Shock

Question 1

what is shock?

Answer 1

insufficient delivery of oxygenated blood to the microcirculation resulting in tissue hypoxia and cellular dysfunction

Question 2

What are the common factors among all types of shock?

Answer 2

hypoperfusion and impaired cellular oxygen utilization

Question 3

What are the 4 types of shock?

Answer 3

1. cardiogenic
2. obstruction
3. hypovolemic
4. distributive

Question 4

obstruction shock

Answer 4

circulatory blockage disrupts CO

Question 5

Distributive shock

Answer 5

greatly expanded vascular space because of inappropriate vasodilation

Question 6

cardiogenic shock

Answer 6

results from heart disorders that cause inadequate CO despite sufficient vascular volume

Question 7

hypovolemic shock

Answer 7

associated with loss of blood volume

Question 8

What can hypoxia lead to?

Answer 8

cell death, organ dysfunction, and stimulation of inflammatory rxns

Question 9

What does lack of oxygen cause?

Answer 9

anaerobic metabolism
failure of ion pumps lead to salt and water reabsorption in cell swelling
formation oxygen radicals
induction of inflammatory cytokines

Question 10

What are the early defects in shock?

Answer 10

displaying signs of insufficient CO and decreased tissue perfusion

Question 11

Nurse K thinks John is in shock how does she know this?

Answer 11

john’s pulse pressure narrows, he is tachycardic, fast and deep respirations, decreased urinary output, increased urine specific gravity, cool/clammy skin, altered mentation and dilated pupils

Question 12

What is progressive shock marked by?

Answer 12

hypotension and hypoxia

Question 13

Nurse K actually detects John is in progressive shock how does she know this?

Answer 13

John has the following clinical manifestations: hypotension, narrow pulse pressure, tachycardia, acute renal failure, decreased level of consciousness, increased respiratory rates and metabolic and respiratory acidosis with hypoxemia

Question 14

Diagnostic features of cardiogenic shock

Answer 14

decreased CO, pulmonary edema, elevated left ventricular end diastolic pressure (preload)

Question 15

Therapy for cardiogenic shock

Answer 15

improving CO and myocardial workload

Question 16

Common causes of Obstructive shock

Answer 16

pulmonary embolism, cardiac temponade, tension pnuemonthorax; manifested as right-sided heart failure

Question 17

What are internal external losses of hypovolemic shock?

Answer 17

External: burns, external hemorrhage, severe vomiting, diarrhea, and diuresis
Internal: internal hemorrhage, fracture of long bones or leakage of fluid into the interstitial space

Question 18

What is the treatment for hypovolemic shock?

Answer 18

therapy is aimed at fluid replacement and controlling the volume by colloids, crystalloids, and and blood

Question 19

What do all types of distributive shock have in common?

Answer 19

vasodilation and profound hypotension

Question 20

What are the types of distributive shock?

Answer 20

anaphylactic, septic, and neurogenic

Question 21

Etiology of anaphylactic shock

Answer 21

IgE Ab binds to receptor releasing histamines,, leukotrienes, and prostagladins that cause bronchiconstriction, peripheral vasodilation and increase capillary permeability

Question 22

Si/Sx of anaphylactic shock

Answer 22

hives, itching, hypotension, bronchiconstriction ( wheezing and cyanosis)

Question 23

Treatment of anaphylactic shock

Answer 23

antihistamines, vasodilators, EP, and vasopressors

Question 24

Neurogenic shock

Answer 24

loss of sympathetic activation of arteriolar smooth muscle

Question 25

Causes of neurogenic shock

Answer 25

brain injury, drug overdose or spinal cord injury

Question 26

Treatment of neurogenic shock

Answer 26

re-establish pooling, elevation of legs, fluids, slow position changes and use of stocking

Question 27

septic shock

Answer 27

results from severe systemic inflammatory response to infection

Question 28

What are the common causes of septic shock?

Answer 28

gram-negative and gram-positive bacteria

Question 29

How is septic shock characterized?

Answer 29

release of immune mediators causing inflammations, profound peripheral vasodilation with hypotension, cellular hypoxia and edema

Question 30

What are complications of shock?

Answer 30

generalized inflammatory response and may affect affect all organs and systems of the body

Question 31

Acute Respiratory Distress Syndrome

Answer 31

most commonly associated with septic shock; pulmonary edema leads to pulmonary compliance; lungs are most affected

Question 32

Disseminated Intravascular Coagulation

Answer 32

usually occurs in septic shock

Question 33

Acute renal failure

Answer 33

kidneys undergo prolonged periods of hypoperfusion, kidneys do not respond to fluids or diuretics