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Med Surg 1 > Caring For Clients With Shock > Flashcards

Caring For Clients With Shock Flashcards

1
Q

Four main categories of shock

A

Hypovolemic
Distributive
Obstructive
Cardiogenic

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2
Q

3 subdivided parts of distributive shock

A

Neurogenic
Septic
Anaphylactic

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3
Q

Most common type of shock

A

Hypovolemic (hemorrhagic) shock

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4
Q

Decreased blood volume with decreased filling of the circulatory system

A

Hypovolemic shock

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5
Q

Hemorrhage (frank and internal)

A

Example of Hypovolemic shock

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6
Q

This shock can develop when overall fluid volume is depleted from significant bleeding, such as during surgery, after trauma or after delivery of an infant

A

Hypovolemic shock

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7
Q

In this shock, the volume of extracellular fluid is significantly diminished, primarily because of lost or reduced blood or plasma

A

Hypovolemic shock

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8
Q

Sometimes called normovolemic shock because the amount of fluid in the circulatory system is not reduced, yet the fluid circulation does not permit effective tissue perfusion

A

Distributive shock

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9
Q

Rarest type of shock

A

Neurogenic

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10
Q

Shock that results from injury that affects the vastomotor center in the medulla of the brain or to the peripheral nerves that extend from the spinal cord to the blood vessels

A

Neurogenic shock

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11
Q

Injury to the spinal cord or head
Overdoses of opioids, tranquilizers or general anesthesia cause this kind of shock

A

Neurogenic shock

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12
Q

In this shock the tone of the sympathetic nervous system is impaired, resulting in decreased arterial vascular resistance, vasodilation and hypotension

A

Neurogenic shock

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13
Q

Example of this shock is spinal cord injury

A

Neurogenic shock

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14
Q

Toxic reaction to gram negative bacterial infection

A

Septic shock

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15
Q

Has the highest mortality rate of the various types of shock

A

Septic shock

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16
Q

Associated with overwhelming bacterial infections

A

Septic shock

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17
Q

This shock is preceded by a systemic inflammatory response syndrome (SIRS)
(An inflammatory state without a proven source of infection)

A

Septic shock

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18
Q

A complication of overwhelming inflammation that results in massive cellular, tissue and organ injury

A

Multiple organ dysfunction syndrome
A result of septic shock & hypotension

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19
Q

Unlike other forms of shock, clients with this shock will have an elevated leukocytes count and initially manifest a fever accompanied by warm, flushed skin & a rapid bounding pulse

A

Septic shock

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20
Q

Severe allergic reaction

A

Anaphylactic shock

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21
Q

Common allergic substances

A

Bee venom, latex, fish, nuts, penicillin (PCN)

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22
Q

Results of this shock are vasodilation, increased capillary permeability accompanied by swelling of the airway and subcutaneous tissues, hypotension and hives or an itchy rash

A

Anaphylactic shock

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23
Q

This shock occurs when there is interference with the circulation of blood into and out of the heart, compromising the volume of blood that enters and leaves the heart en route to the lungs and tissues

A

Obstructive shock

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24
Q

Any condition that fills the thoracic cavity with fluid, air, or tissues can lead to this shock

A

Obstructive shock

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25
Q

Impaired filling of heart with blood due to mechanical impediment

A

Obstructive shock

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26
Q

Examples of this shock is
Cardiac tamponade
Dissecting aneurysm
Tension pneumothorax

A

Obstructive shock

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27
Q

Decreased force of VENTRICULAR CONTRACTION leading to inadequate intravascular volume and tissue hypoxia

A

Cardiogenic shock

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28
Q

Myocardial infarction is an example of this shock

A

Cardiogenic shock

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29
Q

Heart contraction is ineffective, which reduces cardiac output in this shock

A

Cardiogenic shock

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30
Q

Cardiac output is the volume of blood ejected from the ____ ventricle per minute

A

Left

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31
Q

Leading cause of Cardiogenic shock

A

Myocardial infarction with subsequent heart failure

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32
Q

First stage of shock, during which several physiologic mechanisms attempt to stabilize the spiraling consequences

A

Compensation stage

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33
Q

If physiologic mechanisms are successful in the compensation stage _______ may be achieved

A

Homeostatic stability

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34
Q

Neurotransmitters that stimulate responses via the sympathetic nervous system

A

Catecholamines

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35
Q

A mechanism that restores blood pressure when circulating volume is diminished

A

Renin-angiotensin-aldosterone system

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36
Q

Low blood volume stimulates the pituitary to secrete

A

Antidiuretic hormone (ADH)

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37
Q

Promotes reabsorption of water that the kidneys would ordinarily excrete

A

ADH antidiuretic hormone

38
Q

ADH is also known as

A

Vasopressin and andernocorticotropic hormone (ACTH)

39
Q

Stimulates the adrenal glands to secrete corticosteroid hormones, which include glucocorticoids and mineralocorticoids

A

ACTH

40
Q

play an active role in controlling sodium and water balance

A

ACTH
Glucocorticoids
Mineralocorticoids

41
Q

These hormones promote fluid reabsorption and retention

A

ADH
Corticosteroids

42
Q

Stage that occurs as compensatory mechanisms fail.

A

Decompensation stage

43
Q

In the decompensation stage the clients condition spiral into

A

Cellular hypoxia, coagulation defects and cardiovascular changes

44
Q

Decreased oxygen reaching the cells

A

Hypoxia

45
Q

As energy supply falls below the demand, these two acids increase, causing metabolic acidosis

A

Pyruvic and lactic acids

46
Q

Decompensation stage equals

A

Metabolic acidosis

47
Q

Blood pooling equals

A

Clots

48
Q

Clots compromise ____ to deliver oxygen throughout the body

A

RBC

49
Q

____ administered ____ in ____ for severe septic shock

A

Heprin
Subcutaneous
Abdomen

50
Q

As cells become damaged, an ___response ensues

A

Inflammatory

51
Q

In a coagulation defect, platelets become ___ and accumulate in the blood vessels of the volume depleted client

A

Sticky

52
Q

Impaired ___ cells cannot maintain sufficient heart rate and force of contraction to circulate blood efficiently

A

Myocardial

53
Q

In cardiovascular changes, ___ cells in the medulla can no longer sustain the stimulus for vasoconstriction

A

Brain

54
Q

Stage when significant cells and organs become damaged. Clients condition reaches the point of no return

A

Irreversible stage

55
Q

Client no longer responds to medical interventions. Multiple systems being to fail. Kidneys, heart, lungs, liver and brain cease to function

A

Irreversible stage

56
Q

Critical assessment of client with shock
SATA (5)

A

Vital signs
LOL (changes in mentation)
Skin
Urine output
Pulses

57
Q

Early signs and symptoms are evident during this stage

A

Decompensation stage

58
Q

This symptoms is particularly evident in the early signs and symptoms in the decompensation stage

A

Drops in BP

59
Q

Numeric difference between systolic and diastolic BP

A

Pulse pressure

60
Q

If a client has a BP of 120/80 the pulse pressure is

A

40 mm Hg

61
Q

Health care personnel use the ___ and other assessment data to identify the severity of shock and estimate the approximate reduction in blood volume

A

Pulse rate

62
Q

As cardiac output decreases, ___ ___ initially develops to increase cardiac output

A

Compensatory tachycardia

63
Q

In neurogenic shock ___ occurs because there is a loss of compensatory sympathetic nervous system response

A

Bradycardia

64
Q

In this shock, pulse volume becomes weak and thrash as circulating volume diminishes, in later stages the pulse may be slow and imperceptible. Pulse rhythm may change from regular to irregular

A

Neurogenic shock

65
Q

In early stages the client is __, but in profound shock, as death nears, the respiratory rate__

A

Hungry for air
Decreases

66
Q

With exception of septic shock, ___ temperature is characteristic

A

Subnormal

67
Q

___ is often the first sign of inadequate oxygen delivery to the tissues

A

Altered cerebral function

68
Q

Mild ___, increasing ___, agitation and ____ can accompany shock. As the condition deteriorates, the client becomes ___ and ___ ultimately loosing consciousness

A

Anxiety
Restlessness
Confusing
Listless
Stuporous

69
Q

__ may be administer to decrease anxiety and pain

A

Morphine

70
Q

In clients with ___, cyanosis is more accurately detected by inspecting the ___ and __

A

Highly pigmented skin (African American)
Conjunctiva
Oral mucous membranes

71
Q

Decreased cardiac output equals

A

Decreased urine output

72
Q

Continued ____ indicates renal damage caused by reduced blood flow to the kidneys

A

Oliguria

73
Q

ABG specimens are drawn from a direct ___ Or indwelling ___

A

Arterial puncture
Arterial catheter

74
Q

Measures the amount of oxygen bound to hemoglobin, or the saturated oxygen

A

Pulse oximeter

75
Q

Normal oxygen saturation

A

95-100%

76
Q

If spO2 level is about 90% it can be assumed that the PaO2 is

A

60mm Hg

77
Q

CVP is the pressure of the blood in the ____

A

Right atrium or venae cavae

78
Q

Fluid pressures in the ___ side of the heart is more meaningful

A

Left

79
Q

Ratio followed to restore inteavascular volume via IV

A

3:1
3L of fluid administered for every 1L of fluid lost

80
Q

Solutions used to increase osmotic pressure

A

Sodium, other electrolytes, glucose in water, colloid solution containing protein (albumin)

81
Q

Measures to conserve blood & its oxygen carrying capacity
(SATA) (4)

A

Draw minimum for lab analysis
Reinfusing clients own blood collected in a closed circuit cell saver
Administering erythropietin to stimulate bone marrow to manufacture RBCs
Administering cryoprecipitate, factor VIII and thrombin to promote hemostasis

82
Q

Main medications to used to treat shock

A

Andrenergic drugs

83
Q

Drugs with alpha-andrenergic activity, increase peripheral vascular resistance and raise BP

A

Vasopressors

84
Q

Two examples of vasopressors

A

Dopamine (Intropin)
Norepinephrine (levophed)

85
Q

If infusions of first line vasopressors such as dopamine and norepinephrine become ineffective, __ may be used

A

Vasopressin

86
Q

Also know as ADH, causes contraction of arterial smooth muscle, raises BP and diverts blood to vital organs

A

Vasopressin

87
Q

Drugs with beta-andreneric activity that increase heart rate and improve the force of the heart contraction are

A

Positive inotrooic agents

88
Q

What med is a positive inotropic agent

A

Digoxin (Lanoxin)

89
Q

Elevated WBC count supports which shock

A

Septic

90
Q

Dyspnea or airway obstruction resulting from edema accompanies which shock

A

Anaphylactic

91
Q

Low RBC count and hemoglobin correlate with which shock

A

Hypovolemic shock

92
Q

ABG findings is essential for evidence of ___ and ___

A

Hypoxemia
Metabolic acidosis

Med Surg 1 (19 decks)

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