PN III Exam 3 (1) (1).docx - PN III Exam 3 Chapter 37 Shock...

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PN III Exam 3Chapter 37- ShockShock: any problem impairing oxygen delivery to tissues and organs. oS/S: Increased temp, increased Pulse, decreased blood pressure, increased respirationsoLow PH develops: more acidic in body due to lactic acidTypes of shockoHypovolemicLoss of fluid volumeEx: NG on suctionoCardiogenicHeart cant pumpLow blood volumeoDistributiveNeurogenic, anaphylactic and septicoObstructive:Not as important, do not need to knowHypovolemic shockoLow circulating blood volumeoCauses mean atrial pressure (MAP) to decrease, inadequate total body oxygenationoCommonly caused by hemorrhage or dehydrationoLow BP= Low Map. Not enough blood and O2 to tissuesoHappens fast in kids!Stages of shockoInitial stageWatch to catch earlyHR and R increasedConstriction due to body correcting issuesSlight increase of diastolic blood pressureMAP decreased by 10oNon-progressive StageStill want to catch here. BP decreased even moreO2 not where we needKidney: Starts to retain sodiumLeg and arms: decrease blood flowMAP decreases even more 10-15Tissue hypoxia in non-vital organsAcidosis and hyperkalemia and lactic acid presentIntervention: give antibiotics, stop conditions that started shockoProgressive StageHave 1 hr to fix the problem
PN III Exam 3Vital organs begin to develop hypoxiaLife-treatening emergencyCause of shock needs to be corrected fastMAP decreased 20 moreoRefractory StageNot responsive to treatmentTissue is dyingSlim chance of survivingToo little oxygen reaches tissues, cell death startsBody cannot respond effectivelyRapid loss of consciousness, non-palpable pulse, cold, dusky extremities, slow, shallow respirations, unmeasurable oxygen saturationoHypovolemic shockoMultiple Organ Dysfunction Syndrome (MODS)Cell damage caused by massive release of toxic metabolites and enzymesMicro thrombi form—DIC, too much clothing factors gone, massive bleeding occursThink of miscarriageOccurs first in liver, heart, brain and kidneyMyocardial depressant factor from ischemic pancreasHealth promotionCan usually be preventedAvoid trauma and hemorrhageWash hands, avoid catheters, ventilators, Foley’sAssess for early manifestationsPhysical assessmentDecreased cardiac outputIncreased pulseNarrowed pulse pressureoSystolic minus diastolicLow central venous pressureoLow blood volumeSlow cap refillDiminished peripheral pulsesRespiratoryoIncreased respiration rateoShallow depth of respirationsoDecreased PaCO2, decreased PaO2InterpretingHypoxia due to hypovolemia
PN III Exam 3Inadequate perfusion due to active fluid volume loss and hypotensionAnxiety due to potential death and decreased cerebral perfusionDecreased cognition due to decreased cerebral perfusionPlanningOxygenIV therapy—fluid and bloodDrug therapyoDopamine (Increased BP)oNoreephrinphrineHemodynamic monitoringo

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