chapter 29 - Shock/hypotension

Question 1

what is a chronotropic effect

Answer 1

causes a change in HR
-can be positive or negative

Question 2

what is a dromotropic effect

Answer 2

change in speed of electrical conduction
-can be positive or negative

Question 3

what is an inotropic effect

Answer 3

change in myocardial contraction

Question 4

what is normotensive

Answer 4

normal BP

Question 5

what is a pressor

Answer 5

an effect that increases BP

Question 6

homeostatic mechanisms

Answer 6

-autonomic resources
-capillary fluid shifts
-neurohormones

Question 7

causes of hypotension

Answer 7

-failure for the heart to pump effectively -dysrhythmias and HF
- blood or fluid loss
-extreme stress that depletes NE

Question 8

what is the impact of hypotension

Answer 8

-decreased o2 to tissues
-accumulation of waste products
-shock
-cell death

Question 9

what is shock

Answer 9

compromised oxygen delivery, consumption, and utilization
-causes cellular and tissue hypoxia

Question 10

treatment of shock/hypotension

Answer 10

increasing fluids

Question 11

what is hypovolemic shock

Answer 11

decreased circulating volume
most common
-the result of hemorrhage, trauma, burns, diabetes insipidus (increased urine), or ketoacidosis (high sugar)

children can get from V/D

Question 12

what is cardiogenic shock

Answer 12

pumping problem with the heart
-caused by MI, dysrhythmias, valve or ventricle rupture

Question 13

what is obstructive shock

Answer 13

obstruction of flow
-caused by mass, accumulation of fluid, blood clot

Question 14

what is distributive shock

Answer 14

massive vasodilation
anaphylactic: histamine release
neurogenic: spinal cord injury
septic: inflammatory response to infection

Question 15

what happens during compensated shock

Answer 15

activation of SNS
-body attempts to restore homeostasis
-increases HR and vasoconstriction

Question 16

what happens during uncompensated shock

Answer 16

normally body does not have enough blood volume to compensate
-progressive organ dysfunction
-CO/HR/BP continues to decrease
S: cool, clammy, restless, diaphoretic, decreased urine, metabolic acidosis
NEEDS RAPID MEDICAL ATTENTION

Question 17

what happens during irreversible shock

Answer 17

permanent damage
-multi-organ failure, first is normally renal with no urine output
-pH imbalance, decreased CO and SEVERE hypotension

Question 18

how do vasopressors work

Answer 18

potent vasoconstriction

Question 19

side effects of vasopressors

Answer 19

decreased renal profusion, decreased liver profusion, dysrhythmias, ischemia of limbs, extravasation –needs to be given in central line due to toxicity

Question 20

common vasopressor

Answer 20

norepinephrine

Question 21

who can not have vasopressors

Answer 21

dysrhythmias, angina pectoris, hypertension, hyperthyroidism, cerebrovascular disease, and glaucoma, can also worsen psychiatric disorders

Question 22

what does epinephrine do

Answer 22

stimulates beta and alpha receptors, causes vasoconstriction

Question 23

what does dopamine do

Answer 23

potent alpha agonist
low dose: dilate renal and coronary arteries
high dose: increase HR and vasoconstriction

Question 24

what does dobutamine do

Answer 24

stimulates beta 1, increased contractility
-does not cause tachycardia
-can not be run with bicarb