Medical Surgical Nursing

Medical-Surgical Nursing What is Shock? - Inadequate tissue perfusion that impairs cellular function and may lead to organ failure. What part of the body is affected by shock? - "Whole-Body" response; "syndrome" What can start shock? - Any problem impairing oxygen delivery to tissues and organs can start shock, lead to life-threatening emergency. What are the classifications of shock by functional impairment? - *Hypovolemic, *Cardiogenic, *Distributive (Septic, Neurogenic, Anaphylactic), *Obstructive. What are Cardiovascular Manifestations? - *Decreased cardiac output, *Increased pulse, *Decreased blood pressure, *Narrow pulse pressure, *Decreased urine output. What are respiratory manifestations? - *Increased resiratory rate, *Shallow depth of resirations, *Decreased PaCO2, *Decreased PaO2, *Wheezing. Mean Arterial Pressure "MAP"? - Average blood pressure within the arteries (MAP= [(2x diastolic) + systolic] divided by 3) What is Cardiogenic Shock? - Actual heart muscle is unhealthy; pumping is directly impaired, Myocardial infarction in the most common cause. What is Hypovolemic Shock? - Low circulating blood volume causes mean arterial pressure (MAP) decrease; inadequate total body oxygenation. Commonly caused by hemorrhage, and dehydration. What is Distributive Shock? - Blood volume disributed to interstitial tissues where it cannot circulate, deliver oxygen. Caused by loss of symathetic tone, blood vessel dialation, pooling of blood in the venous and capillary beds, capillary leak. Neural-induced distributive shock. Chemical-induced distributive shock. What is Chemical- Induced Distributive Shock? - *Anaphylaxis- Antigen- antibody reaction causing massive vasodialtion. *Neurogenic- Loss of symathetic tone causing massive. *Sepsis- Endotoxins and other mediators (allergens) causing massive vasodialtion. What is Obstructive Shock? - Impaired ability of normal heart muscle to pump effectively. Conditions outside heart prevent either adequate filling of heart or adequate contraction of healthy heart muscle. Pericarditis most common cause. Cardiac tamponade. What are the processes of Shock? - *Initial Stage- Early Stage, *Nonprogressive Stage- Compensatory Stage, *Progressive Stage- Intermediate Stage, *Refractory Stage- Irreversible Stage. What is the Initial Stage? - Baseline MAP decreased by less than 10 mm Hg, Heart and respiratory rate increased from baseline, or slight increase in diastolic blood pressure, Adaptive responses of vascular consrtiction, increased heart rate. What is the Nonprogressive stage? - MAP decreases by 10 to 15 mmHg, Kidney and hormonal adaptive mechanism activated, tissue hypoxia is nonvital organs, acidosis and hyperkalemia, stopping conditions that started chock and supportive interventions can prevent shock from progressing. What is the Progressive stage? - Sustained decrease in MAP of greater than 20mmHg from baseline, vital organs develope hypoxia, life-threatening emergency, conditions causing shock must be corrected within one hour of progressive stage onset. What is the Refractory stage? - To little oxygen reaches tissue; cell death and tissue damage result, body cannot respond effectively to interventions; shock continutes, rapid loss of consciousness, nonpalpable pulse, cold, dusky extremities; slow shallow respirations; unmeasurable oxygen saturation. What is Multiple Organ Dysfunction Syndrome (MODS)? - Sequence of cell damage caused by massive release of toxic metabolites and enzymes, microthrombi form, occurs first in liver, heart, brain, kidney, myocardial depressant factor from ischemic pancreas. What are physical assessment/clinical manifestations of shock? - Cardiovascular, pulse, b/p, oxygen saturation, skin, respiratory, renal and urinary, cns, musculoskeletal..... ATI pg 491. Assessment- Diagnostics? - Arterial line insertion, EKG, Echocardiogram, CT, Cardiac cath. Assessment- Laboratory test? - H&H, ABG'S, Cardiac enzymes, cultures, coagulation tests. Nonsurgical management? - Maintain tissue oxygenation, increase vascular volume to normal range, support compensatory mechanisms, oxygen therapy, iv therapy, drug therapy. Drug therapies? - Vasoconstrictors- Dopamine, Epinepherine, Nonepinepherine, Phenylephrine, agents enhancing contractility, agents enhancing myocardial perfusion, ATI- pages 494-496. What is Sepsis and septic shock? - Complex type of distributive shock- Bacterial/fungal infection progresses to dangerous condition within days, sepsis- widespread infection coupled with general inflammatory responses (SIRS); triggered when infections escapes local control.