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