Exam 1: shock

Question 1

term:

average arterial pressure in one cardiac cycle

Answer 1

MAP (mean arterial pressure)

Question 2

what is the equation for MAP? what should the level be above?

Answer 2

systolic + 2(diastolic) / 3

> 65

Question 3

re: hypovolemic shock, what are the best indicators that tissues are being perfused?

Answer 3

mentation + urinary output

Question 4

what are two most common causes of hypovolemic shock?

Answer 4

trauma (losing blood volume) + dehydration (ex: DKA with DM)

Question 5

most common cause of cardiogenic shock

Answer 5

MI (heart muscle damaged and cannot pump)

Question 6

type of shock:

Heart is normal, but blood cannot get to heart or get out of heart

Answer 6

distributive shock

Question 7

distributive shock is caused by what?

Answer 7

blood vessel dilation –> capillary leakage –> fluid leaving vascular system and pooling in interstitial

Question 8

type of shock:

MAP is lost because of loss/ reduction in Sympathetic Nerve impulse

Answer 8

neural induced distributive shock

Question 9

main distinguishing s+s of neural induced distributive shock

Answer 9

BRADYCARDIA (b/c has no SNS stimulation)

Question 10

type of shock:

Chemicals cause the blood vessel wall to change (irritating vessels)

Answer 10

chemical induced distributive shock

anaphylaxis and sepsis

Question 11

s+s of hypovolemic shock (9)

Answer 11

1. tachycardia
2. tachypnea
3. hypotension
4. anxiety / restlessness
5. low UO
6. cool / moist skin
7. pallor
8. thirst
9. confusion

Question 12

what would H&H look like with hypovolemic shock?

Answer 12

depends on underlying cause…

if bleeding: low
if dehydrated: can be falsely high

Question 13

intervention for hypovolemic shock

Answer 13

depends on underlying cause

bleeding: blood products and fluid
dehydrated: fluids

Question 14

1st line med for sepsis

Answer 14

levophed (norepinephrine) - to vasoconstrict and increase MAP

Question 15

ideal positioning for patient in shock

Answer 15

supine - shunt blood to vital organs (heart, brain)

Question 16

term:

Systemic Inflammatory Response; dysregulated multisystem response to infection

Answer 16

sepsis

Question 17

sepsis is which type of shock?

Answer 17

distributive

Question 18

2 major signs of sepsis

Answer 18

1. widespread inflammation (WBCs, cytokines, capillary leakage)
2. microthrombi (blocking O2 –> hypoxia)

Question 19

what are the components of SIRS criteria for sepsis?

Answer 19

1. tachycardia
2. tachypnea (RR or CO2 < 32)
3. temperature (elevated or decreased)
4. WBC count (high or low)

2+ signs = CODE SEPSIS

Question 20

1 hour sepsis bundle

KNOW

Answer 20

1. lactate level (normal <4)
2. pan cultures
3. ABX within 1 hour
4. crystalloid fluids

Question 21

besides 1 hour sepsis bundle, what are some interventions for sepsis (3)

Answer 21

1. O2
2. glucose management
3. vasopressors