NRS 313 Study Guide - Midterm Guide: Leukocyte Extravasation, Aldosterone, Arteriole
27 May 2018
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W4: Perfusion
• Vascular Shock = hypoperfusion
o The circulatory system is unable to adequately perfuse tissues leading to systemic
cellular dysfunction
o Impaired oxygen delivery and impaired glucose delivery at cellular level
o Unless the body can reverse or compensate, leads to multiple organ failure and
death
• Trendenburg
o Don’t use for shock. Leads to bradycardia.
o Used to slow down labor and posterial drainage
o Baroreceptors in the carotid arteries.
▪ Pay attention to vascular volume
▪ When elevated, receptors send message to cranial nerve X to release Ach.
This slows down HR and the SA node slows down. Therefore we get a
decrease in vascular volume
▪ Hypovolemia-> ischemia->lack of 02 and glucose
• Results of Vascular shock
o 1 – impaired oxygen delivery:
▪ cells begin anaerobic metabolism and intracellular lactic acid accumulates
▪ ATP production declines and then stops
• decreased sodium and potassium pump activity
• Potassium accumulates in extracellular spaces leading to
hyperkalemia.
• sodium accumulates in the cell leading to intracellular swelling
(hydropic swelling with lysis)
• Cell lysis leads to widespread inflammatory response and systemic
acidosis.
▪ Increased intracellular water and decreased extracellular water increases
vascular system viscosity (thickness).
o 2 – impaired glucose delivery
▪ decreased glucose uptake by cells resulting in
gluconeogenesis/glycogenolysis/lipolysis (fatty acids)
• When body isn’t getting glucose. They start using other types of
storages.
• Glycogen in liver starts to be released and fat cells are broken
down. The fat breaks down to fatty acids that lead to Ketones
▪ Acidosis – arterial pH less than 7.35
• Cardiogenic Shock
o decreased CO due to heart failure usually secondary to myocardial infarction
o Symptoms:
▪ Tachycardia
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▪ Tachypnea
▪ BP decreases
▪ Temp: normal
▪ Sp02: decreased
▪ Pain is present
▪ Pumping volume is about half: 30-40ml
o Myocardial infarction: blocking of artery
• Obstructive Shock
o Blood flow is obstructed and reduces amount of blood returning to left ventricle
resulting in inadequate CO. May be caused by pulmonary embolism (PE).
o PE: movement of clot
o Thrombosis: clot at orginal site.
▪ Clot prevents O2 to be pumped out
▪ Raises preload
▪ Only get 30% of blood to L. Ventricle
o Symptoms:
▪ Tachycardia
▪ Tachypnea
▪ Decreased Blood pressure
▪ Decreased SpO2
▪ Pain is present
o Jugular vein distension
▪ Excess preload causes regulation of blood back in Jugular vein
• Hypovolemic
o decreased blood volume due to hemorrhage (900 mL or more), dehydration, fluid
loss
o Approx. 4,500 mL of blood is available for adult circulation.
o Symptoms
▪ Tachycardia
▪ Tachypnea
▪ Pain in the chest
▪ SpO2 low
▪ Low blood pressure
• Neurogenic
o blood volume pooling in extremities and unavailable to heart and vital organs due
to overstimulation of parasympathetic OR under-stimulation of sympathetic
nervous systems
o Does NOT result in tachycardia like other types of shock
▪ Also has vasodialtion: blood pools in the extremities
o Epinephrine: ionotropic. Heart contracts harder
▪ Reduction for neurogenic
o Heart is fine as well as blood volume
o Low Sp02
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find more resources at oneclass.com
