Ch 12: Blood Vessel and Lymphatic Disorders

Question 1

Shock occurs when the rate of arterial blood flow is inadequate to…

Answer 1

….meet tissue metabolic needs. (p. 493)

Question 2

In hypovolemic shock, unreplaced losses of over __% of the intravascular volume can result in hypotension and progressive tissue hypoxia.

Answer 2

15% (p. 493)

Question 3

The clinical definition of cardiogenic shock is…

Answer 3

…tissue hypoxia due to decreased cardiac output in the presence of adequate intravascular volume. (p. 494)

Question 4

What three major conditions can cause obstructive shock?

Answer 4

cardiac tamponade, tension pneumothorax, and massive pulmonary embolism (p. 494)

Question 5

Distributive shock, also known as ____________ shock has many causes including…

Answer 5

vasodilatory; …sepsis, anaphylaxis, SIRS produced by severe pancreatitis or burns, traumatic spinal cord injury (neurogenic shock), or acute adrenal insufficiency. (p. 494)

Question 6

What is the pathophysiologic basis for all forms of distributive shock?

Answer 6

The reduction in SVR results in inadequate cardiac output and tissue hypoperfusion despite normal circulatory volume. (p. 494)

Question 7

Risk factors for septic shock include…

Answer 7

…bacteremia, extremes of age, diabetes, cancer, immunosuppression, and recent invasive procedure. (p. 494)

Question 8

The presence of two or more of the following clinical criteria help to establish the diagnosis of SIRS:

Answer 8

(1) body temp higher than 38 C (100.4 F) or lower than 36 C (96.8 F) (2) heart rate faster than 90 beats per minute (3) respiratory rate more than 20 breaths per minute or hyperventilation with a PaCO2 less than 32 mmHg (4) WBC count > 12,000 or < 4,000, or > 10% bands. (p. 494)

Question 9

When a source of infection is confirmed, SIRS is categorized as ______.

Answer 9

sepsis (p. 494)

Question 10

What is the pathophysiologic basis for neurogenic shock?

Answer 10

Loss of sympathetic tone with a reduction in SVR and hypotension without a compensatory tachycardia. (p. 494)

Question 11

In distributive shock, a wide pulse pressure indicates…

Answer 11

…a large stroke volume. (p. 495)

Question 12

Why is the routine use of pulmonary artery catheters NOT recommended?

Answer 12

Meta-analyses of multiple studies suggest that while pulmonary artery catheters do not increase overall mortality or length of hospital stay, they are associated with higher use of inotropes and vasodilators in critically ill patients. (p. 495)

Question 13

Keeping in mind the recommendation against routine use of pulmonary artery catheters, in some complex situation, they can be used to distinguish between…

Answer 13

…cardiogenic and septic shock. (p. 495)

Question 14

The ScvO₂, which is obtained through the _____, can be used as a surrogate for the SvO₂, which is obtained through the _____.

Answer 14

central venous catheter

pulmonary artery catheter

(p. 495)

Question 15

What measurement is more sensitive than CVP as a measure of fluid responsiveness in volume resuscitation?

Answer 15

pulse pressure variation, (as determined by arterial waveform analysis), or stroke volume variation

(p. 495)

Question 16

SVR is high in what types of shock?

Answer 16

hypovolemic and cardiogenic shock

(p. 496)

Question 17

SVR is low in what types of shock?

Answer 17

septic shock, neurogenic shock, and other types of distributive shock

(p. 496)

Question 18

Each unit of whole blood or PRBCs is expected to raise the hematocrit by what %?

Answer 18

3%

(p. 496)