Exam 3: Shock

Question 1

explain shock

Answer 1

life-threatening
decreased tissue perfusion
affects all body systems
activate inflammatory response

Question 2

what is the bottom line of shock

Answer 2

shock = fluid loss = hypovolemia

Question 3

what are the classifications of shock

Answer 3

hypovolemic
cardiogenic
septic
neurogenic
anaphylactic

Question 4

hypovolemic shock

Answer 4

involves intravascular volume

Question 5

cardiogenic shock

Answer 5

decreased function or failure of myocardium

Question 6

septic shock

Answer 6

distributive shock
acute infection

Question 7

neurogenic shock

Answer 7

distributive shock
loss of sympathetic tone

Question 8

anaphylactic shock

Answer 8

distributive shock
circulatory
allergic reaction
acute systemic vasodilation

Question 9

what is the first stage of shock

Answer 9

compensatory stage

Question 10

why does the body go into the compensatory stage

Answer 10

allows the body to maintain BP & CO

Question 11

explain what happens to the body during compensatory stage of shock

Answer 11

vasoconstriction
increased HR
body pulls all the blood away from periphery and to the heart, brain, and lungs
increased RR
*acidosis

Question 12

the increased RR in the compensatory stage causes what

Answer 12

respiratory alkalosis

Question 13

what is the second stage of shock

Answer 13

progressive stage

Question 14

explain what happens during the progressive stage of shock

Answer 14

decreased BP and MAP
decreased perfusion
increased vasoconstriction
decreased mental status
hypoxia

Question 15

what happens if MAP falls below 70

Answer 15

GFR cannot be maintained, and AKI may occur

Question 16

what is the formula to calculate MAP

Answer 16

SBP + (2x DBP) / 3

Question 17

DIC occurs during which stage of shock

Answer 17

progressive

Question 18

explain DIC

Answer 18

disseminated intravascular coagulation; cycle of blood clotting and not slotting enough blood

Question 19

explain what happens during DIC

Answer 19

first - too many clot factors (small clots all over body)
second - increased bleeding b/c the body has used up all of the clot factors

Question 20

explain the treatment for shock

Answer 20

1. treat the cause of the shock
2. anticoagulants
3. if all plts are gone - FFP or plasma

Question 21

list 2 key pieces of information re: platelets and FFP

Answer 21

LPN cannot administer because it is a blood product
only takes 30 minute to infuse

Question 22

cryoprecipitate

Answer 22

increase clot factors

Question 23

when do you administer FFP

Answer 23

use when you need increased clotting; ex. bleeding

Question 24

what is the last stage of shock

Answer 24

irreversible stage

Question 25

explain irreversible shock stage

Answer 25

the organ damage is so severe that the pt is not responding to treatment. the patient does not survive pt in complete organ failure

Question 26

what fluids do you give for shock; why; two examples

Answer 26

colloids; volume expander; albumin, dextran

Question 27

what do you watch for whenever you give fluids

Answer 27

overload

Question 28

when do you use vasoactive meds

Answer 28

when fluid therapy is not maintaining MAP to stimulate the SNS

Question 29

how often do you assess vitals for a patient on vasoactive meds

Answer 29

Q15 min

Question 30

how should a vasoactive med be administered; why

Answer 30

PICC/CVAD; prevent extravasation

Question 31

what must you have on hand to give a vasoactive med PIV; why

Answer 31

reversal; prevent tissue necrosis

Question 32

what nutrition do we provide for patients in shock

Answer 32

glutamine

Question 33

glutamine

Answer 33

helps maintain intestinal barrier function to decrease bacteria translocation and decrease risk of infection