Shock

Question 1

three types of distributive shock

Answer 1

septic
anaphylactic
neurogenic

Question 2

shock syndrome:
initial

Answer 2

CO is decreased and tissue perfusion is threatened

Question 3

shock syndrome:
compensatory

Answer 3

body attempts to maintain CO, BP, and tissue perfusion

Question 4

shock syndrome:
progressive

Answer 4

compensatory methods begin to fail

Question 5

shock syndrome:
refractory

Answer 5

shock becomes unresponsive to therapy and may be irreversible

Question 6

Shock state: MAP

Answer 6

less than 60

Question 7

what increased lab value indicates shock

Answer 7

serum lactate

Question 8

hypovolemic shock

Answer 8

inadequate fluid volume in intravascular space (DECREASED PRELOAD)

Question 9

absolute hypovolemia
vs
relative hypovolemia

Answer 9

absolute: actual lack of fluid
relative: from vasodilation (still have fluid but body doesn’t realize

Question 10

hypovolemic shock causes a decrease in what

Answer 10

-venous return
-preload
-SV
-CO
-tissue perfusion

Question 11

hypovolemic shock:
nursing management

Answer 11

intake and output
daily weights

Question 12

cardiogenic shock

Answer 12

failure of heart to pump effectively

Question 13

Cardiogenic shock initially causes what acid-base imbalance?
Why?

Answer 13

Respiratory Alkalosis- attempting to improve oxygenation

Question 14

cardiogenic shock:
as the left ventricle fails, what happens?

Answer 14

rales (crackles)
rhonchi
CVP/PCWP >15

due to pulmoary edema and elevated preload

Question 15

What is the end result of cardiogenic shock?

Answer 15

hypoxemia- systems fail at compensating
-metabolic acidosis*
-renal failure*
-cerebral hypo perfusion*

Question 16

What meds do we give patients in cardiogenic shock

Answer 16

-vasopressors: increase BP
-inotropes: increase heart contractility

Question 17

obstructive shock

Answer 17

inability for the heart to pump adequately despite normal intravascular volume and cardiac function

Question 18

what is the cause of obstructive shock

Answer 18

-cardiac tamponade
-massive pulmonary embolus
-tension pneumo

Question 19

cardiac tamponade s/s

Answer 19

BECKS TRIAD
-distended juglar veins
-muffled heart sounds
-hypotension
-pulsus paradoxyl

Question 20

obstructive shock:
cardiac tamponade

Answer 20

-significant compression of the heart from contents in the pericardial sac
-impedes heart from filling and pumping adequately

Question 21

obstructive shock:
massive pulmonary embolus

Answer 21

results in right ventricular failure from a high pulmonary and CVP pressures

Question 22

obstructive shock:
tension pneumo

Answer 22

prevents venous blood return to the heart- impedes stroke volume of the right heart

Question 23

tension pneumo s/s

Answer 23

-decreased or absent breath sounds on affected side
-hyperresonant on percussion of affected side
-tracheal deviation away from affected side

Question 24

anaphylaxis is not always an _________

Answer 24

allergen

Question 25

anaphylactic shock s/s

Answer 25

-vasodilation -increased capillary membrane permeability -decreased venous return

Question 26

neurogenic shock

Answer 26

profound hypotension bradycardia

Question 27

what does the hypotension from neurogenic shock require?

Answer 27

vasopressors

Question 28

neurogenic shock has a difficult time regulating __________

Answer 28

temperature

Question 29

sepsis vs septic shock

Answer 29

sepsis: infections septic shock: when the organs start failing

Question 30

qSofa

Answer 30

tests for sepsis

Question 31

why is it common to have a change in consciousness in sepsis?

Answer 31

organs aren't working... blood not getting to brain... coma

Question 32

how do they control the infection in sepsis

Answer 32

broad spectrum ABX -vanco -rocephin

Question 33

What do we always do before administering ABX

Answer 33

CULTURES

Question 34

MODS

Answer 34

progressive failure of 2+ separate organ systems

Question 35

why does MODS occur

Answer 35

-primary: when something happens to one organ -secondary: widespread sustained systemic inflammation that results in dysfunction of organs not involved in the initial insult (entire body) ex.) primary: UTI Secondary: kidney failure

Question 36

DIC

Answer 36

disseminated intravascular coagulation bleeding+clotting

Question 37

DIC: patient may bleed from....

Answer 37

several sites

Question 38

DIC: platelets

Answer 38

decreased

Question 39

DIC: PT

Answer 39

Increased

Question 40

DIC: PTT

Answer 40

increased

Question 41

DIC: fibrinogen

Answer 41

decreased

Question 42

DIC: fibrinogen split products

Answer 42

increased

Question 43

what are main causes for DIC

Answer 43

-MASSIVE TRANSFUSIONS -recent surgery (HYPOTHERMIA) -severe TRAUMA (burns)

Question 44

Systemic Inflammatory Response Syndrome

Answer 44

SIRS produce similar response as sepsis-without an organism