What are the 3 main stages of shock

Stage 1. COMPENSATION STAGE - the initial stage in which the body tries to compensate for loss of volume by raising the heart rate Stage 2. DECOMPENSATION STAGE - the body, working very hard is losing it's ability to compensate and supply oxygenated blood to vital organs - URGEN INTERVENTION REQUIRED Stage 3. IRRVERSIBLE STAGE - irreversible cellular damage from prolonged shock occurs

Septic shock

- a systemic infection usually caused by gram -negative bacteria - endotoxins are released by the bacteria which affect arteries and arterioles cause profound vasodilation which result, increases total volume in circulation - this also makes arteries leaky causing edema as water is seeped into the tissues - this whole process will affect the perfusion of vital organs - pt with suppressed immune system caused by - chemotherapy - radiation - immune system diseases (AIDS, malnutrition) - pre-existing infection of the bladder - GI tract - surgical procedures - urinary catheters - toxic shock syndrome from tampons used during mens (tampons provide breeding for staphylococcus bacteria)

Causes of septic shock

Symptoms of septic - fever shock - warm extremities in the beginning - warm stage of septic shock - malaise - chills - nausea - confusion - changes in LOC (level of consciousness) first symptoms - cool - pale - bluish extremities (late symptoms) - tachycardia - shallow, rapid breathing - decreased urine output - reddish patches in skin Diagnostic test for septic shock blood culture positive for bacteria, changes in bp

Tx for septic shock - AB

- IV fluids to support bp - blood transfusion if bleeding - respiratory support Distributive shock Tx for all kinds of shock characterized by abnormal vascular system causing maldistribution of blood volume (NAS - Neurogenic, anaphylactic, septic) 1. fluids and blood replacement for Hypovolemic shock 2. o2 therapy 3. vasocontricting drug for low BP 4. digitalis for cardiogenic shock 5. epinephrine and antihistamines for anaphylactic shock 6. AB based on culture for septic shock 7. elevate extremities to ensure circulation to vital organs 8. fluids to support falling bp in septic shock -indicates the ability of kidneys to excrete nitrogenous wastes -normal levels: men 0.85-1.5 mg/100mL; women 0.7-1.25 mg/mL - reflects glomerular filtration and urine [] capacity of the kidneys - estimates GFR (Glomerular Filtration Rate): Increased BUN is seen in decreased GFR ex. Seen in dehydration, altered protein intake, protein catabolism, and acute renal failure - normal = 10-20 mg/dL - a 24 hours urine collection, determines glomerular filtration rate (GFR) and early renal disease HOW TO COLLECT: 1. discard first voided urine of designated time, and then collect all voided urine over a 24-hour period 2. collection may be repeated if one or more voided urine is accidentally discarded 3. normal levels: men=100-150 mL/min; women: 85-125 mL/min Radiologic Tests: Intravenous Pyelography (IVP) Pre IVP determines the presence or absence, size, and location and configuration of KI, and the normal filling of pelvis; also outlines ureters and bladder 1. assess client's allergic reaction to dye 2. bowel cleansing 3. NPO 4. monitor BUN and creatinine levels ( radiopaque dye may cause renal failure) 1. client may experience feeling of warmth, flushing of face and salty taste in the mouth while the dye is injected 2. assess client for allergic reaction to dye 3. have epinephrine and Benadryl readily available (for possible anaphylactic shock)

Serum Creatinine Blood Urea Nitrogen (BUN)

Creatinine Clearance what is it and how to collect it?

During the IVP

Kidney, Ureter, and Bladder is the x-ray of the KI, ureters and bladder -> determine location of the KI or

(KUB) Computed Tomography (CT)

possible stones; no special preparation; usually done in supine position is the visualization (different angles) of the KI and renal circulation *done with or without contrast *if done with contrast, preparation would be the same with IVP

Ultrasound

determine abnormal fluid collections, solid masses, abscess, urethral leaks, and obstructions, requires a full bladder