Shock 2

Question 1

stages of shock

Answer 1

1) initial
2) compensatory
3) intermediate
4) irreversible

Question 2

describe Initial stage of shock

Answer 2

• slight decrease in MAP (<10)
• flow to vital organs is maintained
• loose 1 L of fluid, body can compensate
• increased RR and diastolic BP
• vascular constriction and increased HR to maintain C.O.
• C.O and MAP are relatively maintained

Question 3

how does initial stage of shock appear

Answer 3

-little cold and clammy

Question 4

why is diastolic BP increased in initial stage

Answer 4

d/t shunting blood

more blood is going to the heart so diastolic increases about 10

Question 5

describe compensatory stage of shock

Answer 5

• nonprogressive
• MAP decreases 10-15 mmHg
• body does everything it can to save you
• kidneys and hormones activated
• heart rate is still elevated
• **ACIDIC and hyperkalemia

Question 6

once K reaches ______ the heart stops working

Answer 6

8

Question 7

can compensatory be reversed

Answer 7

yes, if stabilized

Question 8

during compensatory what are the kidneys doing

Answer 8

activate renin, angiotensin, aldosterone to conserve salt which conserves H2O and increases BP
RAAS, epi/norepi is also released

Question 9

describe why the environment is acidodic and hyperkalemic during compensatory

Answer 9

• build up of lactic acid d/t kidney not functioning
• RR attempting to blow off CO2 but cant
• the more acidodic, less Na pump can work , this increases K

Question 10

describe intermediate stage of shock

Answer 10

*progressive
less vital organs become anoxic
ischemia occurs
life threatening
sustained decrease in MAP (>20 mmHg)

Question 11

if nothing is done w/in _____ of intermediate shock, pt will die

Answer 11

1 hr

Question 12

what to do for pt in intermediate shock

Answer 12

1) start 2 large IV lines (1 L of NSS)
can hang blood w/ NSS, any drug is compatible with NSS, eventually give O negative blood
2) give oxygen (8-10 L high flow rate)
*oxygenation, protect airway: facemask, nonrebreather, intubate if gets worse
3) put them on monitor/EKG
4) put Foley in them

Question 13

additional things to do for pt in intermediate shock

Answer 13

start CKGs of abdomen, labs, ABGs (do them often, done by resp. therapist in artery)
eventually give meds

Question 14

describe irreversible shock

Answer 14

• refractory
• too much cell death/tissue damage has occurred
• therapy is not effective even if MAP returns to normal
• nothing can be done to fix/prevent death
• warm pt up to see if dead, check for brain wave activity, check ECHO to see if heart is moving
• if coded and started rigor mortus, stop attempting to revive

Question 15

if renal is affected then it is ______

Answer 15

MODS

Question 16

if in shock then change in _____

Answer 16

MAPS and decrease in BP

Question 17

process of how MODS occurs

Answer 17

1) injury
2) release toxins into plasma/bloodstream to fix area of damage
3) cytokines to stop bleeding in area and identify infection (cells fighting infection causes dilation)
4) vasodilaltion, decrease in BP
5) kidney, liver, lungs, brain
6) shock
7) MODS and death

Question 18

describe hypovolemic shock

Answer 18

too little circulation blood volume
decrease in MAP and O2
**low volume

Question 19

what to do for hypovolemic shock

Answer 19

1) start two large IV with saline
2) oxygen 8-10 L
3) blood if necessary
4) EKG
5) Foley
6) draw ABGs, labs, electrolytes
7) protect airway
8) start line (EJ or IJ)

Question 20

what does flail chest indicate

Answer 20

multiple ribs broken (>2)
lungs and chest collapse
**need chest tube

Question 21

what labs do you draw

Answer 21

4 tubes:

• red/jungle (red/green) are chemistry (K, Cl, CO2, glucose)
• purple: CBC, H & H, platelets, WBC
  green: lactate or ammonia
  blue: platelets, clotting factors (fluid will be in the tube for clotting)

Question 22

what tubes do you fill first

Answer 22

blue and purple to prevent clotting

Question 23

how do you draw up tubes

Answer 23

with 20 mL of fluid

Question 24

describe cardiogenic shock

Answer 24

• heart muscle is unhealthy and pump is impaired
• heart not working
• MI can be cause

Question 25

why is open heart surgery done

Answer 25

performed for CABG, valve replace, tumors, cardiogenic shock requiring revascularization, VAD placement

Question 26

what do you need to tell pt before OHS is done

Answer 26

- it WILL be PAINFUL after surgery - chest tubes following surgery (medial stinal) - may come back from surgery intubated (depends on stability) - get them UP ASAP after surgery, just wait until VS are stable - recovery time is ICU for two days

Question 27

what is the process of CABG procedure

Answer 27

1) heart stopped with K solution and then grafting begins 2) heart is rewarmed and observed for patency 3) epidcardial wires are placed and attached to an external pacemaker/pacer boxes 4) medistinal chest tubes placed, usually 4

Question 28

describe coronary artery bypass surgery

Answer 28

CABG - very common in pts >65 yrs - blockage is removed and the pts own venous or arterial blood vessel is used - before vessels are typically occluded >70%, cannot shunt to all vessels)

Question 29

what is the ejection fraction for effectiveness

Answer 29

>40%

Question 30

_____ % of pts remain pain free 5 yrs post CABG

Answer 30

70 %

Question 31

what is an internal mammary artery

Answer 31

artery used in CABG preferred artery if only 1 or 2 grafts are present

Question 32

what is a saphenous vein

Answer 32

in the leg thinner than artery swelling in the leg is typically after CABG

Question 33

want OHS to be ____, why?

Answer 33

<4 hrs long | longer bypass, greater risk for clots

Question 34

thick muscle tissue is scraped | heart will not beat effectively if occluded here

Answer 34

miectomy

Question 35

what is final product of CABG

Answer 35

take blood from aorta directly to arteries