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NUR 305- Shock

Terms in this set (22)

Initial stage of shock
Sudden drop in perfusion
SNS and RAAS- attempts to maintain CO and BP
SNS increases HR and constricts vessels
Increased renin causes vasoconstriction
Patient is anxious, pale, cold/clammy extremities
Shock is still reversible in this stage
progressive stage of shock
Blood is shunted from lungs, kidney, gut, pancreas, liver (SHOCK KILLS KIDNEYS)
Organs become ischemic and begin to fail
Brain and heart receive the shunted blood
irreversible stage of shock
Heart and brain become ischemic
Widespread cellular hypoxia and anaerobic metabolism
(pH below 6.8 is very likely to result in mortality)
shunting
the body will vasoconstrict in the areas deemed not critical in order to maintain perfusion to the trifecta (heart, lungs, and brain)
consequences of shock
Inflammatory response:
-Increased inflammatory response and demand for oxygen from WBC activation
Lactic acidosis:
-Anaerobic metabolism and renal failure
GI consequences:
-Loss of abdominal organ function
Hormone release:
-Epinephrine and cortisol released in large amounts and lead to hyperglycemia
Activation of coagulation system:
-Propensity for blood clot formation
types of shock
Hypovolemic
Distributive (neurogenic, anaphylactic, septic)
Cardiogenic
Obstructive
hypovolemic shock
Caused by the loss of blood, plasma, or extracellular fluid in large amounts (>20%)
Examples:
-hemorrhage, burns, third-space losses, severe dehydration
Compensatory mechanisms:
-Absorption of fluids from interstitial spaces, conservation of water and sodium, thirst
-Vasoconstriction (RAAS) and increased HR (SNS)
hypovolemic shock manifestations
Tachycardia
Increased thirst
Decreased arterial blood pressure
Cool, clammy skin
Decreased urine output (<30 mL/hr)
Cyanosis
Changes in mental status
Poor skin turgor:
-Depends on severity of volume loss
cardiogenic shock
SEVERE HYPOTENSION (<90/30)
Decreased CO
Hypotension
Hypoperfusion
Tissue Hypoxia
May occur suddenly
Causes
Severe MI
Cardiac tamponade
Arrhythmias
cardiogenic manifestations
Cyanosis
Decreased MAP and SBP
Decreased Urine Output (UO)
Increased preload (high CVP)
Altered Mental Status
Possible tachycardia (depends on cause)
obstructive shock
A circulatory shock that results from a mechanical obstruction of the blood flow through the central circulation
Examples: Dissecting aortic aneurysm, Cardiac Tamponade, Pneumothorax, Pulmonary embolus
Causes increased pressures in right side of heart
dissecting aneurysm
internal lining of vascular sheds collapses and creates obstruction
distributive shock
Loss of blood vessel tone, enlargement of the vascular compartment, and displacement of the vascular volume away from the heart and central circulation.
Causes: decrease in sympathetic control of vasomotor tone; release of excessive vasodilator substances
Shock states related to distributive shock: neurogenic shock, anaphylactic shock, and septic shock
neurogenic shock
Loss of SNS innervation
Causes:
-Trauma to spinal cord or medulla
-Depressive drugs, anesthetics
-Severe emotional stress
-Severe pain
Symptoms:
-Very low blood pressure (severe vasodilation)
-Bradycardia
-Fainting
-Warm and dry skin
anaphylactic shock
Severe allergic reaction
IgE stimulates a large reaction that impacts the whole body (histamine, bradykinin, complement system, prostaglandins)
Causes: exposure to allergen
anaphylactic shock manifestations
Apprehension, anxiety
Itching
Respiratory distress, laryngeal edema, bronchospasm, angioedema, stridor
Hives, burning of the skin
Circulatory collapse from massive vasodilation
Contraction of GI and uterine smooth muscles
systemic inflammatory response syndrome (SIRS)
Overwhelming inflammatory reaction from insult to the body
SNS and endocrine reaction
Many organs inflamed
Tachycardia, Tachypnea, Hyper or Hypothermia, Leukocytosis or Leukopenia
MODS
multiple organ dysfunction syndrome
sepsis
Systemic infection
Immune system depression from SIRS response can lead to infection
Severe multi-organ compromise
Alteration in mental status, hypoxemia, increased lactate levels, oliguria
septic shock
Severe sepsis with severe hypotension
Profound vasodilation, fluid shifts into tissues, outpouring of epinephrine and cortisol, microthrombi
Leads to extensive tissue ischemia throughout body
septic shock manifestations
Hypotension
Hypovolemia
Hypoxia
Tachycardia
Temperature instability
Renal dysfunction
Liver failure: jaundice, clotting issues
Change in mental status
Tachypnea
Metabolic acidosis
complications of septic shock
Pulmonary Injury (ALI/ARDS)
Acute Kidney Injury
Gastrointestinal Ulceration
Disseminated Intravascular Coagulation (DIC)
Multiple Organ Dysfunction Syndrome
Two or more organs severely injured
Death!
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