distributive/circulatory

Question 1

What is distributive shock?

Answer 1

Also known as circulatory shock
Blood volume pools in peripheral blood vessels (abnormal displacement of blood volume)
Lack of vascular tone
- Central regulatory mechanisms (sympathetic tone, constriction)
- Local regulatory mechanisms (cellular biochemical mediators)
- Massive arterial and venous dilation

Question 2

What are the three types of distributive/circulatory shock?

Answer 2

Septic shock (most common circulatory shock)
Neurogenic shock
Anaphylactic shock

Question 3

What is the most common hospitalized shock?

Answer 3

Septic shock

Question 4

What is the most common cause of death in non-coronary ICUs in the US?

Answer 4

Sepsis

Question 5

What is septic shock caused by?

Answer 5

Widespread infection
Gram-negative bacteria (most commonly e. coli)
Gram-positive bacteria (staph aureus and MRSA)
Fungal or viral infections

Question 6

Whatare the risk factors of septic shock?

Answer 6

Immunosuppression (chemo, transplant, AIDs)
Extremes of age (<1 year and >65 years)
Malnourishment
Chronic illness
Invasive procedures
Emergent and/or multiple surgeries

Question 7

What is the pathophysiology of septic shock?

Answer 7

Immune and inflammatory response cause increased capillary permeability and poor tissue perfusion
Systemic inflammatory response syndrome

Question 8

What happens due to systemic inflammatory response syndrome in septic shock?

Answer 8

Clot formation

Question 9

What occurs in the early stage of septic shock?

Answer 9

Hyperthermia with fever
Warm flushed skin
Bounding pulses
Elevated RR
cloudy urine

Question 10

What occurs in the septic shock phase of septic shock?

Answer 10

BP drops and skin becomes cool, pale, and mottled

Question 11

What is the cold phase of septic shock?

Answer 11

This is the late phase
Pulse ox
Ventilator/intubation possible
Skin is cool

Question 12

How do we give those with sepsis the best outcomes?

Answer 12

Early identification and treatment within 3 hours
Using the sepsis bundle chart

Question 13

What is the medical management of septic shock?

Answer 13

Fluid replacement therapy
Pharmacological therapy
Nutritional therapy

Question 14

When should nutritional therapy be initiated with a patient with septic shock?

Answer 14

Within 24-48 hours of ICU admission

Question 15

What is the nursing management of a patient with septic shock?

Answer 15

Sepsis related organ failure assessment score (SOFA)

Question 16

What is neurogenic shock?

Answer 16

Vasodilation due to a loss of balance between parasympathetic and sympathetic stimulation (predominantly parasympathetic stimulation)
Venous pooling in the extremities and peripheral vasodilation!

Question 17

What are common causes of neurogenic shock?

Answer 17

SCI
Spinal anesthesia
Other nervous system damage
Lack of glucose

Question 18

What are the symptoms of neurogenic shock?

Answer 18

Low BP
Low HR
Dry, warm skin
Decreased cardiac output
Patient does not perspire in the paralyzed portions of the body

Question 19

What is the management of neurogenic shock?

Answer 19

Observe for fever
Elevate and maintain the HOB to at least 30 degrees when a patient receives spinal or epidural anesthetic to prevent the spreading of medications up through the spinal cord
Supportive care
Higher risk for DVT
Monitor closely for internal bleeding (Can possibly not feel pain)

Question 20

What is anaphylactic shock?

Answer 20

Caused by severe allergic reaction when patients who have already produced antibodies to a foreign reaction (second exposure)

Question 21

What is the pathophysiology of anaphylactic shock?

Answer 21

The reaction causes mast cells to release vasoactive substances causing widespread vasodilation

Question 22

What are the signs and symptoms of anaphylactic shock

Answer 22

Rapid onset of hypotension
Neurologic compromise
Respiratory distress
Cardiac arrest

Question 23

What is the medical management of anaphylactic shock?

Answer 23

Fluid management
IM epinephrine
IV diphenhydramine
Albuterol