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H&C Ch 11 Shock
H&C Ch 11 Shock pp. 237-250
| Question | Answer |
|---|---|
| if shock is not adequately treated what syndrome might occur ? | MODS - multiple organ dysfunction syndrome |
| What is the criteria for MODS to be declared ? | presence of altered function of two or more organs in an acutely ill patient such that interventions are necessary to support continued organ function |
| what physiologic responses are common to all types of shock? | ypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response |
| how does the body respond to shock ? | by activating the sympathetic nervous system and mounting a hypermetabolic and inflammatory response |
| what type of assessment is required in patients with shock ? | ongoing and systematic assessment |
| what does the clotting cascade cause? | small clots lodge in microcirculation, further hampering cellular perfusion |
| What are the phases of shock ? | compensatory, progressive, irreversible |
| what happens to BP in compensatory phase of shock ? | remains normal |
| in compensatory phase of shock what mechanism increases the HR, increases heart contractility and contributes to adequate cardiac output | vasoconstriction |
| What phase of shock is noted by "fight or flight" | compensatory |
| While BP remains normal in compensatory, inadquate perfusion exists and is manifested how ? | respiratory rate increases, blood pH raises , patient may be anxious or confused |
| What is the first step in managing shock ? | identifying the cause of the shock |
| True or False: the compensatory phase is indefinite | false p. 239 |
| Across the stages of shock what happens to the BP ? | C-normal P-systolic <100, MAP <65, requires fluids, I-requires mechanical/pharmacological support |
| Across the stages of shock what happens to the HR ? | C->100bpm P- >150bpm I- erratic |
| Across the stages of shock what happens to the Respiratory status ? | C- ≥22 breaths/min PaCO2 <32 mm Hg P-Rapid, shallow respirations; crackles; PaO2 <80 mm Hg; PaCO2 >45 mm Hg I-Requires intubation and mechanical ventilation and oxygenation |
| Across the stages of shock what happens to the skin? | C-Cold, clammy ; Capillary refill ≤3.5 s P-Mottling, petechiae; Capillary refill ≥3.5 s I- jaundice |
| Across the stages of shock what happens to the urinary output ? | C- decreased P- <0.5 ml/kg/h I- anuric, requires dialysis |
| Across the stages of shock what happens to the mentation? | C- confusion and agitation P- lethargy I-unconscious |
| Across the stages of shock what happens to the acid-base balance ? | C-Respiratory alkalosis P-Metabolic acidosis I-profound acidosis |
| What are the early interventions for shock ? | IV fluids, oxyggen and obtaining necessary labs |
| In the compensatory stage of shock serum ____________ and ____________ ____________ levels are elevated | sodium, blood glucose p. 240 |
| What should be reported regarding systolic blood pressure with regards to shock ? | BP <100 or drop by 40mm/Hg or a MAP of 65mmHg or less |
| What meds mask signs /symptoms of shock in elders ? | beta blockers |
| What should be considered with regards to temperature and elders with regards to shock ? | elders may lack febrile response , therefore trending is important |
| What should be considered with identifying shock and mental status in those who are elderly ? | do not confuse mentation changes with dementia |
| the nurse should promptly notify the primary provider if the patient exhibits any two of the three following signs: | Respiratory rate greater than or equal to 22 breaths/min Glasgow Coma Scale (GCS) score less than 13 Systolic BP less than or equal to 100 mm Hg p. 241 |
| What is the pulse pressure of a patient with a BP of 100/70 ? | 30 mm Hg |
| How might demands of oxygen of tissues be decreased ? (p. 241) | edating agents may be given to lower metabolic demands, or the patient’s pain may be treated with opioid, nonopioid, or sedating agents to decrease metabolic demands for oxygen. |
| if the BP improves with passive leg raise the patient is thought to be able to do what ? | respond to additional fluids p. 241 |
| True or False : heart failure can only occur in cardiac originating shock | false: the heart becomes dysfunctional, the body’s inability to meet increased oxygen requirements produces ischemia, and biochemical mediators cause myocardial depression |
| lack of blood supply in the progressive phase can lead to what heart condition/status ? | chest pain and/or MI |
| __________ __________ _________ is characterized by increased blood urea nitrogen (BUN) and serum creatinine levels, fluid and electrolyte shifts, acid–base imbalances, and a loss of the renal–hormonal regulation of BP | acute kidney injury |
| GI ischemia in progressive phase of shock can lead to what : | stress ulcers - risk for GI bleed, small intestine sloughing and necrosis causing bloody diarrhea; bacterial toxins can enter the blood stream |
| in _______________________widespread clotting and bleeding occur simultaneously. Ecchymoses and petechiae may appear on the skin | DIC p. 243 |
| __________________ stage of shock represents the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive | irreversible |
| Why are vasoactive medications given in all forms of shock ? | These medications help increase the strength of myocardial contractility, regulate the heart rate, reduce myocardial resistance, and initiate vasoconstriction. |
| how often are vitals taken when vasoactive medications are administered ? | at least every 15 minutes p. 246 |
| Patients in shock require more than ________________ calories per day | 3,000 |
| Inotropic agents' desired actions in shock are : | Improve contractility, increase stroke volume, increase cardiac output |
| examples of inotropic agents are : | Dobutamine Dopamine Epinephrine Milrinone |
| vasodilators desired actions in shock are: | Reduce preload and afterload, reduce oxygen demand of heart |
| examples of vasodilators are: | Nitroglycerin Nitroprusside |
| vasopressor agents' desired actions in shock are: | Increase blood pressure by vasoconstriction |
| examples of vasopressor agents are: | Norepinephrine Dopamine Phenylephrine Vasopressin Epinephrine Angiotensin II |
Created by:
Kelly Quijano
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