CH 46 :Shock Flashcards
Question 1 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this stage of shock, perfusion is reduced to essential tissues, such as the brain and heart. Widespread cellular hypoxia and anaerobic metabolism also occur.
Initial
Progressive
Irreversible
Irreversible
In the irreversible stage of shock, the body’s compensations have failed to maintain adequate blood flow to the brain and heart. As these primary tissues are compromised, further compensatory and regulatory mechanisms fail. Anaerobic metabolism and cell death begin to occur.
Question 2 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this stage of shock, decreased perfusion of kidney, liver, and GI tract develop. Decreased urination and buildup of waste products in the blood occurs.
Initial
Progressive
Irreversible
Progressive
In the progressive stage of shock, the body compensates for circulatory failure by initiating vasoconstriction to tissues such as the GI tract, liver, and kidneys. The decreased perfusion of the kidneys results in reduced urine formation and decreased removal of waste products from the blood.
Question 3 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this stage of shock, a decrease in blood pressure is detected, which activates the sympathetic nervous system. Activation of RAAS also occurs, as the response is similar to the alarm stage of the stress response.
Initial
Progressive
Irreversible
Initial
In the initial stages of shock, a decrease in blood pressure is often the first sign detected by the body. The fall in blood pressure is noted by the baroreceptors which activate the sympathetic nervous system. The activation of this system counteracts the falling blood pressure by increasing the heart rate and contractility of the heart. Reduced blood pressure in the kidneys prompts the juxtaglomerular (JG) cells to release renin, activating the renin-angiotensin-aldosterone system (RAAS). This increases blood volume to maintain blood pressure. Stress hormones epinephrine and cortisol are released.
Question 4 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
This type of shock is manifested by IgE-mediated massive degranulation of mast cells in response to an allergen. Chemical signals result in pronounced vasodilation and bronchospasm.
Anaphylactic
Neurogenic
Septic
Anaphylactic
In anaphylactic shock, an allergen has precipitated a massive immune-mediated response that liberates chemical mediators from mast cells. These chemical mediators cause bronchoconstriction, blocking air passage into and out of the lungs. In addition, the signals cause vasodilation and capillary leakage, resulting in reduced blood return to the heart.
Question 5 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, an infectious organism is actively replicating and producing toxins that disrupt circulation. Hypotension results as venous return is decreased to the heart.
Hypovolemic
Neurogenic
Septic
Septic shock
Septic shock is the result of a widespread inflammatory response to an infectious agent. The infectious agents often produce toxins that disrupt circulation. As circulation is disrupted, hypotension and decreased perfusion of tissues occurs.
Question 6 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, disruption of the sympathetic nervous system, as occurs in spinal cord or brain injury, causes widespread vasodilation. The body is unable to compensate for decreases in blood pressure as expected because of disruption of the sympathetic nervous system.
Cardiogenic
Hypovolemic
Neurogenic
Neurogenic
In neurogenic shock, disruption of the nervous system, specifically the sympathetic nervous system, results in dysfunction of the circulatory system.
Question 7 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
This form of shock results from decreased blood volume, often as a result of trauma. Inadequate blood returns to the heart, reducing cardiac output and blood pressure.
Cardiogenic
Hypovolemic
Neurogenic
Hypovolemic
Hypovolemic shock often results from trauma causing hemorrhagic blood loss. The loss of blood prevents adequate venous return to the heart. With insufficient blood to pump, the heart is unable to maintain pressure and perfusion to the tissues.
Question 8 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
This type of shock occurs when systolic blood pressure falls to less than 90 mm Hg despite adequate fluid volume and venous return. Baroreceptors detect the fall in blood pressure and activate the sympathetic nervous system. Decreased perfusion of the kidneys activates RAAS, which increases fluid volume within the body.
Cardiogenic
Hypovolemic
Anaphylactic
Cardiogenic
As the name implies, cardiogenic shock is related to the functioning of the heart. In this type of shock, fluid volume and other factors are sufficient; the failure to maintain blood pressure results from inadequate cardiac function.
Question 9 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, multiple specialists are involved in the treatment. Appropriate antibiotics are needed, and vasoconstrictors and/or respiratory support may be required. Some cases must be resolved with surgery. Control of hyperglycemia is critical.
Neurogenic
Anaphylactic
Septic
Septic
Septic shock treatment involves a multidisciplinary team approach. Antibiotics are essential when the infection is bacterial in nature. Surgical removal of the source of infection may be necessary. Control of hyperglycemia through IV insulin is required. Other approaches such as vasoconstrictors, respiratory, and renal support may be needed.
Question 10 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, fluid replacement is the key treatment. Although initial form of replacement fluid is under debate, most agree that Ringer’s lactate or normal saline can be used. Blood transfusions may eventually be necessary.
Cardiogenic
Hypovolemic
Septic
Hypovolemic
Hypovolemic shock treatment requires adequate fluid management. Discussions continue as to which fluid should be used first for replacement. However, the key is getting fluid levels to the point that adequate pressure and perfusion can be maintained. Later, the type of fluid infusion or the need for blood transfusions can be considered.
Question 11 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, the cornerstone of treatment is epinephrine, either intramuscular or IV administration. Glucocorticoids are also a standard treatment. Intubation may be necessary.
Cardiogenic
Neurogenic
Anaphylactic
Anaphylactic
Epinephrine counteracts many of the responses that lead to anaphylactic shock, such as bronchoconstriction. Glucocorticoids are used to suppress the overwhelming immune response. As bronchospasm is common in anaphylactic shock, intubation may be necessary.
Question 12 of 12
This or That? Can you differentiate between the different stages and types of shock? Based on each description, select the correct stage or type.
In this type of shock, parasympathetic-drive bradycardia must be counteracted. Atropine, an anticholinergic agent, may be given. Vasoconstrictors and fluid may be administered to maintain blood pressure.
Cardiogenic
Hypovolemic
Neurogenic
Neurogenic
In neurogenic shock, decreased responsiveness of the cardiac system occurs with sympathetic nervous system disruption. Normally, the sympathetic nervous system increases heart rate to compensate for low blood pressure. If the sympathetic nervous system is not functioning properly, this does not occur as needed. Thus, treatments center on maintain adequate heart rate by blocking parasympathetic bradycardia and using vasoconstrictors to maintain blood pressure.
Question 1 of 5
Which of the following are general signs and symptoms of shock? Select all that apply.
Bradycardia Hypotension Increased respiratory rate Tachycardia Oliguria
Hypotension
Increased respiratory rate
Tachycardia
Oliguria
Question 2 of 5
What are the three stages of shock? Select all that apply.
Comprehensive Recurrent Initial Progressive Irreversible
Initial
Progressive
Irreversible
Question 3 of 5
Which of the following may be observed in a patient suffering from shock? Select all that apply.
Inhibition of renin-angiotensin-aldosterone system.
Increased blood flow to the gastrointestinal tract.
Activation of the sympathetic nervous system.
Increased susceptibility to clot formation.
Decreased kidney perfusion leading to oliguria
Activation of the sympathetic nervous system..
Increased susceptibility to clot formation.
Decreased kidney perfusion leading to oliguria.
