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1
Q

what are the 4 types of shock

A

cardiogenic, distributive, obstructive and hypovolemic shock

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2
Q

cause by heart pump failure such as MI, CHF, cardiac tamponade

A

Cardiogenic shock

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2
Q

most common causative agent of Nosocomial infection/bacterial such as staphylococcus arena and MSRA

A

Distributive/ septic shock

under of distributive shock are

-Anaphylactic shock- cause of allergic reaction such as meds

-Neurogenic shock- spine above T6 injury lead to Neurogenic shock

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3
Q

type of shock something is obstructing or getting in the way of blood going into and out of your heart or great vessels

A

obstructive shock

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4
Q

shock that is a serious condition caused by losing a large amount of blood or fluids.

A

hypovolemic shock

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5
Q

type of shock phase that is also known Non- progressive, has a adequate perfusion to tissue, it is Increased HR & RR
-warm, dry skin, pinkish skin (-) pallor

A

compensated phase

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6
Q

sign and symptoms compensated phase

A

1.N= BP is slightly elevated
tachy-tahcy- hyper

  1. normal UO, GI and peripheral perfusion
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7
Q

BQ: what is the earliest sign of shock*

A

Tachycardia/ hypertension

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8
Q

late sign of shock

A

hypotension

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9
Q

how many voids does the infants in a day

A

20- diluted

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10
Q

normal urine output?

A

30-60ml/hr or 2000-300ml/day
dependent is weight 0.5-1ml kg/hr
because water is 60% in out body

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11
Q

what is the N peripheral tissue

A

warm, dry skin, pinkish skin (-) pallor

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12
Q

what is the skin of the shock pt

A

moist

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13
Q

what type of shock phase that is progressive/ worsening. Inadequate perfusion to anemia, more blood is shunted to the vital organ

A

decompensated shock

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14
Q

what are the vital organs

A

brain, heart and lungs

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15
Q

s/sx of decompensted shock

A

Tach- tachy-Hypotension
-Decreased UO,GI, peripheral tissue- COOL CALMY SKIN, [+] pallor and cyanosis
-capillary refill 3 sec and above
-altered mental status (disorientation)
-ALOC- sleepy(somnolent)

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16
Q

BQ: what is the first orientation of the PX?

A

Orient Person-Place- Time (PPT)

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17
Q

Reflactory stage, permanent or terminal phase

A

Irreversible phase, last phase of shock

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18
Q

If the px is revive in irreversible phase called?

A

Refractory

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19
Q

Sx/ irreversible phase

A

1.Hypo-brady-brady
2. Anuria
3. GI-paralytic ilues
4. Peripheral tissue=pulselessness
5. Cell injury= increased hyperkalemia affect the heart
6. Anaerobic metabolism (no oxygen)
=lactic acid= metabolic acidosis

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20
Q

BQ: px in shock (assumed th worst) what is the findings?

A

Cool moist skin

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21
Q

If the pt is in irreversible phase and they’re revived, they will be

A

Amputated peripheral tissue

22
Q

It is cause by burns, plasma in interstitial, hase edema but decrease BV

A

Fluid volume defecit

Dse’s with FVD
-Liver Dse- r/t decreased albumin and oncotic

-dehydration
-shock
-DKA
-Addisons Dse
-DI

23
Q

Causes by SIADH, cushing, CHF, pulmonary edema, CKD/Renal failure

A

Fluid volune overload

24
Fluids in the alveoli with PINK FORTHY SPUTUM
Pulmonay edema
25
BQ: which fluid compartment get depleted first*
intravascular
26
BQ: how does your body compensated depleted intracellular
Interstitial
27
BQ:Intracellular is the last fluid comparted
Most severe in shock
28
What part of the body you assess if the elderly px has FVD*
Clavicle and forehead
29
What part of the body you assess if the adult px has FVD
Clavicle, sternum, forearm
30
What part of the body you assess if the infant px has FVD*
Abdomen
31
What part of the body you assess if the child px has FVD*
Thigh
32
Normal Cardiac output
4-11L/min
33
Normal BP
90/60 lowest normal 119/179 highest normal 120/80 boarderline
34
Normal Central venous pressure
2-8mmhg
35
Normal MAP (mean arterial pressure
70-100 Formula SBP+ BDP (2) ———————- 3
36
What is yhe position in assessing JVD*
Semi fowlers
37
(+) edema and JVD
FVO
38
Lab findings in FVD
All is down CO, BP, CVP, MAP
39
Labs in FVO
All is up CO BP CVP MAP
40
Labs in hemodilution
All down BUN NA Hgb Hct
41
Position in px has hemodilution
Upright to decrease the workload of your heart
42
Mgt for FVO
O2, restrict fluid, give diuretics and anti hypertension (betablocker) ace inhibitors
43
Labs of hemoconcentration
Increased all BUN Na Hgb & Hct
44
What will happen the Hgb and Hct in bleeding
Decreases
45
Mgt for shock
1. Airway &breathing Head- tilt-chin -lift Position in recovery position: left sidelying pisition 2.circulation -lower extremity- femoral artery Upper extremity- brachial artery If infant- brachial artery (middle part of the upper arm)
46
Will you lossen the tourniquet in life and death situation
Never losen/ remove if not in the ER/DR
47
BQ: in ER room the ER nurse with px with multiple gunshot wound. What will you do first? Stop the bleeding or establish IV site?
Established IV site
48
2 large bore access
16-14G, isotonic and PNSS In severe shock use Central line
49
Fastest in All route position
Intraosseus- to the bones, modified trendelenburg for rapid venous return to circulatory O2
50
If decreases BP what would you give
Epinephrine ( vasopressors) given only in FVD C/I in FVO
51
what is the best indicator of fluid status?*
weight in the morning after voiding before meal WOF: >1kg in 24hrs weekly >3-5lbs monitor I & O: accurate catheterization
52
pathognomonic sign of hypoxia
restlessness- keeping moving in the bed N O2 level 95-100%
53
RAAS is triggered by
decreased BP 1. hypothalamus- increased thirst and drinking 2. blood vessels- vasoconstriction 3. adrenal gland- Na & H2o retention result: increase BP

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