shock, sepsis + MODS - powerpoint

Question 1

what is a normal pulse pressure? and how is it calculated?

Answer 1

30-40mmHg;
the difference between systolic pressure and diastolic pressure

Question 2

what stage of shock does failure of the cardiac pump occur?

Answer 2

in the progressive stage

Question 3

what are the 3 most common and SERIOUS side effects of fluid replacement?

Answer 3

cardiovascular overload
pulmonary edema
abdominal compartment syndrome

Question 4

which type of shock is most common and characterized by a reduction in intravascular volume by 15-30%?

Answer 4

hypovolemic shock

Question 5

what is a normal CVP (central venous pressure)?

Answer 5

2-6mmHg

Question 6

where should a mean arterial pressure (MAP) be?

Answer 6

> 65

Question 7

for a patient with hypotension, what position should they be in to bring BP back but while also avoiding more complications like increased ICP?

Answer 7

supine or modified Trendelenburg

Question 8

what are the characteristics seen in all types of shock?

Answer 8

-inadequate tissue perfusion
-affecting all body systems
-rapid or slow onset
-any patient w/ any disease is at Rx. of developing shock

-hypoperfusion
-hypermetabolism
-inflammatory response is activated

Question 9

what process is being explained related to shock?

-shock triggers a systemic stress response
-the sympathetic nervous system releases stress hormones (adrenaline + cortisol) –> this increases metabolic activity to meet the increased energy demands needed for tissue repair and immune function

Answer 9

hypermetabolism

-oxygen consumption increases
-protein + fat is broken down for energy

Question 10

initially hypermetabolism is adaptive, but when its prolonged, what complications can result?

Answer 10

-muscle wasting

-negative nitrogen balance - Nitrogen is a key component of amino acids, which are the building blocks of proteins. This imbalance indicates that the body is breaking down more protein than it is synthesizing - leading to muscle wasting

-impaired recovery

Question 11

The definition of shock is inadequate tissue ______ leading to cellular dysfunction and organ failure, if not corrected.

Answer 11

perfusion

Question 12

After the initial stage of shock, following is the compensatory stage, this is where the sympathetic nervous system is activated to maintain perfusion. what 3 S/S will we see?

Answer 12

tachycardia
cool, clammy skin
decreased urine output

Question 13

following the compensatory stage of shock is the ____________ stage. This is where you’ll see an increased anaerobic metabolism due to the persistent low blood flow. What 3 S/S will you see?

Answer 13

progressive;

-hypotension
-lactic acidosis
-altered mental status

Question 14

The last stage of shock is the ___________ stage. This is profound ______ damage and irreversible ________ hypoxia.

Answer 14

irreversible stage; organ; tissue

Question 15

Inotropic medications like:
-dobutamine
-dopamine
-epinephrine
-Milrinone

are given for shock because they
1.
2.
3.
4.

Answer 15

1, improve contractility
2. increase stroke volume
3. increase cardiac output
4. increase oxygen demand of the heart

this helps maintain adequate tissue perfusion + blood pressure

Question 16

Vasodilators like nitroglycerin and nitroprusside are given for shock to reduce preload and afterload and reduce oxygen demand of the heart. What complication do we need to prioritize assessing for?

Answer 16

hypotension

Question 17

Vasopressors like norepinephrine, dopamine, phenylephrine, vasopressin, epinephrine and angiotensin II are for shock to do what?

Answer 17

bring up blood pressure to ensure perfusion and oxygen to vital organs

Question 18

When administering fluid replacement in a patient with shock, we give LR (crystalloid) because is helps with __________ ___________.

Answer 18

metabolic acidosis

Question 19

Fluid replacement requires a large infusion of volume, over resuscitation can occur. What 2 complications do we need to monitor for?

Answer 19

pulmonary edema and abdominal compartment syndrome

Question 20

Fluid resuscitation with NS also carries the risk of developing pulmonary edema and abdominal compartment syndrome, but what 3 fluid/ electrolyte imbalances can occur?

Answer 20

hypernatremia
hypokalemia
hyperchloremic metabolic acidosis

Question 21

Colloids like albumin are really good for treating especially hypovolemic shock because it is going to rapidly expand plasma volume, but what are 4 negatives about albumin?

Answer 21

1. expensive
2. requires human donation
3. limited supply
4. can cause HF - this is due to heart function already being compromised and the rapid volume expansion can overwhelm the heart

Question 22

what 3 blood products are given to treat hypovolemic shock because you can rapidly replace fluid volume?

Answer 22

plasma
PRBC’s
platelets