Chapter 39

Question 0

Multiple organ dysfunction syndrome MOD

Answer 0

The sequence of cell damage cause pd by the massive release of toxic metabolites and enzymes

Finish page 814

Question 1

Refractory stage

Answer 1

Irreversible stage–> too much cell death and tissue damage result from too little O2 reaching tissue
* therapy is not effective In saving the pts life even if the cause of shock is corrected and MAP temporarily returns to normal

Manifestations are rapid -> loss of consciousness; nonpalpable pulse; cold, dusky extremities; slow, shallow respirations; and unmeasurable O2 stats

Question 2

Shock

Answer 2

Is widespread abnormal cellular metabolism that occurs when oxygenation and tissue perfusion needs are not met to the level necessary to maintain cell function
“It’s a condition not a disease and represents the whole body”

Question 3

Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and can lead to life threatening emergency.

Answer 3

X

Question 4

Most often shock is a result of what to function. (System)?

Answer 4

Cardiovascular problems and changes

Question 5

Who at higher risk of shock?

Answer 5

Pts in acute care settings, but can happen anywhere

Question 6

Tissue and organ perfusion is related to what?

Answer 6

MAP mean arterial pressure

Question 7

B/c the cardiovascular system is a closed but continuous circuit, the factors that influence MAP include: (3)

Answer 7

• Total blood volume
• Cardiac output
• Size of the vascular bed

Question 8

Hypovolemic shock overall cause and (2) specific causes or risk factors

Answer 8

Total body fluid decreased (In all fluid compartments)

Hemorrhage or dehydration

Question 9

Hypovolemic shock “Hemorrhage” causes or risk factors

Answer 9

Trauma
GI ulcer
Surgery
Inadequate clotting
            Hemophilia 
            Liver disease
            Malnutrition
            Bone marrow suppression
            Cancer
            Anticoagulant Therapy

Question 10

Hypovolemic shock “Dehydration” causes or risk factors

Answer 10

Vomiting
Diarrhea
Heavy diaphoresis 
Diuretic therapy
Nasogastric suctioning
Diabetes Insipidus
Hyperglycemia

Question 11

Cardiogenic shock overall cause and specific cause

Answer 11

Overall–> direct pump failure (fluid volume not affected)

Specific cause or risk factors–>

• Myocardial infarction
• Cardiac arrest
• Ventricular dysrythmias
  * fibrillation
  * tachycardia
• Cardiac amyloidosis
• Cardiomyopathies
  * viral
  * toxic
• Myocardial degeneration

Question 12

Distributive shock overall cause

And specific cause or risk factors

Answer 12

Can be caused by a loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds, and increase capillary leak.
All of these can decrease MAP, and may be stated by nerve changes(neuro-induced), or the presence of some chemicals (chemical- induced)
Overall cause –> Fluid shift from central vascular space (total body fluid volume normal or increased)

Specific cause or risk factors –>

• Neural induced
  * pain
  * anesthesia
  * stress
  * spinal cord injury
  * head trauma
• Chemical-Induced
  * anaphylaxis
  * sepsis
  * capillary leak
  - burns
  - extensive trauma
  - liver impairment
  - hyponatremia

Question 13

Obstructive shock overall cause

And specific cause or risk factors

Answer 13

Overall–> Cardiac function decreased by noncardiac factor ( indirect pump failure). Total body fluid is not affected although central volume is decreased

Specific causes or risk factors

• Cardiac tamponade
• Arterial stenosis
• Pulmonary Embolus
• Pulmonary hypertension
• Constructive pericarditis
• Thoracic tumors
• Tension pneumothorax

Question 14

Sympathetic tone

Answer 14

Some nerves continuously stimulate vascular smooth muscle so that the blood vessels are normally partially constricted a condition called –> sympathetic tone

Increasing in sympathetic stimulation constrict smooth muscle even more, raising MAP. A decrease In Sympathetic tone relax smooth muscle, dilating blood vessels and lowering MAP

Question 15

Blood vessels are innervated by the _____________ division of the ________________ nervous system?

Answer 15

Sympathetic

Autonomic

Question 16

What areas can tolerate low levels of O2 for hours without damage or dying?

Answer 16

Skin and skeletal muscles

Question 17

What are some organs can not tolerate low levels of tissue oxygenation (hypoxic)?

Answer 17

Heart
Liver
Brain
Pancrease

Question 18

Types of shock (4)

Answer 18

*Hypovolemic shock
Cardiogenic shock
Obstructive shock
*Distributive shock

Question 19

Hypovolemic shock

Answer 19

Occurs when too little circulating blood volume cause MAP decrease resulting in inadequate total body oxygenation
Common problems leading to Hypovolemic shock–> dehydration and hemorrhage

Question 20

Neuro- Induced Distributive shock

Answer 20

Is a loss of MAP That occurs when sympathetic nerve impulses controlling blood vessel smooth muscle are decreased and the smooth muscle relax, causing vasodilation

This can be a normal response to injury but when it’s widespread shock results

Question 21

Chemical induced Distributive shock has 3 common origins

Answer 21

Can be found inside (endogenous ex: histamine) or outside the body (exogenous)
Anaphylaxis- begins within seconds-minutes after exposure.
The result–>widespread loss of blood vessel tone and
Decrease cardiac output
Sepsis- widespread infection that triggers whole body inflammatory response which leads to–>distributive shock when bacteria is in the blood–> called Septic Shock

Capillary leak syndrome- fluids to shift result from enlarged capillary pores, loss of plasma osmolarity, and increased hydrostatic pressure. Fluid enters the interstitial space where they become stagnant and cannot deliver O2 or remove waste. 
Problems causing fluid shift-->
Severe burns
Liver disorders
Ascites
Peritonitis
Paralytic ileus
Severe malnutrition 
Large wounds
Hyperglycemia
Kidney disease
Hyperproteinemia
Trauma

Question 22

Stages of shock

Answer 22

1) Initial stage (early stage)
2) Nonprogressive stage (compensatory stage)
3) Progressive stage
4) Refractory stage