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TEST # 3 – STUDY GUIDE – CRITICAL CARE1) Know pathophysiology of the shock
Main issue of shock is LACK OF PERFUSION – no O2 and nutrients to the tissues
(Tissue will be damaged) the brain, heart and kidney could suffer from the lack of
perfusion. You will have decreased urinary output and GFR.
A. Cardiogenic: failure of the heart to pump effectively due to a cardiac factor example:
the heart is not pumping normally like in an MI
B. Hypovolemic: decrease in the intravascular volume of at least 15-30%
C. Obstructive: Impairment of the heart to pump effectively because of a non-cardiac
factor like something outside of the heart. Which causes decrease in CO. Cardiac
Tamponade is an example of this.
D. Distributive shock: widespread vasodilation and increase in capillary permeability
neurogenic (blockage in the sympathetic passage like SCI), septic from infection, and
E. Anaphylactic from allergy to substance put in the body (peanuts, latex, bee sting,
antibiotics)
2) Know S/S of neurogenic shock
Decreased urinary output, bradycardia, hypotension, hypothermia.
3) Know about nutritional needs during shock: Rationale for increased nutritional needs
Increased need for calories (hypercaloric) because they are in a hypercaloric state
(Burning more calories) (NG for unconscious and by mouth for conscious) but the
low perfusion will cause PARALYTIC ILEUS (or decreased intestinal motility) which will
then need decompression.
They will also have increased acidity which will develop stomach ulcers.
FAMOTIDINE is what each pt will be on (whether dealing with shock or not)
You will also need to monitor pt.’s blood glucose especially during TPN because their
BG goes up during the fight or flight response- and they can become hyperglycemic.
4) Know role of ADH during shock and its consequences in the UOP
Monitor the UOP because it is reduced (vasopressin is the same as ADH)- because it will
increase the BP by causing vasoconstriction which will increase the systemic vascular
resistance and will also increase the reabsorption of water at the level of the tubules
causing the decrease in UOP.
5) Know priority nursing considerations for the administration of IV Dopamine infusion
Always give it on a central line to prevent extravasation.
This will cause vasoconstriction which is dangerous in pts with coronary artery
disease (CAD)- which can cause angina/chest pain
You cannot give this in a regular IV line OR IM. If this medication goes outside
of the vessel, it will cause vasoconstriction and necrosis of the tissue.
If the person develops angina, slow the speed of infusion.
, Make sure to give during constant hemodynamic monitoring and make sure
that you are also giving the pt. fluid management (continuous IV infusion)
Monitor UOP
Given with inotropic meds (which can cause vasodilation and this vasopressor
will help that)
6) Know S/S of shock stages
Initial: no visible changes in patient parameters; only changes in the cellular level
Compensatory (non-progressive): Measures to increase cardiac output to restore
tissue perfusion and oxygenation. You will notice symptoms in this stage. They will
have tachycardia, hyperglycemia, restlessness, confusion, tachypnea, weak pulse,
cool moist skin (from the vasoconstriction), oliguria, decreased bowel sounds.
Tachycardia and tachypnea are the compensatory mechanism (respiratory alkalosis)
increased CO2.
Progressive: compensatory mechanisms begin to fail. Hypotension/ blood pressure
begins going down, s/s of acidosis because of the low perfusion, cells cannot release
toxins from the body causing the metabolic acidosis; increased respiratory rate
(Compensation mechanism), lethargy or coma, hypotension, dysrhythmias, anuria,
cold extremities, severe respiratory acidosis.
Refractory: irreversible shock and total body failure, decreased HR and respiratory
rate, coma, severe hypotension, hepatic failure, renal failure, peripheral tissue
ischemia and necrosis. Severe metabolic and respiratory acidosis.
Physical assessment findings: Manifestations can include
chest pain, lethargy, nausea,
somnolence, constipation < all related
restlessness, to decreased perfusion.
anxiousness, Hypoxia,
dyspnea, tachypnea progressing to
diaphoresis, greater than 40/min,
thirst, hypocarbia,
Muscle weakness,
skin can be pale, mottled, or dusky, diaphoretic, warm, flushed with fever (in
septic shock),
rash (anaphylactic) as well as wheezing and angioedema.
Decreased BP and NARROW or low pulse pressure (subtract systolic from
diastolic)
Postural hypotension, tachycardia, pulse that is WEAK, thready, or bounding
(Distributive shock), and decreased CO.
CVP is DECREASED in HYPOVOLEMIC SHOCK
CVP is INCREASED in CARDIOGENIC SHOCK
Decreased UOP*** (assessment of restoration of the hypovolemia is return
of uresis)
Seizure
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