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Flashcards in Week 4 - SHOCK Deck (62)
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1

_____________ sympathetic stimulation increases vasoconstriction and systemic vascular resistance

increased

2

Nutritional Support for shock patient 1) GOAL 2) interventions

GOAL: Maintain caloric requirements 1) Parenteral or enteral nutrition shoulds be started asap

3

Elevated Serum Lactate Level?

> 2 mmol/L

4

As a result of REDUCED cardiac output...a narrowing pulse pressure is often consistent with ….(2)

1) hypovolemia 2) cardiogenic shock

5

S/S of Stage 1 (Early / Compensated Shock)

  • NEURO: Anxiety, confusion, restlessness, altered mental status
  • CARDIAC: BP often remains normal and helps to maintain adequate CO and vascular tone (hypotension typically begins in stage 2)
    • VASOCONSTRICTION (narrow pulse pressure- distance between systolic / diastolic)
    • INCREASED HR (slight tachycardia)
    • INCREASED CONTRACTILITY (bounding central pulses)
  • RESPIRATORY
    • SLIGHT INCREASE IN RATE

EARLY INTERVENTION AT THIS STAGE CAN PREVENT PROGRESSION TO SHOCK

6

Whys is nutrition a critical component when treating a SHOCK patient.

-Shock increases metabolic rates d/t catecholamine. -This leads to an INCREASED CALORIC NEED by the body -If nutrition is NOT maintained the body will break down the skeletal muscle to accomodate the increased need -Loss of skeletal muscle prolongs recovery time

7

Condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function

SHOCK

8

 

S/S of Stage 3

(Irreversible Shock)

  • NEURO: Obtunded, Stuporous, Comatose or unresponsive
    • Obtunded: responds slowly to external stimuli. needs repeated stimulation to maintain attention and response to the environment
    • STUPOROUS:responds minimally with vigorous stimulation
    • Comatose:  no observable response to external stimuli

 

  • CARDIAC: Bradycardia with arrhythmias.  Severe Hypotension MAP < 60 mmHg despite therapy

 

  • RESPIRATORY: Bradypnea w/Shallow breaths (Cheynes Stokes)
  • INTEGUMENTARY: Coagulopathies with petechiae purpura, or bleeding

9

TRUE | FALSE The Body uses a variety of compensatory mechanisms to restore blood flow

TRUE

10

Stimulation of BETA 1 adrenergic receptors leads to:

*increased heart rate *increased myocardial contractility *increased rate of conduction through the AV NODE *activation of the receptors in the kidney leads to the release of renin.

11

 

Nursing Management of Stage 1 shock (Early / compensatory)

  1. Assess and identify the cause of shock
  2. Correct underlying disorder
  3. Initiate measures aimed at supporting the bodys compensatory mechanism
  4. Fluid and medication therapy
  5. Monitor hemodynamic status
    1. Vital signs
    2. LOC
    3. Urinary output
    4. Skin temp/color
    5. peripheral pulses
    6. lab values

12

decreased systemic stimulation allows___________, which decreases systemic vascular resistance

vasodilation

13

Stimulation of BETA 2 adrenergic receptors leads to...

-Bronchial stimulation leads to bronchodilation *activation of receptor in uterine * activation of receptors in the liver causes a breakdown of glycogen into glucose *Skeletol muscle receptor activation, leads to muscle contraction which can lead to seizures

14

STROKE VOLUME

Amount of blood pumped into the aorta with each contraction of the left ventricle

15

Goals (6) of patient care in Stage 2

  • INTERVENTIONS SHOULD DEPEND ON THE TYPE OF SHOCK AND ITS UNDERLYING CAUSE
  • Optimize intravascular volume
  • Support the pumping action of the heart (Using medication and\or therapy)
  • Improve competence of the vascular system (meds that assist with vasoconstriction / vasodilation)
  • support the respiratory system
  • Continual assessment and reassessment of the bodys response to interventions
  • Involve patient and family in the plan of care---end of life issues--expected outcomes

16

Stage where Lactic Acid moves out of the intracellular and into the intravascular places

Stage 2

17

Lactic acid production creates an _______________ intracellular environment which creates capillary permeability (aka: leaky cells). The increased capillary permeability causes the intracellular components to become extracellular components---leading to a metabolic state called __________ ___________

acidotic METABOLIC ACIDOSIS

18

One of the most important factors in decreasing the probability a patient will end up in shock?

EARLY DETECTION **we must be able to recognize subtle as well as obvious signs

19

what is "Stroke Volume" ?

amount of blood pumped into the aorta with each contraction of the left ventricle.

20

To maintain cellular metabolism- the cells of all body organs and tissues require a regular and consistent supply of__________and removal of ___________

oxygen metabolic wastes

21

Patient with good perfusion uses _________ metabolism to create energy

aerobic

22

NORMAL PT (Pro Thrombin)

10-15 seconds

23

NORMAL INR Lav values

1 - 1.2 seconds

24

S/S of Stage 2

(Intermediate / Progressive-Uncompensated)

  • NEURO
    • Decreasing LOC
  • CARDIOVASCULAR
    • Obvious Tachycardia >100 bpm
    • DECREASED BLOOD PRESSURE (hypotension)
      • d/t epinepherine / norepinepherine starting to wear out
    • Weak Thready Pulses (difficult to palpate)
    • Cool, Clammy, cyanotic skin (d/t peripheral vasoconstriction)
  • RESPIRATORY
    • Rapid, shallow breaths (body attempting to blow off CO2 and balance out the high lactic acid level)
  • LABS
    • Elevated Lactate Levels >2 mmol/L
    • (this increase is indicative of anerobic metabolism occurring in the body)

 

25

 

Progression into STAGE 3 (refractory / irreversible shock)

  • Happens when tissue perfusion cannot be restored

 

  • Organ damage from anoxia and cellular death can become so severe that the patient cannot survive despite all treatments provided

26

With regard to the vascular system.,,,the vessels in the body need to have good "tone". What is tone?

Tone is the ability to constrict or dilate to maintain normal pressure

27

difference between systolic and diastolic blood pressure

pulse pressure

28

Progression of SHOCK in "5" steps:

1) Poor delivery of O2 and nutrients to cells 2) Cellular starvation 3) Cell death 4) Organ dysfunction 5) Organ failure and death

29

(true | false) Bodies do NOT function well in a acidotic state

TRUE

30

Adequate Tissue Perfusion requires (3)

1) Adequate Cardiac Pump 2) Effective vasculature &amp; circulatory system 3) Sufficient blood volume **IF ONE OF THESE IS IMPAIRED, TISSUE PERFUSION IS THREATENED AND\OR COMPROMISED