PN3 EXAM 3 STUDY GUIDE
Shock Syndromes:
Shock is a systemic condition where there is an imbalance between the oxygen supply to the tissues/organs and the oxygen needs of those tissues/organs. There are different types of shock. Any situation that decreases vascular volume, blood pressure, or card...
shock syndromes shock is a systemic condition where there is an imbalance between the oxygen supply to the tissuesorgans and the oxygen needs of those tissuesorgans there ar
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PN3 EXAM 3 STUDY GUIDE
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PN3 EXAM 3 STUDY GUIDE
Shock Syndromes:
Shock is a systemic condition where there is an imbalance between the oxygen supply
to the tissues/organs and the oxygen needs of those tissues/organs. There are different
types of shock. Any situation that decreases vascular volume, blood pressure, or cardiac
function can lead to shock.
Shock can be divided according to the cause. There are three main types of shock.
Distributive shock is further divided into another three categories.
Cardiogenic: pump (heart) failure
Hypovolemic: lack of circulating volume
in the vascular space Distributive:
alteration in the vascular bed size
● Neurogenic: impaired sympathetic nervous system
● Anaphylactic: hypersensitivity response due to antigen-antibody reaction
● Septic: Due to
systemic infection
Complications of each type
● Multiple Organ Dysfunction Syndrome (MODS)
● Disseminated Intravascular Coagulation (DIC)
● Acute respiratory Distress
Syndrome (ARDS) Treatment goals
of each type
● Identify and treat the underlying cause
● Deliver oxygen to the tissues
● Maintain Circulation
● Monitor for complications
● Provide comfort and
emotional support 4 stages of
shock:
● Initial: decreased CO and impaired tissue perfusion
● Compensatory: activation of sympathetic nervous system (SNS)
● Progressive: every system in the body is affected and MOD happens
● Refractory: body will no longer respond to therapy
SIRS is a clinical response to a nonspecific insult. Regardless of the etiology of the insult,
the body responses are similar. If the process cannot be contained by the innate counter-
inflammatory response, there is an increased activation of the inflammatory cells,
including release of neutrophils, macrophages, and lymphocytes; and additional
damage to the vascular epithelium, deterioration in distribution of nutrients to the
organs, and subsequent complication of multiple organ dysfunction syndrome
(MODS) or multiple organ failure (MOF). Conditions commonly associated with SIRS
include infection, pancreatitis, ischemia, trauma, hemorrhagic shock, aspiration of
, gastric contents, massive transfusions, and host defense deficiencies It is essential that
you assess all patients at risk for SIRS, especially for the cardinal signs of the body’s
inflammatory response. At least two or more of the following findings will be present
in SIRS:
● Change in temperature either higher than 38° C (100.4° F) or lower than 36° C
(96.8° F)
● Pulse greater than 90 beats per minute
● Respiratory rate greater than 20 breaths per minute or a partial pressure of
carbon dioxide (PC02) less than 32 mm Hg
● White blood cell (WBC) count higher than 12 × 103/mm3, or with more than
10% band cells
BOX 65-3: ASSESSMENT AND DIAGNOSIS OF SHOCK
Common clinical manifestations of the shock syndrome will vary according to the
underlying cause, the stage of shock, and the individual person’s response to shock. The
exact course of events can be variable. Each person must be assessed individually prior to
any intervention:
● Regardless of the type of shock, it leads to a systolic blood pressure (SBP) of
less than 90 mm Hg and the narrowing of pulse pressure that is inadequate
to meet the tissue needs. (SBP may be elevated initially.)
● Early shock symptoms are subtle, requiring close surveillance to avoid
overlooking their presence.
● All persons in shock are at risk of deterioration in status. Prompt intervention is
required.
● Nurses must have a clear understanding of the pathophysiology of the different
etiologies of shock.
● In all instances of shock following a trauma incident, consider hypovolemia or
hemorrhage unless proven otherwise.
● Shock is a frightening experience for the patient and family. Effective
psychological support is essential.
Symptoms include:
● Hypothermia
● Tachycardia or bradycardia
● Rapid thready pulse, slow capillary refill, or collapse of superficial veins in
extremities
● Altered mental status—dissociation from normal thought processes,
detached, a feeling of numbness, and impaired sensory- emotional response.
Loss of consciousness, restlessness, anxiety, irritability, and weakness may
be present.
● Clinical findings correlated with organs compromised by inadequate
oxygen supply and the phases of the shock syndrome. Examples:
○ a. Skin: cold, clammy, cyanotic, poor capillary refill, or warm dry skin
due to pooling of blood in extremities.
Cyanosis (circumoral, earlobes, finger tips, or toes).
○ b. Kidneys: decreased urine output; anuria, or oliguria.
○ c. Lungs: dyspnea, crackles, or wheezes.
○ d. GI system: thirst, dry mucous membranes; nausea and vomiting; or
decreased bowel sounds.
Acute Coronary Syndrome:
Unstable Angina (VS stable angina)
● Unstable angina: condition in which your heart doesn’t get enough blood flow
, and oxygen--may lead to a heart attack. DO NOT KNOW THE TRIGGERS
● Stable angina: chest pain or discomfort that most often occurs with activity or
emotional stress. KNOW WHAT
POTENTIAL TRIGGERS ARE. Usually a chronic condition that causes stable
angina.
Non ST segment elevation myocardial infarction (NSTEMI)--> Indicates a partial
thickness injury to the heart muscle. Less severe than a STEMI. Partial occlusion of a
major coronary artery
ST segment elevation myocardial infarction (STEMI)--> indicates a full thickness
injury of the heart muscle.
Assessment of chest pain:
Including: Special populations assessment:
elderly, women Onset: When did the pain begin?
Location: Where is the pain?
Duration: How long does the pain last?
Characteristics:Describe the pain? Crushing, stabbing, ingestion like, dull, ache for
example
Associating Factors: Other symptoms associated with the pain such as
nausea and/or vomiting, weakness, fatigue, breathlessness, syncope, cold and
clammy?
Relieving Factors/Radiation: Does the pain radiate such as down the arm, up into the
neck for example? Relieving factors: pain stops when activity ceases, relieved by sitting
forward or resting?
Treatment/Temporal factors: Use of GTN, pain was relieved by rest or decrease in
physical activity. Pain non comparable to previous ischemic chest pain
Severity (Intensity): A numerical scale (1 no pain- 10 worse pain experienced ) is used to
gauge pain severity
Older adults: Typical chest pain→ Usually intense and unremitting for 30-60
minutes. Is retrosternal and often radiates up to the neck, shoulder, and
jaws, and down to the left arm. The chest pain is usually described as a
pressure sensation that can be perceived as squeezing, aching, burning, or
even sharp. Anxiety, lightheadedness, cough, nausea, profuse sweating,
shortness of breath, wheezing, rapid or irregular heart rate,
fullness/indigestion/choking feeling
Women may or may not experience chest pain but may experience any of the
symptoms above.
● Place one nitroglycerin tablet under the tongue and
allow to dissolve. (Do not chew or swallow.)
● Tablet will cause a tingling sensation, heart pounding,
flushing, and headache.
● Stay in resting position for 15 to 20 minutes and get up
slowly after taking nitroglycerin to prevent fainting from
postural hypotension.
● If angina is not relieved in five minutes, the dose may be
repeated two times at five-minute intervals for a total of three
doses.
● If angina is not relieved after two doses, seek immediate
medical attention.
● Report angina that increases in frequency, lasts longer,
limits previous level of activity, and occurs at rest.
● Carry tablets at all times in the original prescription container.
Pharmacology→(what Jenni told us to remember) MONA (Morphine,
Oxygen, Nitro, Ativan)
Antiplatelet agents-
Aspirin, Varopaxar
Nitrates-relax smooth
muscles
Analgesics-Morphine-decreases sympathetic stress, in addition to providing some
preload reduction.
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