Chapter 9

Question 1

Cells maintain their normal metabolic functions by producing and using energy in the form of

Answer 1

Adenosine triphosphate ATP

Question 2

The most efficient method of generating this needed energy is via

Answer 2

Aerobic metabolism

Question 3

The sensitivity of cells to the lack of oxygen varies from organ system to organ system. The sensitivity is called ischemic lack of oxygen sensitivity, and its greatest in the

Answer 3

Brain heart and lungs

Question 4

It may take only 4 to 6 minutes of anaerobic metabolism before one or more of these vital organs are injured beyond repair

Answer 4

Skin and muscle tissue have a significantly longer ischemic sensitivity as long as 4 to 6 hours abdominal organs generally fall between these two groups and are able to survive 45 to 90 minutes of anaerobic metabolism

Question 5

The correct definition of shock is

Answer 5

A lack of tissue perfusion oxygenation at the cellular level that leads to anaerobic metabolism and loss of energy production needed to support life

Question 6

When blood is lost from the circulation, the heart is stimulated to increase cardiac output by increasing the strength and rate of contractions. The stimulus results from the release

Answer 6

Epinephrine From the adrenal glands
At the same time the sympathetic nervous system releases nor epinephrine to constrict blood vessels to reduce the size of the container and bring it more into proportion with the volume of remaining fluid

Question 7

A patient who has signs of compensation such as tachycardia is already in shock not going into shock when the defense mechanisms can no longer compensate for the amount of blood lost a patient’s blood pressure will drop his decrease in blood pressure Marx to switch from

Answer 7

Compensated to D compensated shock a sign of impending death

Question 8

Class one hemorrhage

Answer 8

A loss of up to 15% of blood volume in the adult of the 750 mL this stage has few clinical manifestations tachycardia is often minimal and no measurable change in blood pressure pulse pressure or ventilatory rate occur most healthy patient sustaining this amount of hemorrhage require only maintenance fluid as long as no further blood loss occurs

Question 9

Class 2 hemorrhage

Answer 9

A loss of 15% to 30% of blood volume 750 to 1500 ML most adults are capable of compensating for this amount of blood loss by activation of the sympathetic nervous system which will maintain their blood pressure clinical findings include increased dilatory rate tachycardia and narrowed pulse pressure clinical clues to this phase are tachycardia tachypnea and normal systolic blood pressure because the blood pressure is normal this is compensated shock that is the patient is in shock but is able to compensate for the time being

Question 10

Class 3 hemorrhage

Answer 10

Represents a loss of 30% to 40% of blood volume 1500 to 2000 ML when blood loss reaches this point most patients are no longer able to compensate for the volume loss and hypotension occurs classified as a shock or obvious and include tachycardia heart rate greater than 120 tachypnea then a toy rate of 30 to 40 and severe anxiety and confusion.

Question 11

Class for hemorrhage

Answer 11

Represents a loss of more than 40% of blood volume greater than 2000 ML the stage of severe shock is characterized by marked tachycardia heart rate greater than 140 to keep near the Letory rate greater than 35 profound confusion or lethargic and greatly decreased systolic blood pressure typically in a range of 60 mmHg

Question 12

Shark research has demonstrated that for lost blood, the replacement ratio with electrolyte solution should be

Answer 12

3 L of replacement for each liter of blood lost This high ratio of replacement fluid is required because only about 1/4 to 1/3 of the volume of an isotonic crystalloid solution such as normal Celine or lactated ringer’s solution remains in the intravascular space 30 to 60 minutes after infusing it.

Question 13

The result of administering too much crystalloid is

Answer 13

Increased interstitial fluid Adema which impairs oxygen transfer to the remaining RBCs and into the tissue cells. The goal is not to raise the blood pressure to normal levels but to provide only enough fluid to maintain perfusion and continue to provide oxygenated RBC used to the heart brain and lungs

Question 14

Best crystalloid solution for treating hemorrhagic shock

Answer 14

Lactated ringer’s solution. Normal Celine is another isotonic crystalloid solution that can be used for volume replacement, but it’s used may produce hyperchloremia ( Marked increase in the blood chloride level, leading to acidosis

Question 15

Distributive shock or vasogenic shock

Answer 15

Occurs when the vascular container in large is without a proportional increase in fluid volume after trauma this is typically found in patients who have sustained a spinal cord injury

Question 16

Neurogenic shock or more appropriately neurogenic hypotension

Answer 16

Occurs when a spinal cord injury in a Rupps the sympathetic nervous system pathway that usually involves injury to the lower cervical thoracolumbar and thoracic levels because of the loss of sympathetic control of the vascular system which controls the smooth muscles in the walls of the blood vessels the peripheral vessels dilate below the level of injury the marked decrease in systemic Vascular resistance and peripheral vasodilation that occurs as the container for the blood volume increases results and relative hypovolemia the patient is not really hypovolemic but the normal blood volume insufficiently Fills an expanded container

Question 17

Decompensated hypovolemic shock and neurogenic shock both produce

Answer 17

Decreased systolic blood pressure

Question 18

Decreased sister Alec. and diastolic pressures and a narrow pulse pressure characterize

Answer 18

Hypovolemic shock

Question 19

Neurogenic shock also displays decreased systolic and diastolic pressures but the pulse pressure remains normal or is widened

Answer 19

.

Question 20

Hypervolemia producers cold clammy pale or cyanotic skin and delayed capillary refill in time

Answer 20

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Question 21

Neurogenic shock patient has warm dry skin especially below the area of injury

Answer 21

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Question 22

The pulse in hypovolemic shock patience is weak, thready, and rapid

Answer 22

.

Question 23

And neurogenic shock because of lack of parasympathetic activity on the heart bradycardia is typically seen rather than tachycardia but the pulse quality maybe week

Answer 23

.

Question 24

Hypovolemia produces a decreased level of consciousness or at least anxiety and often competitiveness. In the absence of a Trumatic brain injury the patient with neurogenic shock is usually alert oriented and lucid when in supine position

Answer 24

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Question 25

Patients with neurogenic shock frequently have associated injuries that produce significant hemorrhage. Therefore a patient who has neurogenic shock and signs of hypovolemia such a tachycardia should be treated as if blood loss is present

Answer 25

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Question 26

Fluid in the pericardial sac will prevent the heart from refilling completely during the

Answer 26

Diastolic relaxation phase of the cardiac cycle

Question 27

Tension pneumothorax creates at least ; problems

Answer 27

Tidal volume with each breath is reduced. The collapsed alveolar I are not available for oxygen transfer into the RBCs. The pulmonary blood vessels are collapsed, reducing blood flow into the lung and heart. A greater force of cardiac contraction is required to force blood through the pulmonary vessels pulmonary hypertension

Question 28

The loss of energy production when the body switches from a Robeck to anaerobic metabolism results in

Answer 28

A 19 fold decrease in ATP production and the energy needed to maintain aerobic metabolism in all the cells of the body

Question 29

Acidosis from anaerobic metabolism produces

Answer 29

Rapid ventilations as a body attempts to blow off the carbon dioxide byproduct and correct the decrease in serum pH

Question 30

There are two components in the assessment of circulation

Answer 30

Hemorrhage and the amount of blood loss. Perfusion with oxygenated blood. Total body and regional

Question 31

Assessment of mental status represents

Answer 31

End organ perfusion and function