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Shock
Shock and Nursing Management
| Question | Answer |
|---|---|
| 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 |
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LeidiSwts
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