LO1 TO LO3

Question 1

describe compensatory stage of shock:

-BP
-HR
-RR status
-Acid base imbalance
-Skin
-Urine output
-mentation

Answer 1

-normal bp
-over 100 bpm (vasoconstriction)- release of catecholamines
-greater than 20
-rr alkalosis
-cool and clammy (blood shunted to organs)
-decrease urine output (ADH) and hypoactive bowels
-confused, anxious

Question 2

describe progressive stage of shock:

-BP
-HR
-RR status
-Acid base imbalance
-Skin
-Urine output
-mentation

Answer 2

-systolic is less than 80-90, MAP is less than 65 Hg (requires fluid resuscitation) to restore
-above 150 bpm
-rapid shallow respirations (holding co2), crackles
-metabolic acidosis
-mottled, petechiae
-0.5 mL/kg/hr (less than 30 mL/hr) THINK OF KIDNEYS NOT WORKING
-lethargy

Question 3

describe irreverable stage of shock:

-BP
-HR
-RR status
-Acid base imbalance
-Skin
-Urine output
-mentation

Answer 3

-requires mechanical or pharm support
-hr is erratic
-rr status: need intubation or mechanical ventilation
-profound acidosis
-jaundice (LIVER ENZYMES ELEVATED)inter
-anuric, need dialysis
-unconscious

Question 4

how to calculate MAP

Answer 4

2 diastolic plus systolic divided by 3

Question 5

what is an early sign of shock

Answer 5

narrowing of pulse pressure (normal between 30-40) this is because the body is trying to vasocontrict ; late is wide (septic shock-wide is early)

Question 6

nursing interventions for compensatory stage

Answer 6

-assess for BP drop
-get MAP
-start IV
-adminster fluids

Question 7

medical management for compensatory

Answer 7

treating cause

Question 8

nursing intervention for progressive stage of shock

Answer 8

-early intervention
-hemodynamic monitoring thru map, caprefill, hr, bp
-check serum electrolytes
-change in mental status
-blood gasses
-prevent complications: hob 30 degrees, for aspiration, oral care, good IV, prevent infection
-providing rest

Question 9

medical management for progressive

Answer 9

fluids, optimizing intravascular volume, supporting pump of heart, improving incompetence of vasculature

Question 10

when administering cryalloids for a pt in shock what should u assess

Answer 10

for overload of fluids

Question 11

what are 3 classes of meds given for shock

Answer 11

-ionotropic (improve cardiac output) ex. dopamine and adrenaline
-vasodialtors (reduce preload and afterload which decreases o2 demands for heart)
- vassopressor (increase bp with vasoconstriction)

Question 12

what side of the heart pumps blood to the body

Answer 12

left

Question 13

Briefly describe the compensatory mechanisms of shock.

Answer 13

the response of the primary and secondary regulatory mechanisms . Activation of homeostatic response, increased sympathetic response (increase HR, BP, contractility), increased respiratory rate to increase 02 saturation and delivery, activation of renin-angiotensin (increases reabsorption of sodium and water), increased catecholamines and cortisol to increase glucose for metabolism.

Question 14

How do this body system react to shock

renal system

Answer 14

Renal system - Increased release of aldosterone and ADH. This increases reabsorption of sodium and water from the intravascular compartment. This response is triggered by the drop in blood pressure. Urine output drops to less than 30 mL/hr.

Question 15

How do this body system react to shock
cardiovascular system

Answer 15

Cardiovascular system - When blood pressure drops due to low volume, epinephrine and norepinephrine are released by adrenal medulla. These increase the heart rate and cause vasoconstriction, thus, BP will increase. Eventually, compensatory mechanisms fail and BP drops. Pulse quality becomes weak and thready. Decrease in cardiac output.

Question 16

How do this body system react to shock
nervous system

Answer 16

Become anxious and restless; then confused to lethargic, and eventually non-responsive.

Question 17

How do this body system react to shock
respiratory system

Answer 17

Respiratory system - Increase in respiratory rate in an attempt to get oxygen to the cells. Decrease in oxygen saturation.

Question 18

Explain the hemodynamics of shock and treatment:

ABGs
Lactate level
Electrolytes/fluid volume

Answer 18

ABG’s – initially, the patient will be in respiratory acidosis due to CO2 retention. As the lactate levels increase, the patient will present with metabolic acidosis. After massive blood transfusion, patients can convert to metabolic alkalosis because of the conversion of citrate to bicarbonate in the liver.
Lactate level – lactate levels increase as oxygen is not available to the cells. Cells then use anaerobic metabolism which creates lactic acidosis.
Electrolytes/fluid volume
With blood transfusion, hyperkalemia will result from the destruction of stored red blood cells in the transfused unit. Hyperkalemia is at a greater risk for patients in metabolic acidosis as well as renal failure.
Hypocalcemia – excess citrate may combine with ionized calcium in the blood causing a decrease in available ionized calcium in the blood. Temporary problem where a calcium replacement is only given to those patients who are symptomatic.
Patient experiences hypovolemia then volume overload and CHF can become complications of treatment with blood transfusion and large volumes of IV fluid. Caution with patients who have a compromised cardiovascular system. Use of packed RBC’s instead of whole blood is preferred. IV Lasix may be administered between units of blood to remove excess fluid to prevent cardiac overload.

Question 19

describe cardiogenic shock

Answer 19

poor pump — decrease in pre and afterload = decrease in stroke volume and in HR THUS HEART CANT EJECT BLOOD IN SYSTOLE —- POOLING OF BLOOD INTO LUNGS

Question 20

3 types of distributive shock

Answer 20

anaphylactic

septic

neurogenic

Question 21

true or false. fluid bolus should be given rapidly for cardiogenic shock.

Answer 21

false. never give a rapid bolus of fluids with cardiac failure because it may result in acute pulmonary edema

Question 22

describe distributive shock

Answer 22

massive venous and arterial vasodialation= pooling of peripheral blood

Question 23

risk factors for neurogenic shock

Answer 23

depressant meds

spinal injury

spinal anesthesia

Question 24

risk factors for septic shock

Answer 24

immunocompromised
greater than 65
malnourished
chronic illness
invasive procedure
emergent surgeries

Question 25

in neurogenic shock what type of activation happens

Answer 25

parasympathetic causes vascular smooth muscle to dialate= pooling of blood

Question 26

what is diff abt neurogenic shock and how it presents

Answer 26

pt presents with warm and dry skin and is bradycardia and hypotensive instead of tachy

Question 27

what type of spine injury puts pts at risk for neurogenic shock

Answer 27

above T5

Question 28

what can you see in SIRS (initial infection)

Answer 28

elevated temp more than 38 or less than 36
hr is greater than 90
rr rate is greater than 20 per min
white blood cells greater than 12 000

Question 29

describe patho of sepsis

Answer 29

immune response, cytokines produce inflammatory response, – increased capillary permeability which leads to a leaky capillaries= vasodialtion= poor tissue perfusion

Question 30

rue or False: The parasympathetic nervous system loses the ability to stimulate nerve impulses in patients who are experiencing neurogenic shock. This leads to hemodynamic changes.

Answer 30

FALSE….the statement should say: The sympathetic (NOT parasympathetic) nervous system loses the ability to stimulate nerve impulses in patients who are experiencing neurogenic shock. This leads to hemodynamic changes.

Question 31

A 42-year-old male patient is admitted with a spinal cord injury. The patient is experiencing severe hypotension and bradycardia. The patient is diagnosed with neurogenic shock. Why is hypotension occurring in this patient with neurogenic shock?

Answer 31

The sympathetic nervous system (which is a division of the autonomic nervous system) is unable to stimulate the nerves that regulate the diameter of the blood vessels (there’s a loss of vasomotor tone). So, now the vessels are relaxed and this causes massive vasodilation. Systemic vascular resistance will decrease and hypotension will occur.

Question 32

signs of septic shock

Answer 32

-high temp above 38
-increased wbcs
-rr over 20
-altered mental status
-hr above 90
-dyuria
-abdominal pain and distention
-sob
neck stiffness wound discharge

Question 33

describe recognition stage of immune response

Answer 33

antigen is present— lymph notes increase release of lymphocytes and macrophages process antigens thru phagocytosis

Question 34

describe proliferation stage of immune response

Answer 34

lymphocytes send message for T to become killer T and B release antibodies (lymph nodes enlarge)

Question 35

describe response stage of immune response

Answer 35

either cell mediated thru T by connecting to invader antigen or humoral thru B

Question 36

physical barriers

Answer 36

skin, mucous membranes, respiratory tract, cilia

Question 37

mechanical barriers

Answer 37

hand washing, vomitting, urination (sloughing off and replacement of dead skin cells also removes adherant bacteria)

Question 38

biochemical barriers

Answer 38

mucus, perspiration, ear wax , tears (biochemical secretions that trap microgorganism and kill them)

Question 39

triggers for seizures

Answer 39

Specific time of day or night
Sleep deprivation – overtired, not sleeping well, not getting enough sleep, disrupted sleep
Illness (both with and without fever)
Flashing bright lights or patterns
Alcohol - including heavy alcohol use or alcohol withdrawl
Drug use - Use of cocaine and other recreational drugs such as Ecstasy
Stress
Menstrual cycle or other hormonal changes
Not eating well, long times without eating, dehydration, not enough fluids, low blood sugar, vitamins, and mineral deficiencies
Specific foods, excess caffeine or other products that may aggravate seizures
Use of certain medication

Question 40

does co2 cause vasodialation or vasoconstriction

Answer 40

vasodialaor= worsening icp

Question 41

describe diabetes insipidus

Answer 41

decreased ADH from compression of pituitary gland= polyuria and polydipsia
-increased urine osmolality
COMPLICATION OF ICP INCREASE
hypernatremia

Question 42

describe syndrome of inappropriate diuretic hormone (SIADH)

Answer 42

increased ADH= becomes overloaded, urine output diminishes, serum sodium dilute so hyponatremia
-increased urine osmolality
-EXTRACELLULAR FLUID

Question 43

describe cerebral salt wasting syndrome (CSW)

Answer 43

hyponatremia from hypovolemia nad loss of extracellular water because of sodium transport abnormality