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Different Types of Shock
Terms in this set (29)
What is seen on a pt with septic shock?
-increased temp initially
-high CO/CI initially then low
-full bounding pulse
What is the medical management for septic shock?
eradicate the cause
reverse pathophysiologic responses
promote metabolic support
What are the interventions for septic shock?
within 3 hours: measure serum lactate, obtain blood cultures prior to antibiotics, administer broad-spectrum antibiotics within 1 hour, 30 mg/kg crystalloid for hypotension
care of intra-arterial catheter for BP monitoring
follow guidelines for norepinephrine, epinephrine, vasopressin, dopamine, and dobutamine
IV hydrocortisone if unable to restore stability
RBC and platelets if needed
intubation and ventilation with PEEP for ARDS
monitor BS and administer insulin to keep BS > 180
monitor UOP for prn hemodialysis
NO SODIUM BICARB WITH LACTIC ACIDEMIA
What position should a pt with septic shock be in?
prone with HOB 30-45 degrees
Describe hypovolemic shock
loss of circulating or intravascular volume
decreased SV and CO
inadequate fluid volume in intravascular space
What are risk factors for hypovolemic shock?
loss of bodily fluids (decreased body fluids, GI bleeding, N/V/D, DI, diuresis, plasma loss through burns)
What are the manifestations of hypovolemic shock?
-poor skin turgor
-low systemic and pulmonary preloads
When is the diagnosis of hypovolemic shock made?
after a loss of 15% intravascular volume
What is seen on assessment for a pt with hypovolemic shock?
decreased CO and CI
decreased CVP and PAOP
loss of peripheral pulses
cyanotic, mottled skin
decreased mental status
marked peripheral vasoconstriction
How is hypovolemic shock managed?
-correct the cause
-restore perfusion (fluid resuscitation)
-limit fluid loss
Describe cardiogenic shock
failure of heart to pump effectively which leads to decreased in SV and increase in blood left in ventricle at the end of systole
problem with the heart itself
What are the causes of cardiogenic shock?
What are the manifestations of cardiogenic shock?
anxiety and delirium
decreased cardiac output
dusty skin color
narrow pulse pressure
cool, moist skin
For a pt with cardiogenic shock, what is seen decreased on assessment?
diminished heart tones
weak ,thready, fast pulse
For a pt with cardiogenic shock, what is seen increased on assessment?
How is cardiogenic shock treated?
-intra-aortic balloon pump
Describe anaphylactic shock
type of distributive shock, result of an immediate hypersensitivity reaction
What are risk factors for anaphylactic shock?
-diagnostics, biologic, and environmental agents
What does the immune reaction cause when a pt goes into anaphylactic shock?
-increased capillary permeability
-excessive mucus secretion
What are the manifestations of anaphylaxis shock?
feeling of apprehension
tightness in throat
tingling in mouth, face, or throat
loss of consciousness
What is seen on assessment for a pt in anaphylactic shock?
restless, apprehensive, decreased LOC
For a pt with anaphylactic shock, what is seen decreased on assessment?
How is anaphylactic shock treated?
-remove offending antigen
-2nd line (Benadryl, corticosteroids)
-IV fluids, inotropes, and vasoconstrictors
-ensure adequate airway
How is epinephrine given for a pt in mild anaphylactic shock?
0.2 mg- 0.5 mg of a 1:1000 dilution
How is epinephrine given for a pt in severe anaphylactic shock?
0.05-0.1 mg of a 1:10,000 dilution IV
Describe obstructive shock
indirect pump failure - cardiac function decreased by non cardiac factor OCCURS OUTSIDE THE HEART
What are causes of obstructive shock?
What is seen on assessment for a pt with obstructive shock?
How is obstructive shock managed?
maintain BP while treating underlying cause
volume replacement with crystalloids
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