Neurogenic Shock
These cardiovascular findings are characteristic of neurogenic shock.
Hypotension and bradycardia
This population is at especially high risk for sepsis and rapid deterioration.
Older adults
This lab indicates poor tissue perfusion and should be monitored for trends.
Lactate
This is the primary physiologic problem in cardiogenic shock.
An ineffective cardiac pump.
These are the three stages of shock.
Compensatory, progressive, refractory/irreversible
This is the underlying cause of neurogenic shock.
Loss of sympathetic nervous system tone causing widespread vasodilation.
These are three potential sources for hospital-acquired sepsis.
CAUTIs, CLABSIs, VAP
These are the two criteria that define septic shock.
Persistent hypotension Requires vasopressors to maintain MAP ≥65 mmHg
Lactate >2 mmol/L despite adequate fluid resuscitation
List a potential cause of cardiogenic shock other than MI.
•Heart failure, cardiomyopathy, dysrhythmias, valvular disease, cardiac tamponade
Other noncoronary causes of cardiogenic shock are related to conditions that stress the myocardium (e.g., severe hypoxemia, acidosis, hypoglycemia, hypocalcemia)
List the three sub-types of distributive shock.
Septic, neurogenic, anaphylactic
What would the nurse expect to find when performing a skin assessment on a patient with neurogenic shock?
Warm, dry skin.
Describe the immune system response in sepsis - what is being released by the body?
Releases large amounts of cytokines and inflammatory mediators
This is the first-line vasopressor for septic shock.
Norepinephrine
What occurs immediately after myocardial damage in the pathophysiology of cardiogenic shock?
Decreased contractility - decreased stroke volume and cardiac output - decreased tissue perfusion
This complication can develop from any form of shock but is mainly seen in patients with sepsis.
MODS - multiple organ dysfunction syndrome
the presence of altered function of two or more organs in an acutely ill patient such that interventions are necessary to support continued organ function
This bedside screening tool is used outside the ICU to rapidly identify patients at risk for sepsis.
List three potential findings characteristic of early sepsis (warm shock)
•Fever
•Tachycardia
•Tachypnea
•Warm flushed skin
•Bounding pulses
•Altered mental status
•Elevated lactate and inflammatory markers
•Decreased urine output
This is why nutritional therapy is important in management of septic shock patients.
Help address hypermetabolic state present with septic shock. Malnutrition further impairs the patient’s resistance to infection
List three pulmonary findings that are associated with cardiogenic shock
Tachypnea, crackles, dyspnea, pulmonary edema, and decreased oxygen saturation.
Fluids should be used cautiously in this kind of shock.
Cardiogenic - more fluid may worsen pulmonary edema
These four interventions are commonly used in management of neurogenic shock.
IV fluids, vasopressors (norepinephrine, dopamine), atropine (for significant bradycardia), and spinal stabilization when indicated
List the interventions included in the one-hour sepsis bundle.
Blood cultures, lactate level, broad-spectrum antibiotics, 30 mL/kg crystalloid bolus, and vasopressors if needed.
List three potential assessment findings in septic shock.
•Persistent hypotension MAP <65 mmHg
•Vasopressor requirement
•Cool, mottled skin
•Oliguria
•Rising lactate
•Worsening organ dysfunction
•MODS
List four diagnostics (labs or imaging) you would expect to see in cardiogenic shock - and give a reason for each.
•Evidence of Myocardial Injury - troponin, ECG changes
•Evidence of Heart Failure - BNP
•Evidence of Poor Perfusion - elevated lactate, increased creatinine, decreased urine output
•Cardiac Assessment - echocardiogram, continuous ECG monitoring
These are three ways in which the body attempts to compensate to maintain perfusion in shock.
•Sympathetic nervous system activation
•Increased heart rate
•Vasoconstriction
•Renin-Angiotensin-Aldosterone System (RAAS)
•Antidiuretic hormone (ADH) release