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M6 13-005
Exam 4: Cardiovascular System; Shock
| Question | Answer |
|---|---|
| shock | 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. |
| Cardiac system | Heart Blood Vascular bed Microcirculation |
| Functions of Cardiac System | Delivers oxygen and nutrients Remove waste products Regulation of blood volume Constrict or dilate to regulate blood flow |
| When does shock begin? | Shock begins when cardiovascular system fails |
| 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) |
| Identify the three events that lead to the development of shock: | Blood volume decrease (volume problem). Heart failure as an effective pump (pump problem). Peripheral blood vessel dilation (tank problem) |
| How is shock classified? | Hypovolemic Distributive Obstructive Cardiogenic |
| Hypovolemic Shock | Most common cause Decrease in fluid volume |
| types of causes for hypovolemic shock | Hemorrhage Prolonged vomiting or diarrhea Burns Large, draining wounds Reduced fluid intake Diabetes insipidus, DKA |
| Distributive Shock | Volume is adequate, but perfusion is inadequate Vascular beds are dilated Blood flow is not sufficient |
| Types of Distributive Shock | Neurogenic Septic Anaphylactic |
| Causes of Neurogenic Shock | Injury or disease to upper spinal cord Spinal anesthesia Drugs that vasodilate |
| Neurogenic Shock leads to.... | vasodilation hypvolemia bradycardia |
| Causes of Anaphylactic Shock | Anitgen-antibody response Histamine |
| Anaphylactic Shock leads to... | Capillary permeability-fluid shift Hypovolemia |
| Causes of Septic Shock | Systemic inflammatory response syndrome to toxins Multiple organ dysfunction syndrome |
| Septic shock leads to... | Fluid shift Hypotension Coagulation |
| What is Obstructive Shock? | Compression of the heart or great vessels |
| How does Obstructive shock affect circulation? | Compression reduces blood that can enter and leave the heart Heart is unable to fill Cardiac output is reduced |
| What causes obstructive shock? | Any condition that fills the thoracic cavity with fluid, air or tissue. |
| Examples of Obstructive Shock causes. | Cardiac tamponade Tension pneumothorax Pericarditis Pulmonary emboli Abdominal distention Ascites Positive end expiratory pressure (PEEP) Aortic stenosis |
| Cardiogenic Shock | The heart fails. |
| Mortality rate of Cardiogenic Shock? | 50-80%. Most common cause... MI |
| Causes of Cardiogenic Shock | Myocardial infarction Dysrhythmias Cardiomyopathy Myocarditis Valvular disease and structural disorders |
| What happens with Cardiogenic Shock | Reduced contractility Reduced stroke volume Ventricular pressure increases Reduced cardiac output Reflex peripheral vasoconstriction |
| Identify the four types of shock | Hypovolemic Shock Distributive Shock Obstructive Shock Cardiogenic Shock |
| What are the four stages of shock? | Initiation Compensatory Progressive Refractory (Irreversible) |
| Describe Stage 1: Initiation | Initial stage of shock characterized by subclinical hypoperfusion |
| Describe stage 2: Compensatory | Activation of compensatory mechanisms to maintain hemostasis |
| What 3 specific mechanisms begin to work independently during Compensatory? | Neural Endocrine Chemical |
| Neural Compensation | Baroreceptors Chemoreceptors Activation of the Sympathetic Nervous System (SNS) Stimulation of autonomic nervous system |
| Endocrine Compensation | Hormonal response to low blood pressure Stimulates the pituitary gland to release the adrenocorticotropic hormone (ACTH) ACTH acts on the adrenal cortex to release Renin-Angiotensin-Aldosterone Response (RAAS) |
| Chemical Compensation | Respiratory rate and depth increase Patient hyperventilates Respiratory alkalosis occurs Cerebral perfusion may decrease |
| Describe Stage 3: Progressive | Profound hypoperfusion and further deterioration |
| What is happening during Stage 3: Progressive? | Continued shunting of blood to vital organs Sodium-potassium pump failure Cardiac output, blood pressure, and tissue perfusion continue to decrease |
| Describe Stage 4: Refractory | Irreversible Prolonged inadequate tissue perfusion Sympathetic nervous system dysfunction results in massive vasodilation Lethal decrease in tissue perfusion Unresponsive to therapy |
| Physiological effects during Stage 4: Refractory | Severe tissue hypoxia Worsening acidosis Multiple organ dysfunction syndrome (MODS) |
| Clinical Presentation of Sate 4: Refractory | Life threatening dysrhythmias Respiratory and metabolic acidosis Organ failure Cerebral ischemia/infarction |
| Identify the 3 compensatory mechanisms in the second stage of shock. | Neural Endocrine Chemical |
| Impending shock systolic blood pressure | 90-100 mmHg |
| Shock systolic blood pressure | 80 mmHg |
| Difference between systolic and diastolic pressures. | Normal is 30-50 mmHg |
| What are you looking for when assessing for shock (Cardiovascular)? | Weak and thready pulse Tachycardia Neck veins Distended : cardiogenic/obstructive Flat : hypovolemic/distributive Delayed capillary refill |
| What are you looking for when assessing for shock (Respiratory)? | Rapid and deep initially Progress to slow and shallow Pulse oximetry Aterial blood gas |
| What are you looking for when assessing for shock (Temperature)? | Heat regulating mechanisms are depressed. Diaphoresis increases heat loss. Hypothermia is characteristic, except with septic shock. |
| What are you looking for when assessing for shock (CNS)? | Agitation Anxiety Nervousness Restlessness Drowsiness Disorientation Lethargy Syncope |
| What are you looking for when assessing for shock (Skin & Mucous Membranes)? | Depends on type of shock: Color Temperature Texture Turgor Moisture Rash |
| What are you looking for when assessing for shock (Renal)? | Reduced renal perfusion Vasoconstriction Urine output Oliguria |
| What is a sensitive indicator of systemic perfusion? | Urine output: >30ml/hr |
| Medical Management for shock | Intravenous therapy Types of fluids Crystalloids-LR, NS Colloid-albumin, dextran, hetastarch Fluid Resuscitation Blood products |
| How are Vasosupressors (Alpha-adrenergics) used? | Increase peripheral vascular resistance. |
| How are Positive Inotropic Agents (Beta-adrenergics) used? | Increase force of myocardial contractions. |
| Mechanical management used for shock | Intra-aortic balloon pump Ventricular assist device Pneumatic anti-shock garment (PASG) or Military anti-shock trousers (MAST) |
| What types of fluids are administered to the patient with hypovolemic shock? | Crystalloid, colloid, blood. |
| What are the Nursing Intervention goal? | Recognition of the early signs of shock |
| What is the nursing priority with Shock? | ABC's |
| How can we maximize oxygen delivery for shock? | Airway patency Monitor respiration Oxygenation Airway maintenance Suctioning Chest physical therapy |
| What are Nursing interventions for shock (circulation)? | Monitor for bleeding Skin color and temp LOC VS Heart sounds Pulses Patient positioning |
| What are Nursing interventions for shock (Lab Values)? | Identify anemia (hypovolemic). Identify elevated WBC count (septic). Identify electrolyte imbalances and acid-base disturbances. Identify thrombocytopenia and clotting abnormalities. |
Created by:
jtzuetrong
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