Shock

Question 1

Hypovolemic Shock – What is it?

Answer 1

decreased amount of circulating volume in the body

“normal noodle, not enough sauce”

Question 2

Hypovolemic Shock – Cause

Answer 2

Blood loss – hemorrhage, N/V/D with blood, trauma, CABG surgery

Fluid loss – burns, pelvic fx, diabetes, N/V/D, over-diuresis, third-spacing, severe dehydration, fever

Question 3

Hypovolemic Shock – Pathophysiology

Answer 3

Due to blood or fluid loss there is an inadequate amount of circulating volume which leads to a lack of perfusion. Cells and tissues are not being oxygenated which can lead to death of the tissue and multi-organ dysfunction. SNS kicks in causing vasoconstriction to try to move what little volume there is around, but it isn’t enough to make a difference unless the volume is replaced.

Question 4

Hypovolemic Shock – Assessment/S&S

Answer 4

Assessment Qs: hx, VS, black stools or blood in vomit, UOP, LOC, skin integrity

S/S: tachy, hypotension, rapid/deep respirs, AMS, cool/clammy, dec UOP, black stools, bloody vomit, etc.

Question 5

Hypovolemic Shock – Labs/Diagnostics

Answer 5

Labs: lactate, ABGs (low pH), CBC (Hgb, Hct), electrolytes

Question 6

Hypovolemic Shock – Medical Treatment

Answer 6

Restore volume – fluid boluses (warm isotonic soln thru large bore IVs), blood transfusions, colloids (albumin)
Resolve cause – CT to dx possible internal bleeding, stop bleeding if bleeding outwardly, pt may req surgery to stop internal bleeds
Vasopressors – constrict the vessels to increase BP (may not work though if hypovolemia too severe)

Question 7

Hypovolemic Shock – Nursing Dx

Answer 7

Deficient fluid volume
Ineffective tissue perfusion
Decreased cardiac output

Question 8

Hypovolemic Shock – Nursing Interventions

Answer 8

Give warm isotonic fluids (in large bore IVs)
Find the cause of the fluid loss
Give colloids like albumin (depending on cause)
Assess BP, mental status, UOP, CVP, dysrhythmias, O2/ABGs
Assess for FVO post-tx (lung sounds – crackles)

Question 9

Hypovolemic Shock – Age-specific concerns

Answer 9

Elderly pt may have more chronic health issues, which increases their risk for this type of shock.

Question 10

What is an isotonic crystalloid solution that can be used for treatment of hypovolemic shock?

Answer 10

Lactated Ringers

Question 11

The nurse should warm intravenous fluids when a rapid infuser is being utilized to prevent which complication?

1. Hemorrhagic shock
2. Hypothermia
3. Sepsis
4. Cardiogenic shock

Answer 11

Hypothermia

Question 12

A patient is admitted to the emergency department after sustaining abdominal injuries and a broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory rate 34 breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type of shock?

a. ) Hypovolemic
b. ) Cardiogenic
c. ) Neurogenic
d. ) Distributive

Answer 12

Hypovolemic

Question 13

Cardiogenic Shock – what is it?

Answer 13

loss of contractile function of the heart which results in inadequate cardiac output and tissue perfusion
“small noodle”

Question 14

Cardiogenic Shock – Cause

Answer 14

most common cause = myocardial infarction
others: cardiac tamponade, PE, OD of beta-blockers/Ca-channel blockers, ventricle issues, HF, conduction dysrhythmias, cardiac contusion, pericarditis, cardiac surgery, electrolyte changes, head injury causing damage to the cardioregulatory center

Question 15

Cardiogenic Shock – Pathophysiology

Answer 15

pump failing = hypotension which triggers the body’s compensation – retain Na+ and water, vasoconstricts
body retains volume and tries to compensate but cannot adequately use it causing damage to the heart and pulm function = poor perfusion, output, oxygenation