Shock 1

Question 1

shock is a ______

Answer 1

condition

Question 2

shock is a lack of ______ and _______

Answer 2

perfusion and oxygenation

Question 3

describe hypoxia

Answer 3

no perfusion of organs

inability to oxygenate the rest of the body

Question 4

describe perfusion

Answer 4

how good blood is flowing to the body
identified by BP, color, warmth
if MAP is maintained then good perfusion is ensured

Question 5

what is oxedated phosporylation

Answer 5

normally, 36-38 molecules of ATP is produced
if no oxygen, anaerobic cycle produces only 2 molecules of ATP
*cannot survive on this

Question 6

what is the oxygenation cycle

Answer 6

lungs
coronary arteries
carotid artery
kidneys (get 1/4 of blood supply)
liver (get 2/3 blood supply)

Question 7

why do you go into shock??

Answer 7

no oxygen is going to the organs and eventually no oxygen goes to the heart and lungs

Question 8

what is the MAP and formula

Answer 8

mean arterial pressure

MAP=systolic + diastolic (2) / 3

Question 9

what is the minimum the MAP can be

Answer 9

> 70

means perfusing to extremities, kidneys, liver, lungs

Question 10

if workload is increased, you need a ______ MAP

Answer 10

higher

Question 11

what is the stroke volume(SV) formula

Answer 11

systolic BP - diastolic BP

Question 12

what is a normal SV

Answer 12

50-60 mL/beat

Question 13

what does stroke volume mean

Answer 13

amount of blood per beat that you push out

can be manipulated by vasoconstriction

Question 14

what happens when you first go into shock

Answer 14

• gets cold
• blood starts SHUNTING UP trunk (no longer in extremities)
• vasoconstriction pushes blood to important liver, heart, lungs (eventually only pumps to heart)

Question 15

what are the factors that influence MAP

Answer 15

1) total blood volume
2) cardiac output
3) size of vascular bed

Question 16

what is the cardiac output formula

Answer 16

SV x HR

Question 17

what is a normal C.O.

Answer 17

4-6 L

Question 18

describe afterload

Answer 18

SYSTOLIC

force heart has to push to get blood out (push of blood from left ventricle to aorta)

Question 19

describe preload

Answer 19

DIASTOLIC
left ventricle and diastolic volume
how much blood left after heart pushes out blood
*never pushes ALL out (leftover blood)

Question 20

describe the ejection fraction

Answer 20

the percent of blood you push out of the heart

Question 21

what is a normal ejection fraction

Answer 21

70s (65-75)

aka if heart is working well you will push this amount out

Question 22

pt w/ CHF or MI will have a ______ ejection fraction

Answer 22

decreased

no good cardiac output (may be as low as 20)

Question 23

describe the vascular bed

Answer 23

where does the blood have to go?
in septic shock: dilation of vessels
not enough blood flow

Question 24

what are the 4 types of shock

Answer 24

hypovolemic
cardiogenic
distributive
obstructive

Question 25

describe hypovolemic shock

Answer 25

*total body fluid is decreased hemorrhage and dehydration loss of fluid... cannot maintain C.O.

Question 26

how do you fix hypovolemic shock

Answer 26

easy | give more fluid and blood

Question 27

describe obstructive shock

Answer 27

*clot cardiac function decreased by non cardiac functions fluid is NOT affected pulmonary HTN, pneumothorax, pericarditis, tamponade

Question 28

describe cardiogenic shock

Answer 28

``` **pump failure fluid volume is NOT affected no strength to push blood out of heart r/t HF (something has hurt the heart) cannot pump well d/t MI, valvular problems, dysrthymias, cardiac arrest, myopathies ```

Question 29

describe distributive shock

Answer 29

**fluid SHIFTED from central vascular space body fluid is either normal or increased two kinds: neural or chemical

Question 30

describe distributive shock (neural)

Answer 30

loss of vascular tone cut in spinal cord, cannot maintain C.O. or vascular tone cannot get epi or sympathetic to work well

Question 31

what causes shock

Answer 31

* anaerobic environment | * decrease in MAP: d/t decrease in C.O, blood volume, or expansion of vascular bed

Question 32

what is the chemical process for the start of shock

Answer 32

drop of just 5-10 mmHg is detected by baroreceptors in the aortic arch and carotid sinus which causes shock process

Question 33

how does the pt appear in shock??

Answer 33

- cold (d/t shunting of blood, elevate legs!!) - gut/GI doesnt work - liver doesnt work (no outward sign) - kidneys stop working (outward sign is decreased renal output, put in foley to monitor) - head/brain stop working (dizziness, lightheaded, pass out) - heart and lungs stop working

Question 34

what is normal urine output

Answer 34

30 mL/ hr (if less than this it is a problem)

Question 35

full chemical process of shock

Answer 35

1) baroreceptos send info to brain, which starts to shunt blood to vital areas (heart lungs, brain) 2) leads to increased lactic acid, protein destroying enzymes and oxygen radicals

Question 36

if shock is corrected in ______ it may be reversible, if not can lead to ______

Answer 36

1-2 hrs | MODS

Question 37

describe baroreceptors

Answer 37

sit on glomerulus triggered to conserve blood flow, no output oxygen free radicals attack the heart

Question 38

what is MODS

Answer 38

multiple organ dysfunction system | d/t lack of oxygenation