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Patho chap 46
Shock
| Question | Answer |
|---|---|
| what is the purpose of perfusion | to provide nutrients and remove cellular wastes through blood circulation |
| describe the process of SIRS | overwhelming inflammatory reaction, develops significant damage to body --> all major systems compensate |
| what systems compensate for SIRS | SNS and endocrine response similar to alarm stage of stress response which will increase catecholamines, glucocorticoids, minealcorticords, ADH, angiotensin II |
| symptoms to diagnose SIRS | increased HR, cardiac output and respiratory rate with a decreased GI activity and urine output |
| the progression of SIRS can lead to | CARS |
| CARS does what to the immune system | decreases it |
| if someone gets CARS what 2 things can they develop | an overwhelming infection in the blood or sepsis |
| septic shock | when the body is not receiving adequate perfusion |
| if more than 2 organs start to dysfunction it can lead to ? | MODS |
| if we are unable to reverse MODS, the patient will what? | die |
| describe CARS and how can this lead to an increased risk of infection when it's supposed to be a compensatory reaction | after SIRS, leads to increased infection risk because it's so busy compensating it often forgets about it's main job because it's focused on something different |
| describe sepsis and how it leads to septic shock | sepsis is a blood stream infection and it overwhelms the immune system most common form is bacterial sepsis |
| key manifestations that will arter the nurse to the presence of sepsis | confusion, hypoxemia, elevated plasma lactate level, oliguria any type of infection in an organ that looks like it's been spread to the blood stream |
| describe MODS | progressive and potentially reversible dysfunction of 2 or more organs |
| MODS stage 1 symptoms | increased volume requirements, mild respiratory alkalosis, oliguria, hyperglycemia, increased insulin requirements |
| MODS stage 2 symptoms | tachypnea, hypocapnea, hypoxemia, moderate liver dysfunction with possible hematologicla changes |
| MODS stage 3 symptoms | shock with azotemia & acid base disturbances significant coagulation abnormalities |
| MODS stage 4 symptoms | vasopressor dependent, oliguric or anuric, ischemic colitis, lactic acidosis |
| define shock | the inability of the heart and lungs to satisfy needs of peripheral tissues |
| 5 types of shock | cardiogenic, hypovolemic, neurogenic, anaphylactic, septic |
| initial phase of shock | sudden drop in tissue perfusion activation of SNS and RAAS |
| patient symptoms during initial phase of shock | increased HR, RR and pale |
| goal of initial phase of shock | to compensate to maintain perfusion |
| progressive phase shock | decrease perfusion of lungs, kidneys, gut, pancreas and liver, as perfusion decreased further manifestations develop |
| patient symptoms during progressive phase of shock | decreases GFR and Gi peristalsis increased toxins |
| goal of progressive phase of shock | to conserve blood for heart and blood |
| irreversible phase of shock | perfusion no longer maintained to heart and brain, myocardial and cerebral ischemia, widespread cellular hypoxia anaerobic metabolism |
| patient symptoms during irreversible phase of shock | hyperkalemia and EKG |
| goal of irreversible phase of shock | at this point your body is at a downward spiral -> organelles fail, cell dies and release lysosomal enzymes |
| inflammatory response to shock | immune system stimulated by cellular breakdown chemotaxis, intestinal barrier breaks down with hypoxia, stimulating immune response further, massive cytokines release leading to capillary permeability, compromising perfusion further |
| lactic acidosis response to shock | result of anaerobic metabolism due to inadequate oxygen, lactic acid levels build up -> cardiac, respiratory, neurological & brain function are adversely affected --> progressively worsen with increasing lactic acid levels |
| causes of septic shock | from sepsis - typically a bacterial infection |
| septic shock symptoms | severely low BP, cool & clammy hands, delayed capillary refill, confusion, high WBC count |
| what makes septic shock so unique | pink & warm flushed skin with a full bounding pulse |
| causes of cardiogenic shock | problem with the pump |
| cardiogenic shock symptoms | low urine output, cyanosis, altered mental status, increased heart rate and low BP |
| what makes caridogenic shock so unique | crackles and tachycardia |
| hypovolemic shock causes | hemorrhage, severe dehydration, decreased venous return, reduced intravascular blood volume |
| hypovolemic shock symptoms | hypotension, tachycardia, weak & thready pulse |
| hypovolemic shock compensatory mechanisms | RAAS and SNS activated to help with vasoconstriction and fluid retention |
| what makes hypovolemic shock so unique | cold and clammy hands |
| anaphylactic shock cause | overwhelming immune response to an allergen |
| anaphylactic shock symptoms | swelling of the throat, bronchoconstriction, wheezing, respiratory distress |
| septic shock compensatory mechanisms | epinephrine and cortisol |
| what makes anaphylactic shock unique | stridor |
| neurogenic shock causes | spinal cord injury ABOVE T6, brain injury, or during anesthesia |
| neurogenic shock symptoms | hypotension, vasodilation, low & slow vitals |
| neurogenic shock mechanisms | body is unable to compensate for low BP |
| what makes neurogenic shock unique | bradycardia and warm dry skin |
Created by:
sammy.e7
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