Shock - MedSurg II Test 4
Terms in this set (37)
Necessary MAP for tissue and organ perfusion
60 - 70
Mean Arterial Pressure
(MAP)=[(2x DP) + SP]/3
Baseline MAP decreases < 10 mm Hg
Heart and respiratory rates WNL
Slight ↑ diastolic BP
Adaptive mechanisms are effective at maintaining tissue perfusion.
Cellular metabolism remains aerobic despite lactic acid production
initial/early stage of shock
MAP decreases 10-15 mm Hg
Cardiac rate ↑
"Fight or Flight"
Catecholamines (epinephrine and norepinephrine) are released through stimulation of the sympathetic nervous system
The body shunts blood from skin, kidneys, GI to heart & brain.
compensatory/nonprogressive stage of shock
Subjective clinical manifestation of compensatory/nonprogressive stage of shock
8 objective clinical manifestations of compensatory/nonprogressive stage of shock
Altered Mental Status: anxiety, confusion or combativeness
Skin is cool and clammy
Bowel sounds hypoactive
Urine output ↓
↑ respirations, 2-5% ↓ O2 saturation
↓ systolic BP
Arteriolar dilation ↑
(Prognosis is good if treated at this stage.)
Sustained with decrease in MAP >20 mmHg from baseline.
Adaptive/compensatory mechanisms cannot maintain sufficient oxygenation to vital organs.
Vital organs develop hypoxia and less vital organs will become anoxic and ischemic.
Progressive/Intermediate stage of shock
2 subjective clinical manifestations of progressive/intermediate stage of shock
Extreme anxiety, "impending doom"
9 objective clinical manifestations of progressive/intermediate stage of shock
Cool, moist skin
Cyanosis to skin and oral mucosa, nail beds
Rapid, weak pulse
5%- 20% ↓ in O2 saturation
(THESE CONDITIONS ARE LIFE THREATENING AND MUST BE REVERSED WITHIN 1 HOUR!)
Organ damage is overwhelming.
The body cannot respond to interventions.
Therapy may reverse the cause and correct MAP, but tissue damage cannot be corrected.
refractory/irreversible stage of shock
5 clinical manifestations of refractory/irreversible stage of shock
Rapid loss of consciousness
Cold, mottled, dusky extremities
Slow, shallow respirations
Immeasurable oxygen saturation (O2 Sat).
4 types of shock
Loss of blood volume from the vascular space which ↓ the MAP → slows blood flow → ↓ tissue perfusion.
Loss of oxygen carrying capacity from circulating RBCs.
Leads to cellular anaerobic conditions and abnormal metabolism.
causes of hypovolemic shock
dehydration and hemorrhage
what to use to rehydrate hypovolemic shock?
Crystalloids: NS, LR, Hypertonic Saline (3%, 5%, 7.5%)
Colloids: Albumin, blood products
3 drugs used to treat hypovolemic shock
Occurs when the heart's ability to contract and pump blood is impaired.
Cardiac output, a function of stroke volume and heart rate is compromised, leading to impaired tissue perfusion and fluid accumulation in the lungs.
non-coronary causes of cardiogenic shock
Metabolic: hypoxemia, acidosis, hypoglycemia, hypocalcemia
3 clinical manifestations of cardiogenic shock
a polyethylene balloon mounted on a catheter, which is generally inserted into the aorta through the femoral artery in the leg. The pump is available in a wide range of sizes (2.5 cc to 50 cc) that will fit patients of any age and size. The balloon is guided into the descending aorta, approximately 2 cm from the left subclavian artery. At the start of diastole, the balloon inflates, augmenting coronary perfusion. At the beginning of systole, the balloon deflates; blood is ejected from the left ventricle, increasing the cardiac output by as much as 40 percent and decreasing the left ventricular stroke work and myocardial oxygen requirements. In this manner, the balloon supports the heart indirectly.
Intra-aortic Balloon Pump (IABP)
IABP is used in __________ shock
5 drugs used to treat cardiogenic shock
Results from fluid shifting from central vascular space.
Total body fluid is normal or increased.
Caused by blood vessel dilation or
↑ permeability or pooling of blood in
capillary or venous beds.
Results in ↓ MAP
4 causes of neural induced distributive/circulatory shock
3 causes of chemical induced distributive/circulatory shock
Capillary leak (burn, hepatic dysfunction, hypoproteinemia)
8 clinical manifestations of distributive/circulatory shock
-Skin is cool and clammy
-Bowel sounds hypoactive
-Urine output ↓
-↑ respirations, 2-5% ↓ O2 saturation
-↓ systolic BP
HOB >___ degrees for neurogenic shock
A complex type of distributive shock that generally begins as a bacterial or fungal infection and progresses to a dangerous condition over a period of days.
Localized infection does not normally lead to shock in the healthy individual.
widespread infection coupled with a general inflammatory response.
Systemic Inflammatory Response Syndrome (SIRS), triggered when infection is out of control.
↓ urine output per intake (compensatory)
↑ RR (compensatory)
↓ cardiac output
Temperature can be normal, high or below normal
WBC count ↑ as any systemic infection
Microthrombi begin to form within the capillaries of some organs, causing some cell hypoxia and reducing organ function.
If stopped at this point, organ damage is reversible
Progression of sepsis with an amplified inflammatory response.
All tissues have some hypoxia.
Some organs are experiencing cell death and dysfunction.
DIC is occurring
May be present over 24 hours and still missed.
Blood pooling & capillary leak stimulate the heart and cardiac output is increased with ↑HR and BP, extremities feel warm, pt "looks" better.
WBC count may be lowered to WNL.
Multiple organ failure is evident
Even with appropriate treatment death occurs to >60% of patients.
Lack of available clotting factors
Capillary leak continues
know slide 38 in shock powerpoint
know slide 38 in shock powerpoint
12 predisposing factors to sepsis
Large open wounds
Over 80 years old
Infection with resistant organisms
interventions for septic shock
Drug therapy to enhance cardiac output and restore vascular volume, adrenal insufficiency, hyperglycemia and clotting problems.
-Low dose corticosteroids for adrenal insufficiency caused by the stress of severe sepsis.
-Maintain blood glucose levels < 150 mg/dL
-Activated protein C to manage microvascular abnormalities
Blood replacement therapy
Caused by problems that prevent the normal heart muscle from pumping effectively.
Most common causes: pericarditis & cardiac tamponade
a CONDITION where the cardiovascular system fails to perfuse the body tissues adequately, bringing about widespread disruption of cellular metabolism, resulting in functional disturbances at organ/tissue level.