vital organs |
| Nursing Interventions: Circulation | Circulation Monitor for bleeding Skin color and temp LOC VS Heart sounds Pulses Patient positioning |
| Nursing Interventions Body temperature | Warm, not overheated Increases stress on body |
| What are the priorities for caring for a patient with shock? | ABCs. |
| Nursing Care plan-Diagnosis Goal | Diagnosis Hypothermia related to hemorrhage. Goal: Patient will maintain normothermia |
| Shock Interventions | Keep patient dry and covered. Raise room temperature to 80 F. Place patient under warming blanket or warming lights. Keep patient's head covered. Warm IV solutions and blood products. Warm humidified air applied to patient. |
Created by:
ninja3lake
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