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M6 13-005

Exam 4: Cardiovascular System; Shock

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