NRS 440 - Exam 3 Already Passed!!!

shock - condition in which the CV system fails to perfuse tissues adequately life-threatening an impaired cardiac pump, circulatory system, and/or volume can lead to compromised blood flow to tissues inadequate tissue perfusion can lead to - generalized cellular hypoxia (starvation) widespread impairment of cellular metabolism tissue damage - organ failure death dx of shock - MAP 60 clinical s/s of hypoperfusion of vital organs -increased HR -hypothermia -agitation/confusion -restlessness MAP - (SBP + (2DBP))/3 compensatory mechanisms - sympathetic NS - adrenal response: -hormonal fight or flight response (increased HR/RR, and decreased perfusion) - renin angiotensin system & adrenal cortex (maintain CO/BP, and perfusion) renin-angiotensin system - decreased renal perfusion - releases renin - angiotensin I - angiotensin II (increase BP) - potent vasoconstriction & Na and H2O retention - ADH acts on renal tubules to retain H2O and increase BP adrenal response - anterior pituitary release adrenocorticotropic hormone (ACTH) - stimulates adrenal cortex to release glucocorticoids - blood sugar increases to meet increased metabolic needs stages of shock - 1) initial stage: tissues are under-perfused, decreased CO, increased ANAerobic metabolism, lactic acid is building 2) compensatory stage: reversible; SNS activated by low CO and BP, attempting to compensate for the decrease tissue perfusion 3) progressive stage: failing compensatory mechanisms: profound vasoconstriction from the SNS - *ISCHEMIA*; lactic acid production is high - metabolic acidosis (dramatic drop in BP) 4) irreversible or refractory stage: cellular necrosis and multiple organ dysfunction syndrome may occur - *death is imminent* blood pressure - pre-shock: near normal shock: SBP: 80-90 mmHg end-organ dysfunction: requires mechanical or pharmacological support heart rate - pre-shock: 100 bpm shock: 100-150 bpm end-organ dysfunction: erratic or asystole respiratory status - pre-shock: 20 bpm shock: rapid, shallow respirations - crackles end-organ dysfunction: requires ventilation skin - pre-shock: cold, clammy shock: mottled, petechiae end-organ dysfunction: jaundice urinary output - pre-shock: mildly decrease shock: severely decreased end-organ dysfunction: anuric, requires dialysis mentation - pre-shock: confusion shock: lethargy end-organ dysfunction: unresponsive acid-base balance - pre-shock: respiratory alkalosis shock: metabolic acidosis -cannot compensate; heart and kidneys show dysfunction first end-organ dysfunction: profound acidosis -complete support; bradycardia, tachypnea, arrhythmia geriatric considerations - beta-blockers will mask tachycardia and other compensatory measures immune system may not elicit a febrile response arrhythmias may be interpreted as a normal aging process changes in mentation may be interpreted as dementia generalized shock: VS - hypotensive (may be WNL or increased due to compensatory measures) MAP 60 mmHg tachycardia: weak and thready pulse tachypneic: blow off CO2 - respiratory alkalosis