Shock

Question 1

**what is shock

Answer 1

inadequate tissue perfusion resulting in cellular, metabolic and hemodynamic derangement’s

Question 2

shock begins with

Answer 2

cardiovascular system failure

Question 3

alterations in 1 of 4 components in shock, what are they

Answer 3

blood volume
myocardial contractility
blood flow
vascular resistance

Question 4

shock is a life-threatening response to alterations in circulation, t or f

Answer 4

true

Question 5

in shock there is an imbalance of

Answer 5

oxygen supply and demand

Question 6

Shock results from

Answer 6

ineffective cardiac function, inadequate blood volume and vascular tone

Question 7

what lab value will you always check with shock

Answer 7

lactate levels

Question 8

impaired cellular metabolism leads to

Answer 8

impaired O2 use - anaerobic metabolism - increased lactate metabolic acidosis

Question 9

stages of shock - stage 1

Answer 9

initiation

Question 10

stages of shock - stage 2

Answer 10

compensatory

Question 11

stages of shock - stage 3

Answer 11

progressive

Question 12

stages of shock - stage 4

Answer 12

refractory

Question 13

which stage of shock will be difficult to recognize

Answer 13

stage 1 (initiation)

Question 14

clinical presentations in stage 1 of shock (initiation)

Answer 14

*decreased tissue oxygenation, hypo-perfusion,

may not see obvious clinical signs*

Question 15

clinical presentations in stage 2 of shock (compensatory)

Answer 15

neural, endocrine, and chemical compensation*
rapid, deep respiration's*
narrowed pulse pressure*
restlessness leading to confusion*
oliguria (small amt of urine)*
cool, moist skin

Question 16

clinical presentations in stage 3 of shock (progressive)

Answer 16

anaerobic metabolism with lactic acidosis*
progressive tissue hypo-perfusion*
decreased BP*
lethargy to coma*
anuria (no urine output)
increased BUN, creatinine and potassium (kidneys aren’t working well)
absent bowel sounds

Question 17

clinical presentations in stage 4 of shock (refractory)

Answer 17

severe tissue hypoxia w/necrosis and ischemia*
worsening acidosis*
severe hypotension despite vasopressors*
multiple organ failure*
acute respiratory failure
SIRS/MODS

Question 18

what is a first sign/clinical indicator that something might be going wrong

Answer 18

change in respiration’s

Question 19

how does a nurse assess for adequate tissue perfusion

Answer 19

BP, urine output, pulse ox, skin temperature

Question 20

nursing mgmt for shock

Answer 20

Nutritional support - early enteral feeding, increased metabolic needs
Skin integrity - increased risk for pressure ulcers, skin care
psychological support - end of life decision making, communication

Question 21

4 categories of shock

Answer 21

hypovolemic
cardiogenic
obstructive
distributive

Question 22

all 4 categories of shock have issues with

Answer 22

perfusion - reason/cause differs

Question 23

in hypovolemic shock there is

Answer 23

inadequate intravascular blood volume

Question 24

in cardiogenic shock the

Answer 24

heart fails to act an an effective pump

Question 25

in obstructive shock there is

Answer 25

physical impairment to adequate circulating blood flow

Question 26

in distributive shock there is (septic)

Answer 26

widespread vasodilation and decreased vascular tone resulting in relative hypovolemia

Question 27

all categories of shock have how many stages

Answer 27

4

Question 28

cause of hypovolemic shock

Answer 28

``` external loss (car accident, trauma, hemorrhage) Internal sequestrations (hemorrhage, ascites, pelvic fxr) ```

Question 29

presentation of hypovolemic shock

Answer 29

decreased cardiac output, right arterial pressure | increased systemic vascular resistance

Question 30

mgmt of hypovolemic shock

Answer 30

treat cause fluid resuscitate check BP monitor Pulmonary Artery Occlusion Pressure (PAOP)

Question 31

what labs will be drawn for hypovolemic shock

Answer 31

CBC, type and screen | BUN and Creat

Question 32

cause of cardiogenic shock

Answer 32

Acute MI Dysrhythmias Valvular Disease HF Exacerbation

Question 33

presentation of cardiogenic shock

Answer 33

``` decreased cardiac output decreased venous oxygen saturation increased vascular resistance increased right arterial pressure *chest pain *dysrhythmia low urine output tachycardia tachypnea (rapid breathing) ```

Question 34

mgmt of cardiogenic shock

Answer 34

``` promote myocardial contractility decrease myocardial oxygen demand increase oxygen supply* treat cause improve contractility reduce preload and after-load mechanical support give diuretics ```

Question 35

If HF Exacerbation Caridiogenic Shock manage this way

Answer 35

lasix transplant lvad end of life decision making

Question 36

if acute MI cardiogenic shock manage this way

Answer 36

MONAB | revascularization therapy

Question 37

if dysrhythmias cardiogenic shock manage this way

Answer 37

cardio-version | pacemaker

Question 38

if vulvular disease cardiogenic shock manage this way

Answer 38

valve replacement

Question 39

what does MONAB stand for

Answer 39

morphine, oxygen, nitrogen, aspirin, beta-blocker

Question 40

cause of obstructive shock

Answer 40

cardiac tamponade pulmonary embolism aortic dissection

Question 41

presentation of obstructive shock

Answer 41

``` *decreased cardiac output systemic vascular resistance norm or increased right arterial pressure increased after-load decreased ventricular filling ```

Question 42

mgmt of obstructive shock

Answer 42

treat the cause of obstruction (pericardiocentesis) | decompression

Question 43

with a tension pneumothorax pt will present with

Answer 43

``` deviated trachea severe chest pain JVD hypoxia dyspnea increased HR ```

Question 44

cause of distributive shock

Answer 44

widespread vasodilation | decreased systemic vascular resistance

Question 45

presentation of distributive shock

Answer 45

DECREASED: cardiac output, systemic vascular resistance, right arterial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure

Question 46

3 types of distributive shock

Answer 46

neurogenic anaphylactic septic

Question 47

in neurogenic (distributive) shock there is an

Answer 47

imbalance between sympathetic and parasympathetic stimulation causing massive vasodilation - impaired thermoregulation

Question 48

causes of neurogenic shock

Answer 48

spinal cord injury spinal/general anesthesia nervous system damage

Question 49

presentation of neurogenic shock**

Answer 49

bradycardia | hypotension

Question 50

mgmt of neurogenic shock

Answer 50

treat the cause | maintain tissue perfusion - avoid fluid overload

Question 51

the nurse is developing a care plan for the patient in cardiogenic shock, the goals for therapy include

Answer 51

decrease after-load

Question 52

most common cause of cardiogenic shock

Answer 52

acute MI