Clinical Exemplars

What to watch out for pregnancy and fetal perfusion?

• increased blood volume, with decreased return

• changes in hydrostatic pressure and blood pressure

• problems with maternal perfusion can impact placental (fetal) perfusion

what to watch out for during birth?

• monitor for signs of hemorrhage in birthing parent

• rapid changes in heart at birth

  • assess newborns HR, BP, SpO2, heart sounds

  • some transient cyanosis around mouth, hands, and feed is not uncommon in the first 3-4 days of life

what to watch out for infants when they have perfusion problems related to a congenital defect?

• poor feeding

• poor weight gain

• failure to thrive

• dusky color

what to watch out for toddlers and children when they have perfusion problems related to a congential defect?

• squatting and fatigue

• developmental delay

• failure to hit milestones

what are the common congenital defects?

• atrial septal defect

• tetra of fallot

• transposition of great arteries

what is atrial septal defect?

• septal defect allowing mixing of blood

• usually not detected until preschool years or later

what is tetralogy of fallot?

• multiple defects (4-5)

• infants develop hypoxia and cyanosis

what is transposition of the great arteries?

• pulmonary artery and aorta are transposed

• life threatening at birth

what happens to the heart in older adults?

• myocardium less efficient and less contractible

• SA node decreases control

• left ventricular slight hypertrophy

• vessels become stiffer

what is shock?

impaired tissue perfusion to the entire body

what can shock result in?

inadequate cellular oxygenation and life-threatening cellular dysfunction

what are the levels of shock?

• early

• compensatory

• decompensated

• Refractory

what happens in the early level of shock?

something causes a decrease in MAP (rarely detected stage

what happens in the compensatory level of shock?

• body starts to compensate for a lack of MAP

• changes to HR, BP, peripheral perfusion, mental status noted (GCS 3-15)

what happens in the decompensated level of shock?

• body no longer compensating for lack of perfusion

• notable changes in assessment indicating worsening perfusion

what happens in the refractory level of shock?

• irreversible

• results in death of cells, tissues, organs

what are the type of shocks?

• hypovolemic

• cariogenic

• obstructive

• distributive

  • septic

  • neurogenic

  • anaphylactic 

what is hypovolemic shock?

intravascular volume loss - absolute or relative (hemorrhage = absolute and relative = fluid shift

what causes hypovolemic shock?

• significant loss of blood or fluids

• often d/t bleeding from injuries, surgery, or severe dehydration

what is cardiogenic shock

Pump failure

what causes cardiogenic shock?

failure of the heart to pump effectively, often d/t heart attack, heart failure, and severe arrhythmias

what is obstructive shock?

physical obstruction

what causes obstructive shock?

blocked blood flow from a pulmonary embolism, cardiac tamponade, or tension pneumothorax

what is distributive shock?

systemic vasodilation

what is septic shock?

infection

what causes septic shock?

severe complication of infection with widespread blood vessel dilation and reducing BP

what is anaphylactic shock?

widespread hypersensitivity

what causes anaphylactic shock?

severe allergic reaction causing exaggerated histamine symptoms

what is neurogenic shock?

spinal cord injury

what causes neurogenic shock?

damage to the nervous system, spinal anesthesia, and cerebral ischemia

what is atherosclerosis, angina?

when there is plaque in the arteries that can accumulate