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Flashcards in Week 4 - SHOCK Deck (62)
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31

SYMPATHETIC NERVOUS SYSTEM (SNS) maintains the smooth muscle surrounding the arteries and arterioles in a state of partial contraction called ____________

sympathetic tone

32

In the absence of sufficient O2, cells revert to using ___________ metabolism to create energy

anaerobic

33

Three (3) Stages of shock

1) Early, reversible & compensatory 2)Intermediate or Progressive (Uncompensated) 3) Refractory or Irreversible

34

This process indicates that anaerobic metabolism is occurring in the body

Elevated Serum Lactate

35

Define "Cardiac Output" What is the FORMULA?

the amount of blood (L/min) pumped per minute into the aorta by the left ventricle. Cardiac Output = Stroke Volume x Heart Rate

36

Respiratory support for Shock

GOAL: increase the amount of O2 carried by the hemoglobin in the blood 1) continuous pulse-ox monitouring 2) frequent respiratory assessments 3) Mechanical ventilation if respiratory failure occurs

37

Mean Arterial Pressure (MAP)

Average Pressure in the arterial circulation throughout the cardiac cycle. *it is the product of CARDIAC OUTPUT and Systemic Vascular Resistance (SVR) **CO, SVR, or total blood volume rises conversely so does your MAP and tissue perfusion **CO, SVR or total blood volume falls-- then MAP and tissue perfusion also decrease

38

Three factors that make up "Stroke Volume"

1) Preload 2) Afterload 3) Contractility

39

Anaerobic metabolism leads to the production of ________

Lactic acid

40

(9) Nursing Management of Stage 2 shock (Intermediate / Progressive-Uncompensated)

  • Pt needs to be closely monitored in ICU
    • Invasive hemodynamic monitoring (CVP)
    • Telemetry monitoring (Continuous ECG)
    • ABG's (watching their PH and acidotic state)
    • ELECTROLYTES (b/c they become altered in an acidotic state)
    • PHYSICAL and MS changes (improving or worsening mental status?)
  • RAPID & FREQUENT ADMIN OF MEDS & FLUIDS
    • Usually require vasopressors with titration
  • SUPPORTIVE THERAPIES (IF OUR ORGANS BEGIN TO FAIL)
    • Mechanical Ventilation (respiratory failure)
    • DIalysis (renal failure)
  • NURSE NEEDS EXPERTISE IN ASSESSING AND UNDERSTANDING THE SIGNIFICANCE OF CHANGES IN DATA

41

Widening pulse pressure is consistent with ________ Narrow pulse pressure is consistent with _________ and ______________

Septic shock hypovolemia, cardiogenic shock

42

 

Nursing Management of Stage 3 shock

(Irreversible Shock)

  • SAME TX AS FOR THE SECOND STAGE
  • Monitoring patient
  • Preventing complications
  • Protection from injury
  • Providing comfort / dignity
  • Communication with family about outcome ***explain about what is happening **Offer opportunities to see, touch, talk **Spiritual advisors visitation

43

Stimulation of ALPHA 1 adrenergic receptors is responsible for ….?

Stimulation of this receptor site causes vasoconstriction of: Arterioles of skin viscera | mucous membranes

44

NORMAL aPTT (lab value)

< 35 seconds

45

 

PROGRESSION INTO STAGE 2 

  1. Body loses the ability to compensate
  2. Clinical signs become more obvious (pt becomes symtomatic)
  3. Inflammatory response activated (can lead to ARDS)
  4. Decreased perfusion leads to extracellular acidotic state (metabolic acidosis)
  5. Coagulation become impaired
  6. AGGRESSIVE TX IS ESSENTIAL TO SURVIVAL OF THE PATIENT
  7. Sustained decrease in MAP of 20 mmHg or more below normal level
  8. Fluid loss of 35% - 50%

46

EARLY INTERVENTION AT THIS STAGE CAN PREVENT PROGRESSION TO SHOCK

EARLY / COMPENSATED SHOCK

47

TRUE / FALSE ANY CONDITION THAT COMPROMISES OXYGEN DELIVERY TO ORGANS AND TISSUES CAN LEAD TO SHOCK

TRUE

48

Explain process of anaerobic metabolism (5)

1) Absence of sufficient O2-->cells revert to anaerobic metabolism 2) Anaerobic metabolism leads to the production of lactic acid 3) This creates an acidotic intracellular environment 4) This increases capillary permeability 5) This permeability causes LEAKAGE of intracellular components which leads to increased extracellular acidosis.

49

PRELOAD vs AFTERLOAD

  • PRELOAD
    • vOLUME OF BLOOD IN VENTRICLE JUST BEFORE IT CONTRACTS
  • AFTERLOAD
    • THE PRESSURE THE HEART HAS TO OVERCOME IN ORDER TO GET BLOOD OUT (vasculature)

 

50

When our Systemic Vascular Resistance is very high--(meaning that we are very clamped down and vasoconstricted) then our afterload is very ____________

HIGH

51

PRELOAD is INCREASED in what types of situations?

*hypervolemia

*regurgitation of cardiac valves

*Heart failure

52

AFTERLOAD is INCREASED in what types of situations?

*Hypertension

*Vasoconstriction

 

 

INCREASED AFTERLOAD = INCREASED CARDIAC WORKLOAD

 

 

 

53

54

In the early stages of shock the body is doing things to BOOST cardiac output and the body releases excessive amounts of EPINEPHERINE and NOREPINEPHERINE. These are natural VASOPRESSORS that assist in boosting HR and CO.  What are the neurological S/S that the patient will begin to demonstrate?

 

ANXIETY

CONFUSION

RESTLESSNESS

55

what is the PULSE PRESSURE OF 120 / 80

Pulse Pressure = 40

56

__________________ suggests significant blood loss and if often one of the 1st signs of SHOCK.  Often the results of increasing diastolic pressure from compensatory cetecholamine release

 

100/66              100/74                     100/84

 

Narrowing Pulse Pressure

57

58

one of the ways that the body attempts to fix 
ACIDOSIS is to...

increase the rate of breathing and blow that CO2 off

59

 

CARDIAC OUTPUT (CO)

 

AMOUNT OF BLOOD PUMPRED PER MINUTE INTO THE AORTA BY THE LEFT VENTRICLE

 

CO  =  SV  *  HR

60

 

 

Mean Arterial Pressure (MAP)

 

Average pressure in the arterial circulation throughout the cardiac cycle

 

MAP  =  CO  *  SVR