Chapter 37: Hemodynamic Shock

Question 1

Shock is a _______ progressing life-threatening process. Early detection with rapid response is necessary to improve client outcome.

Answer 1

rapidly

Question 2

_____ is a state of inadequate tissue perfusion that impairs cellular function and can lead to organ failure.

Answer 2

Shock

Question 3

Any condition that compromises _____ delivery to organs and tissues can lead to shock.

Answer 3

oxygen

Question 4

Older adult clients can have reduced compensatory mechanisms and rapidly progress through the _____ of shock.

Answer 4

stages

Question 5

________ secretions might not improve cardiac contractility or cause vasoconstriction as in younger adults due to decreased baroreceptor response.

Answer 5

Catecholamine

Question 6

Decreased ability to compensate can cause sustained low ______ and blood pressure.

Answer 6

cardiac output

Question 7

The type of shock is ______ by its underlying cause.

Answer 7

identitifed

Question 8

______ shock is the failure of the heart to pump effectively due to a cardiac factor.

Answer 8

Cardiogenic

Question 9

_______ shock occurs when a decrease in intravascular volume of at least 15% to 30%.

Answer 9

Hypovolemic

Question 10

_________ shock is impairment of the heart to pump effectively as a result of a noncardiac factor.

Answer 10

Obstructive

Question 11

______ shock is widespread vasodilation and increased capillary permeability. This includes neurogenic, septic, and anaphylactic shock.

Answer 11

Distributive

Question 12

During the _____ stage of shock occurs with no visible changes in client parameters; only changes on the cellular level.

Answer 12

initial

Question 13

All types of shock progress through the _____ stages and produce similar effects on body systems.

Answer 13

same

Question 14

The _________ stage of shock measures to increase cardiac output to restore tissue perfusion and oxygenation.

Answer 14

compensatory (non-progressive)

Question 15

The __________ stage of shock is when the compensatory mechanisms begin to fail.

Answer 15

progressive

Question 16

The _______ stage of shock is irreversible shock and results in total body failure.

Answer 16

refractory

Question 17

The stages of shock

Answer 17

Initial
Compensatory (non-progressive)
Progressive
Refractory

Question 18

With ________ shock educate the client about ways to reduce the risk of a myocardial infarction (MI), such as exercise, diet, stress, reduction, and smoking cessation.

Answer 18

cardiogenic

Question 19

With ______ shock advise the client to drink plenty of fluids when exercising or when in hot weather.

Answer 19

Hypovolemic shock

Question 20

With ________ adivise the client to obtain early medical attention with illness or trauma and with any evidence of dehydration or bleeding.

Answer 20

Hypovolemic shock

Question 21

With _______ shock educate the client about the manifestations of dehydration, including thirst, decreased urine output, and dizziness.

Answer 21

Hypovolemic shock

Question 22

With _________ educate the client about wearing seat belts and helmets, and the use of caution with dangerous equipment, machinery, and burning.

Answer 22

obstructive
neurogenic
hypovolemic

Question 23

With _____ shock adivse the client to obtain early medical attention with evidence of an infection, such as localized redness, swelling, drainage, fever, or urinary frequency and burning.

Answer 23

septic shock

Question 24

With _____ shock advise the client to complete the entire course of antibiotics as directed.

Answer 24

septic shock

Question 25

With _____ shock advise the client to wear a medical id wristband, avoid allergens and to have an _______ available at all times.

Answer 25

Anaphylactic shock | epinephrine pen

Question 26

Teach the client and family how to use the ______ and to be alert to early manifestations of an allergic reaction with _______ shock.

Answer 26

epinephrine pens | anaphylactic

Question 27

Older adult clients are at increased risk for MI and cardiomyopathy with ________.

Answer 27

cardiogenic shock

Question 28

_________ due to a direct cardiac cause, such as MI, heart failure, cardiomyopathy, dyrhythmia, and valvular rupture or stenosis are risk factors for cardiogenic shock.

Answer 28

Cardiac pump failure

Question 29

Excessive fluid loss from diuresis, vomiting, or diarrhea; or blood loss secondary to surgery, trauma, gynecologic/obstetric causes, burns, and diabetic ketoacidosis are risk factors for ______ shock.

Answer 29

hypovolemic

Question 30

Older adult clients are more prone to dehydration due to decreased fluid and protein intake and the use of medications, such as diuretics. Minimal amounts of fluid loss (vomiting, diarrhea) can cause the older adult client to become dehydrated are risk factors for _______.

Answer 30

hypovolemic shock

Question 31

Cardiac pump failure due to an indirect _______, such as a blockage of the great vessels, pulmonary artery, stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax and aortic dissection are all risk factors for ______.

Answer 31

cardiac factor | obstructive shock

Question 32

There are three types of _____ shock: nurogenic, septic, anaphylactic.

Answer 32

distributive shock

Question 33

______ shock occurs when there is a loss of sympathetic tone causing massive vasoldilation. Head trauma, spinal cord injury, and epidural anesthesia are among the causes.

Answer 33

neurogenic

Question 34

_____ shock is when endotoxins and other mediators cause massive vasodilation. Most common cause is a gram-negative bacteria.

Answer 34

septic

Question 35

______ is more frequent in older adult clients due to increased use of catheters in long-term care facilities and late detection of UTI (decreased sensation of burning, urgency).

Answer 35

Urosepsis

Question 36

______ shock is when allergen exposure results in an antigen=antibody reaction causing massive vasodilation. Common causes include antibiotics, foods (e.g. peanuts), latex, and bee stings.

Answer 36

anaphylatic

Question 37

Manifestations of hemodynamic shock can include

Answer 37

``` chest pain lethargy somnolence restlessness anxiousness dyspnea diaphoresis thirst muscle weakness nausea constipation ```

Question 38

A physical finding of hemodynamic shock is hypoxia, tachypnea progressing to greater than _______, and hypocarbia.

Answer 38

40/min

Question 39

A physical finding of hemodynamic shock is when the skin can be pale, ______ or _____ in color, cool, diaphoretic, warm, flushed with fever (distributive shock), and exhibit a rash (anaphylactic or septic shock).

Answer 39

mottled or dusky

Question 40

A physical finding of ______ shock is is angioedema.

Answer 40

anaphylactic shock

Question 41

A physical finding of _____ is wheezing.

Answer 41

shock

Question 42

A physical finding of hemodynamic shock is decreased bp with narrowed ______.

Answer 42

pulse pressure

Question 43

A physical finding of hemodynamic shock is _______ hypotension.

Answer 43

postural

Question 44

Pulse that is weak, thready, or bounding is an expected finding of _______.

Answer 44

distrubitive shock

Question 45

A physical finding of _____ shock is tachycardia.

Answer 45

hemodynamic

Question 46

A physical finding of _____ shock is decreased central venous pressure.

Answer 46

hypovolemic shock

Question 47

A physical finding of _____ shock is central venous pressure increased with increased systemic vascular resistance.

Answer 47

cardiogenic sock

Question 48

A physical finding of ______ shock is decreased urine output and seizures.

Answer 48

hypovolemic shock

Question 49

Lab tests for shock

Answer 49

ABGs Serum lactic acid Serum glucose and electrolytes

Question 50

The ______ can show decreased tissue oxygenation (decreased pH, decreased PaO2, increased PaCO2).

Answer 50

ABGs

Question 51

The serum ______ will increase due to anaerobic metabolism.

Answer 51

lactic acid

Question 52

Serum glucose and electrolytes can ______ during shock.

Answer 52

increase

Question 53

A lab test for ______ shock will test for cardiac enzymes such as _______ and troponin.

Answer 53

creatine phosphokinase

Question 54

For ________ shock, there will be decreased with hemorrhage and increased with dehydration.

Answer 54

hypovolemic

Question 55

For _____ shock you monitor ______ via blood, urine, and wound. You also want to do a coagulation tests as well such as PT, INR, aPTT.

Answer 55

Septic | cultures

Question 56

Diagnostic procedures for hemodynamic monitoring (2)

Answer 56

arterial line insertion | pulmonary artery catheter insertion

Question 57

Hemodynamic monitoring includes an ______ insertion monitors continuous blood pressure monitoring and blood specimens for ABGs and other tests.

Answer 57

arterial line

Question 58

Hemodynamic monitoring includes a _______ which is inserted to measure central venous pressure, pulmonary artery pressures, and cardiac output.

Answer 58

pulmonary artery catheter insertion

Question 59

Continuous hemodynamic monitoring is important to manage fluids and dosage of ________ medications.

Answer 59

inotropic

Question 60

With a pulmonary artery catheter insertion the nurse must monitor the ______ during catheter insertion.

Answer 60

ECG

Question 61

With a pulmonary artery catheter insertion the nurse must have _____ and equipment ready.

Answer 61

resuscitation medications

Question 62

With a pulmonary artery catheter insertion the nurse must monitor the hemodynamic _______ and readings.

Answer 62

waveforms

Question 63

With a pulmonary artery catheter insertion the nurse must confirm catheter placement using a ______.

Answer 63

chest x ray

Question 64

With cardiogenic and obstructive shock use a _____ to assess changes associated with MI and dysrhythmias.

Answer 64

ECG

Question 65

With cardiogenic and obstructive shock use an _______ for cardiomegaly, cardiomyopathy, evaluation of cardiac contractility and function, _______, and valve function.

Answer 65

echocardiogram | ejection fraction

Question 66

With cardiogenic and obstructive shock use a ______ for cardiomegaly, cardiac tamponade, pulmonary emboli, cardiomyopathy, aortic dissection, or aneurysm, and pericardial effusion.

Answer 66

CT

Question 67

With cardiogenic and obstructive shock use a _______ to identify coronary artery blockage.

Answer 67

cardiac catheritization

Question 68

With cardiogenic and obstructive shock use a _____ to diagnose cardiomegaly and pneumothrorax, and to evaluate lungs.

Answer 68

chest x-ray

Question 69

With hypovolemic shock investigate possible sources of bleeding which can be located in...

Answer 69

blood in the nasogastric drainage or stools esophagogastroduodenoscopy CT scan of the abdomen

Question 70

With hypovolemic shock you should continuously monitor airway and ______.

Answer 70

vital signs

Question 71

With hypovolemic shock you should provide hemodynamic support by administration of ____ and meds because a client who has suspected shock can be hemodynmaically unstable.

Answer 71

fluids

Question 72

With hypovolemic shock you should have resuscitation equipment available when ______ the client to and from procedures.

Answer 72

transporting

Question 73

When investigating hypovolemic shock explain all _____ to the client.

Answer 73

procedures

Question 74

With shock monitor (6)

Answer 74

oxygenation status (priority) vital signs cardiac rhythm with continous cardiac monitoring urine output: hourly, report if less than 20 mL/hr LOC skin color, temp, moisture, capillary refill, turgor

Question 75

With shock explain procedures and findings to the client and family while providing _____.

Answer 75

reassurance.

Question 76

With shock place the client on _____ oxygen, such as a 100% nonrebreather face mask. If the client has COPD, insert a _____ L/min nasal cannula and increase the oxygen flow as needed.

Answer 76

high flow | 2L/min nasal cannula

Question 77

When a patient is in shock be prepared to _____ the client. Have emergency resuscitation equipment ready.

Answer 77

intubate

Question 78

When a patient is in shock maintain a ______ IV access.

Answer 78

patent

Question 79

When a patient is in shock, to treat ______, place the client flat with his legs elevated to increase venous return.

Answer 79

hypotension

Question 80

When a patient is in shock if a change in status occurs, notify the _________ and provider of the findings.

Answer 80

rapid response team

Question 81

When a patient is in shock prepare for and maintain client care during _____ to the ICU, surgery, other specialty unit, or diagnostic area.

Answer 81

transfer

Question 82

When a patient is in shock prepare for perform hemodynamic monitoring. Monitor CVP, PAP, CO, and pulse pressure. ____ continuous IV drips to maintain hemodynamic parameters as prescribed.

Answer 82

Titrate

Question 83

Inotropic agents

Answer 83

milirinon lactate | dobutamine

Question 84

Iontropic agents strengthens cardiac _______ and increases cardiac output.

Answer 84

contraction

Question 85

Iontropic agents (milirinon lactate, dobutamine) should be administered by _______ with constant hemodynamic monitoring.

Answer 85

continuous IV infusion

Question 86

Iontropic agents (milirinone lactate, dobutamine) can be ______ to maintain hemodynamic parameters.

Answer 86

titrated

Question 87

Iontropic agents (milirinone lactate, dobutamine) can cause ______ in some clients.

Answer 87

vasodilation

Question 88

Iontropic agents (milirinone lactate, dobutamine) are often administered in combination with a _____.

Answer 88

vasopressor

Question 89

Vasopressors

Answer 89

Dopamine hydrochloride | norepinephrine

Question 90

Vasopressors (dopamine hydrochloride, norepinephrine) strengthens cardiac contraction and increases ______.

Answer 90

cardiac output

Question 91

Vasopressors (dopamine hydrochloride, norepinephrine) increases kidney perfusion at ______ doses.

Answer 91

low

Question 92

Vasopressors (dopamine hydrochloride, norepinephrine) decreases kidney perfusion at ______ doses.

Answer 92

high

Question 93

Administer vasopressors (dopamine, norepinephrine) should be administered via ______ with constant hemodynamic monitoring.

Answer 93

continuous IV infusion

Question 94

Can titrate ______ to maintain prescribed hemodynamic parameters.

Answer 94

vasopressors

Question 95

With vasopressors monitor _____ output.

Answer 95

urine

Question 96

Administer vasopressors through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.

Answer 96

central line

Question 97

Pituitary hormone _______ causes vasoconstriction, increases systemic vascular resistance, and increases BP.

Answer 97

vasopressin

Question 98

Vasopressin is administered via ______ and can be titrated to maintain prescirbed hemodynamic parameters.

Answer 98

continuous IV infusion

Question 99

With Vasopression monitor ______ output.

Answer 99

urine

Question 100

Administer vasopressin through a _____ to prevent extravastion. Rapid onset occurs in 5 min, and short duration occurs in 10 minutes.

Answer 100

central line

Question 101

Sympathomimetics: Epinenphrine is a rapid acting ______.

Answer 101

bronchodilator

Question 102

Sypathomimetics: Epinenphrine increases _______ and CO.

Answer 102

heart rate

Question 103

With sympathomimetics: epinenphrine you need to monitor

Answer 103

bp, pulse, cardiac output

Question 104

With sympathomimetics: epinephrine can cause sloughing if it infiltrates ______.

Answer 104

tissue

Question 105

Opioid analgesics: morphine sulfate is used for ____ management.

Answer 105

pain

Question 106

With Opiod analgesic: morphine sulfate monitor (5)

Answer 106

``` RR of clients who are non ventilated BP HR SaO2 ABGs ```

Question 107

Use opioid analgesics cautiously in conjunction with ______ sedatives.

Answer 107

hypnotic

Question 108

Assess and document the client's pain level and response to medication with ________.

Answer 108

opioid analgesics: morphine sulfate

Question 109

Opioid analgesics: morphine sulfate should be used cautiously due to the risk for increased _______ and hypotension.

Answer 109

vasodilation

Question 110

When using opioid analgesics: morphine sulfate have ______ and resuscitation equipment available for sever respiratory depression in a client who is non ventilated.

Answer 110

naloxone

Question 111

Proton-pump inhibitors: pantoprazole protects against _______ development.

Answer 111

stress ulcer

Question 112

Proton-pump inhibitors: pantoprazole should not be ____ with other medications.

Answer 112

mixed

Question 113

Anticoagulants (2)

Answer 113

low molecular weight heparin | enoxaprin sodium

Question 114

Anticoagulants are used for phophylaxis of _____.

Answer 114

DVT

Question 115

Anticogulants are usually administered ____.

Answer 115

subq

Question 116

_____ can develop from severe hypotension and perfusion of ischemic cells, causing further tissue injury.

Answer 116

MODS