Nursing the Shocked patient

Question 1

What is the defintion of Shock?

Answer 1

An acute circulatory failure resulting in inadequate tissue perfusion + energy production

Question 2

In basic (I mean basic) terms, what is shock?

Answer 2

Acute
Circulatory
Failure

Question 3

How does an acute circulatory faliure affect the body?

Answer 3

Results in inadequate tissue, nutrients perfusion + energy production

Question 4

True or False

As shock develops, patients don’t deteriorate as quickly as you would think.

Answer 4

False, patient’s deteriorate very rapidly!

Question 5

What are the 2 most vital aspects of preventing shock?

Answer 5

1. Early recognition
2. Treatment

Question 6

What 3 things does Normal tissue perfusion, perfuse?

Answer 6

1. Oxygen
2. Nutrients
3. Energy

Question 7

Name 3 Cardiovascular abilities that Normal tissue perfusion relies on

Answer 7

1. Cardiac output
2. Circulating volume
3. Peripheral vascular resistance

Question 8

What is the combination of Vasoconstriction + Vasodilation in the peripheries called?

Answer 8

Peripheral Vascular Resistance

Question 9

What is cardiac output?

Answer 9

The pumping output volume of the heart

Question 10

If there is a reduction in any parameter results of normal tissue perfusion, during Shock, what are 3 potential resulting factors?

Answer 10

1. Inadequate perfusion
2. Trigger of compensatory mechanisms
3. Altered efficacy of all systems

Question 11

When the compensatory mechanisms are triggered during Shock, with a reduction of normal tissue perfusion, what is the most basic mechanism that is applied to the body, in order to cope?

Answer 11

Prioritzes the organs!

Question 12

What 2 organs are prioritized when the compensatory mechanism is triggered, during shock?

A. Brain + Heart
B. Kidneys + Heart
C. Heart + Liver

Answer 12

A. Brain + Heart

Question 13

How many stages of the shock are there?

A. 5
B. 4
C. 3
D. 6

Answer 13

C. 3

Question 14

Name the 3 stages of shock (in order)

Answer 14

1. Compensatory
2. Decompensatory
3. Irreversible

Question 15

What the basic aim of body, in the 1st stage of shock, Compensatory shock?

Answer 15

Mechanisms are intiated in attempt to reduce the effects of shock on the body

Question 16

State the 3 basic steps of Compensatory shock

Answer 16

1. Baroreceptors in heart detect reduced cardiac output
2. Hypoxia occurs in tissues
3. Hypoperfusion of kidney

Question 17

Describe the role of Baroreceptors in sub-stage 1 of Compensatory shock

Answer 17

1. Baroreceptors in the heart detect changes in blood pressure in kidneys + vessels = reduced cardiac output
2. This stimulates the release of adrenaline + non-adrenaline
3. Results in increased heart rate + contractility

Contractility = Quickly pumping out more blood to improve blood volume

Question 18

What does Hypoxia of the tissues in sub-stage 2 of Compensatory shock lead to?

Answer 18

1. Hypoxia occurs due to lack of O2 tissue perfusion
2. Results in metabolic acidosis
3. Ventilation increases in order to address the acid-base balance

Ventilation increases = to gain more O2 to counteract the acidity

Question 19

What does Hypoperfusion of the Kidney in step 3 of Compensatory shock lead to?

Answer 19

1. Underperfusion of O2 to kidneys activates the Renin Aldosterone Angiotensingin (RAA) System
2. Aldosterone acts no collecting ducts to retain Sodium Chloride (Na) + Water (H20)
3. Additional - causes peripheral vasoconstriction

Question 20

Name the hormonal compensatory mechanisim which regulates blood pressure in the body

Answer 20

The Renin Angiotensin Aldosterone System

Question 21

Describe the RAA system

Answer 21

1. Kidney releases Renin into blood + Liver releases Angiotensinogen into blood
2. Renin (enzyme) > Angiotensinogen > Angiotensin I
3. Angiotensin-converting enzyme (ACE) released from Pulmonary circulation into blood
4. ACE > Angiotensin I > Angiotensin II (hormone)
5. Angiotensin II stimulates =
   - Vasoconstriction
   - Uptake of more Na from convulted tubules of kidneys
   - Triggers release of Aldosterone from renal cortex
6. Aldosterone stimulates water + Na retention (+ CNS)
7. Stimulates Hypothalamus = Increase thirst
8. Stimulates Posterior Pitutary = Produce antidiuretic hormone (water retention)
9. Reduces Baroreceptor sensitivity/response*

- All increases blood pressure + volume
- Angiotensin II = works for onl

• = Reducing Baroreceptor response, prevents the system from counteracting it!

Question 22

What happens if Compensatory shock isn’t treated, and the compensatory mechanisims in stage 1 start to fail?

Answer 22

The patient goes into stage 2 - Decompensatory shock

Question 23

State the 4 basic sub-stages of Decompensatory shock

Answer 23

1. Fluid + protein leak from circulation + into tissues due to peripheral vasodilation, increasing blood viscosity
2. Acidosis increases*
3. Gut becomes Ischaemic + bacteria enters the blood stream
4. Comatose

Fluid leaking into tissues = Oedema in limbs

• = State known as ‘Acidotic’

Question 24

What is the defintion of Ischaemic?

Answer 24

A state where blood flow is obstructed by partial or total blockage of an artery

Question 25

What is the term used to describe the following situation: "Fluid + proteins leak from the circulation and into the tissues. This is due to peripheral vasodilation, and the viscosity of blood increases."

Answer 25

Hypovolaemia!

Question 26

What is the state called where bacteria leaks into the blood stream, during Decompensatory shock?

Answer 26

Sepsis!

Question 27

How does Sepsis occur in Decompensatory shock?

Answer 27

The gut becomes Ischaemic, so the permability of the gut wall increases in attempt to gain more blood - increasing vulnerability to toxic bacteria, into the blood stream

Question 28

What happens if Compensatory shock isn't treated, and the decompensatory mechanisims in stage 3 start to fail?

Answer 28

The patient will go into stage 3 = Irreversible shock

Question 29

True or False. Stages 2 + 3 of shock are reversible

Answer 29

False. Stage 2, Decompensatory is reversible. Stage 3, Irreversible - isn't.

Question 30

What essentially occurs ( in very basic terms) in the last stage of shock?

Answer 30

Cell death, patient death.

Question 31

State the 4 basic sub-stages of Irreversible shock

Answer 31

1. Systemic Inflammatory Response Syndrome (SIRS) 2. Disseminated Intravascular Coagulation (DIC) 3. Multi-Organ Dysfunction (MOD) 4. Death

Question 32

What is stage 1 of Irreversible shock called?

Answer 32

Systemic Inflammatory Response Syndrome (SIRS)

Question 33

What happens in the 'Systemic Inflammatory Response Syndrome' stage of Irreversible shock?

Answer 33

Inflammatory injury to one organ system > that causes damage to others

Question 34

True or False. SIRS can be caused by only Infectious causes.

Answer 34

False. It can be caused by either Infectious or Non-infectious causes

Question 35

What happens in the 'Disseminated Intravascular Coagulation' stage of Irreversible shock?

Answer 35

Activation of Haemostatic mechanisms > induces Prothrombotic stage > bleeding tendancies ## Footnote Can't clot well!

Question 36

# (Acronym) What is the DIC infamously known as in the VP?

Answer 36

'*Death Is Coming*'

Question 37

What leads to the 'MOD' stage of Irreversible shock?

Answer 37

SIRS + Septic shock

Question 38

What happens in the 'Multi-Organ Dysfunction' stage of Irreversible shock?

Answer 38

Multi-Organ Failure

Question 39

# (Shock) What does SIRS stand for?

Answer 39

Systemic Inflammatory Response Syndrome

Question 40

# (Shock) What does DIC stand for?

Answer 40

Disseminated Intravascular Coagulation

Question 41

# (Shock) What does MOD stand for?

Answer 41

Multi-Organ Dysfunction

Question 42

# Including Stages 1, 2 + 3's names! Multi-Q !! 1. State the 3 sub-stages of the 1st stage of shock. 2. State the 4 sub-stages of the 2nd stage of shock. 3. State the 4 sub-stages of the final stage of shock, number 3.

Answer 42

The 1st stage of shock is called = **Compensatory** 1. Baroreceptors in heart detect reduced cardiac output 2. Hypoxia occurs in tissues 3. Hypoperfusion of kidney 2nd stage is called = **Decompensatory** 1. Fluid + protein leak from circulation > into tissues due to vasodilation, Blood viscosity increases 2. Acidosis increase 3. Gut becomes Ischaemic + Sepsis occurs 4. Comatose 3rd/final stage is called = **Irreversible** 1. SIRS = Systemic Inflammatory Response System 2. DIC = Disseminated Intravascular Coagulation (Death Is Coming) 3. MOD = Multi-Organ Dysfunction 4. Death

Question 43

Name the 4 main types of shock

Answer 43

1. Hypovolaemic 2. Septic (or Distributive) 3. Cardiogenic 4. Obstructive

Question 44

What does Hypovol....

Question 45

Scenario.. A 15 y/o CKCS has **Endocarditis**. He has **collapsed** + has signs of shock. What type of shock is this?

Answer 45

Cardiogenic shock

Question 46

Scenario.. A 5 y/o Cat has been involved in an **RTA**, knocked over by a car + has an **arterial haemorrhage** from its **lower right hind leg**. What type of shock is this?

Answer 46

Hypovolaemic shock (Due to blood loss)

Question 47

Scenario.. A 6 y/o **FE** Lab has **had a season** around **6 weeks ago** + is now **V+** + **depressed**. The patient is showing **severe signs** of shock + is awaiting surgery. What type of shock is this?

Answer 47

Septic shock (Bacterial = Pyo!)

Question 48

Scenario.. A 10 m/o GSD **puppy** has been admitted to the hospital w/**severe D+** + diagnosed with/**Parvo**. The patient is **severely dehydrated** + is now showing signs of shock. What type of shock is this?

Answer 48

Hypovolaemic shock (Body is compensating for V+ + D+, so pulls fluid from cells >> Hypovolaemia)

Question 49

Scenario.. A 14 y/o Cat has been diagnosed w/**aortic thromboembolism** + the patient is now showing signs of shock. What type of shock is this?

Answer 49

Obstructive shock (Embolism comes from Aorta)