Concepts Exam#2 (Ch. 37)

Question 1

Shock

Answer 1

widespread abnormal cell metabolism occurring when gas exchange with oxygenation and tissue perfusion needs aren’t met sufficiently to maintain cell function.

Question 2

Progressive stage of Schock

Answer 2

Life-threatening emergency - Vital organs can tolerate this situation for only a short time before being permanently damaged.

Question 3

MODS

Answer 3

Multiple Organ Dysfunction Syndrome

Question 4

Multiple Organ Dysfunction Syndrome

Answer 4

Sequence of cell damage caused by massive release of toxic metabolites and enzymes

Question 5

Shock Syndrome

Answer 5

Problems resulting form it occur in a predictable sequence

Question 6

Mean Arterial Pressure Factors include

Answer 6

Total blood volume, Cardiac output, size and integrity of the vascular bed, esp. capillaries. If TBV and CO increase, so does MAP, vice versa.

Question 7

Hypovolemic Shock

Answer 7

Occurs when too little circulating blood volume decreases MAP, resulting in inadequate total body perfusion and oxygenation.

Question 8

Common Problems leading to Hypovolemic Shock

Answer 8

Poor clotting with hemorrhage and dehydration.

Question 9

Cariogenic Shock

Answer 9

Occurs when the heart muscle is unhealthy and pumping is impaired.

Question 10

Distributive Shock

Answer 10

Occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot perfuse organs. Caused by blood vessel dilation, pooling of blood in venous and capillary beds, and increased capillary leak.

Question 11

Septic Shock

Answer 11

Widespread infection that triggers whole-body inflammation.

Question 12

Sepsis

Answer 12

Presence of infection systemic manifestations. Infectious organisms have entered the bloodstream. Results in widespread inflammation, known as system inflammatory response syndrome (SIRS)

Question 13

Anaphylactic Shock

Answer 13

Extreme type 1 allergic reaction. Begins within seconds to minutes after exposure to a specific allergen in a susceptible person.

Question 14

Anaphylaxis Results in

Answer 14

Widespread loss of blood vessel tone, with decreased BP and CO.

Question 15

Neurogenic Shock

Answer 15

Type of distributive shock resulting in low BP, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord. It can occur after damage to the CNS such as spinal cord injury.

Question 16

SIRS

Answer 16

Widespread inflammation from increase of infectious organisms entering bloodstream… Triggered as a result of infection escaping local control.

Question 17

Multiorgan Dysfunction syndrome (MODS)

Answer 17

When shock conditions continue for longer periods without help, resulting acid-base imbalance and increase metabolites cause so much cell damage in vital organs that they are unable to perform their critical functions. Once MODS occurs, recovery from shock is no longer possible.

Question 18

MODS Manifestations

Answer 18

Rapid loss of consciousness, non palpable pulse; cold, dusky extremities; slow, shallow respirations; unmeasurable oxygen saturation.

Question 19

Who should be assigned to assess vital signs of a patient who is at risk for or suspected of having hypovolemic shock?

Answer 19

Registered Nurse rather than a LPN/LVN or UAP.

Question 20

These organ systems characterize MODS

Answer 20

Respiratory, Renal, Cardio, Neurologic, Hepatic, Hematologic

Question 21

MODS Causes

Answer 21

Occurs as a secondary phenomenon. Include unrestrained inflammatory reaction or infectious response due to a severe injury or illness. Septic shock is most common reason for MODS.

Question 22

Main indicators of Shock presence or progression

Answer 22

Systolic Blood Pressure changes, pulse rate changes and quality.

Question 23

Interventions and Response to Shock

Answer 23

Focus on reversing the shock, restoring fluid volume to normal range, preventing complications.

Question 24

More interventions to Shock

Answer 24

Oxygen therapy, IV Therapy (Crystalloids), Plasma, Protein-containing colloid fluids restore osmotic pressure and fluid volume (whole blood, packed RBCs, Plasma),

Question 25

Drug Therapy for Shock

Answer 25

Vasoconstrictors (Dopamine, Norepinephrine), Inotropic Agents (Dobutamine), Agents Enhancing Myocardial Perfusion (Sodium - Nirtoprusside)

Question 26

Drug Alert - Monitor patient closely because drugs that dilate coronary blood vessels can cause systemic vasodilation and increase shock if patient is volume depleted

Answer 26

Example - Nitroprusside

Question 27

Nursing Interventions for Shock

Answer 27

Monitor Vitals q15min until shock is controlled, Hemodynamic monitoring (intra-arterial monitoring, Mixed venous Oxygen saturation, pulmonary artery monitoring, pulmonary capillary wedge pressures), Insertion of Central Venous Pressure catheter

Question 28

Risk Factors for Hypovolemic Shock

Answer 28

Diuretics, diminished thirst, immobility, aspirin, anticoagulants, ginkgo biloba

Question 29

Risk Factors for Cariogenic Shock

Answer 29

Diabetes mellitus, presence of cardiomyopathies

Question 30

Risk Factors for Distributive Shock

Answer 30

Diminished immune response, reduced skin integrity, presence of cancer, peripheral neuropathy, strokes, hospital stay, malnutrition, anemaia

Question 31

Action Alert - Use only normal saline for infusion with blood or blood products because the calcium in Ringer’s Lactate induces clotting of the infusing blood.

Answer 31

Nothing