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NUR 546 EXAM II- Shock, CRRT, SIADH & DI Latest Update
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NUR 546 EXAM II- Shock, CRRT, SIADH &DI Latest Update
Define shock - ANS inadequate tissue perfusion
Shock: Initial stage - ANS Not clinically apparent. Changes begin at the cellular level
where metabolism switches from aerobic to anaerobic, due to decreased perfusion &
O2 supply.
Shock: Compensatory Stage - ANSWER hypovolemia low BP & CO + imbalance of
supply/demand of O2 → SNS stimulation → tachycardia & tachypneic response →
shunting of blood away from the GI, kidneys, lungs, & skin (potential development of
increased BP related to aldosterone release = warm sepsis) → RAAS is stimulated → Na+
H2O retention → ADH is stimulated (through influence of high serum osmolality)→
increased circulatory volume & BP, CO
The body attempts to overcome the consequences of anaerobic metabolism in
maintaining homeostasis through neural, biochemical, and hormonal activation.
Patient A&O x4, restless, anxious, confused.
SHOCK : Progressive stage - ANSWER Low CO + BP → altered LOC → weak
pulses/ischemia of extremities → capillary permeability (systemic edema/anasarca) →
alveolar edema, crackles, tachypnea → GI ulcers/bleeding → AKI + oliguria, increased
BUN&Creatinine→ jaundice/liver enzymes → DIC risk → further decreasing perfusion
Shock: Refractory (Irreversible) stage - ANSWER impaired perfusion + O2 → Anaerobic
metabolism → lactic acid accumulation, contributes to capillary permeability → impaired
circulatory volume → impaired coronary BF + CO → impaired cerebral BF + ischemia
ensues → profound hypotension + hypoxemia → liver, lung, & kidney dysfunction →
accumulation of waste product → organ dysfunction → total body failure
, Cardiogenic Shock-ANSWER impaired systolic/diastolic function -> reduced CO, SV, +
BP -> decreased cardiac perfusion -> continued decline of CO, perfusion, and cardiac
function.
systolic dysfunction -> reduced CO/CI
diastolic dysfunction -> reduced SV
Hypovolemic Shock- ANSWER Inadequate volume of fluid in intravascular space to
maintain adequate perfusion. This can be absolute, or lost outside the body, or relative
hypovolemia where the fluid moves into the extravascular space-aka third spacing.
Obstructive Shock-ANSWER Obstruction to the cardiovascular system leads to a
reduction in blood flowing to the heart to ultimately perfuse vital organs. Obstruction
can occur by way of cardiac tamponade, hemothorax/pneumothorax, or non-cardiac
causes.
Distributive Shock- neurogenic, anaphylactic, & septic shock ANSWER generalized
vasodilation & increased capillary permeability (the increased permeability accounts for
the decreased SVR values)
Neurogenic shock ANSWER Circulatory failure due to paralysis of the nerves that
control the diameter of the blood vessels, which causes widespread dilation; seen with
patients who have had spinal cord injuries.
Anaphylactic shock - ANSWER Severe reaction when an allergen is introduced to the
blood stream of an allergic individual. Characterized by bronchoconstriction, labored
breathing, widespread vasodilation, circulatory shock, and sometimes sudden death.
Septic shock - ANSWER Lifethreatening syndrome in response to infection,
characterized by persistent hypoperfusion despite fluid resuscitation attempts.
Reaction to infection is exaggerated
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