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