Shock

Question 1

When cardiovascular system fails to perfuse tissues adequately

Answer 1

Shock

Question 2

Initiated by subclinical hypoperfusion

Answer 2

Stage I (Initiation)

Question 3

Sustained reduction in tissue perfusion initiates a set of neural, endocrine, and chemical compensatory mechanisms

Answer 3

Stage II (Compensatory Stage)

Question 4

During this stage, symptoms become apparent but shock may still be reversed.

Answer 4

Stage II (Compensatory Stage)

Question 5

Baroreceptors and chemoreceptors located in the carotid sinus and aortic arch detect the reduction in arterial blood pressure.

Answer 5

Neural Compensation

Question 6

Heart rate and contractility increase to improve cardiac output.

Answer 6

Catecholamine Release

Question 7

To increase perfusion to the myocardium to meet the increased demands for oxygen.

Answer 7

Dilation of the coronary artery

Question 8

Improves blood pressure

Answer 8

Arterial vasoconstriction

Question 9

Augments venous return to the heart, increasing preload and cardiac output.

Answer 9

Venous vasoconstriction

Question 10

Messages relayed to the hypothalamus, which stimulates the anterior and posterior pituitary gland.

Answer 10

Endocrine Compensation

Question 11

Activates the adrenal cortex to release aldosterone.

Answer 11

Angiotensin II

Question 12

Attempt to combat shock by providing the body with glucose for energy and by increasing the intravascular blood volume.

Answer 12

Endocrine Compensation

Question 13

Profound hypoperfusion results with further patient deterioration.

Answer 13

Stage III (Progressive Stage)

Question 14

Reduces the energy available for cellular metabolism.

Answer 14

Anaerobic metabolism

Question 15

Causes failure of the sodium-potassium pump.

Answer 15

Lack of ATP

Question 16

Exerts opposite effect and dilates to increase the blood supply to meet local tissue neds

Answer 16

Microcirculation

Question 17

Attempts to keep vital organs perfused.

Answer 17

Constriction of arterioles

Question 18

Allowing blood to flow into the capillary bed.

Answer 18

Postcapillary sphincters

Question 19

Caused by increased capillary hydrostatic pressure, and pushed fluid from the capillaries into the interstitial space.

Answer 19

Interstitial Edema

Question 20

Prolonged inadequate tissue perfusion that is unresponsive to therapy.

Answer 20

Stage IV (Refractory Stage)

Question 21

Decreases the glomerular filtration rate.

Answer 21

Renal vasoconstriction and hypoperfusion

Question 22

Massive vasodilation, depression of cardiac and respiratory centers, and impaired thermoregulation.

Answer 22

Systemic Nervous System Dysfunction

Question 23

Damages the reticuloendothelial cells, which recirculate bacteria and cellular debris, thereby predisposing the patient to bacteremia and sepsis.

Answer 23

Hypoperfusion

Question 24

Causes the liver to be unable to detoxify drugs, toxins, and hormones, conjugate bilirubin, or synthesize clotting factors.

Answer 24

Damage to hepatocytes.

Question 25

May occur because of the endogenous corticosteroids, exogenous corticosteroids, or insulin resistance.

Answer 25

Hyperglycemia

Question 26

Impair blood flow and result in microvascular thrombosis

Answer 26

Hypoxia and release of inflammatory cytokines

Question 27

Cause a reduction in heart rate, impaired myocardial contractility

Answer 27

Alterations in the CVS

Question 28

Occurs because of the reduction in cerebral blood flow

Answer 28

Cerebral Ischemia

Question 29

Pulmonary blood flow is reduced, ventilation-perfusion imbalances occur.

Answer 29

Chemical compensation

Question 30

Attempt to combat shock by increasing oxygen supply.

Answer 30

Chemical compensation

Question 31

Ineffective pumping of the heart.

Answer 31

Cardiogenic shock

Question 32

Insufficient volume of circulating blood.

Answer 32

Hypovolemic shock

Question 33

Massive vasodilation of the vascular bed causing maldistribution of blood.

Answer 33

Distributive shock

Question 34

Obstruction of blood flow.

Answer 34

Obstructive shock

Question 35

Caused by loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (diaphoresis, DM, DI, emesis, diarrhea, or diuresis) in large amount.

Answer 35

Hypovolemic shock

Question 36

Decreased output and evidence of tissue hypoxia in the presence of adequate intravascular volume.

Answer 36

Cardiogenic shock

Question 37

Caused by obstruction in the heart or great vessels that either impeded venous return or prevents effective cardiac pumping action.

Answer 37

Obstructive shock

Question 38

Result from widespread vasodilation and decreased peripheral resistance.

Answer 38

Distributive shock

Question 39

Imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle.

Answer 39

Neurogenic shock

Question 40

Widespread hypersensitivity; Release of large amount of histamine, producing marked vasodilation.

Answer 40

Anaphylactic shock

Question 41

Sepsis-induced shock with hypotension requiring vasopressors to maintain blood pressure.

Answer 41

Septic shock

Question 42

Features common to all shock states.

Answer 42

Hypoperfusion, hypercoagulability, and activation of the inflammatory response.

Question 43

To provide optimal oxygenation.

Answer 43

Supplemental oxygen/mechanical ventilation

Question 44

To restore intravascular volume.

Answer 44

Fluid replacement

Question 45

To restore vasomotor tone and improve cardiac function.

Answer 45

Vasoactive medications

Question 46

To address the metabolism.

Answer 46

Nutritional support

Question 47

Given in all types of shock.

Answer 47

Fluid replacement (Resuscitation)

Question 48

Best fluid to be given.

Answer 48

Fluid that is readily available

Question 49

Contains dextrose and electrolytes dissolved in water.

Answer 49

Crystalloids

Question 50

Often selected crystalloid because they contain the same concentration of electrolytes as the extracellular fluid.

Answer 50

Isotonic crystalloid solutions

Question 51

Contain substances that should not diffuse through capillary walls.

Answer 51

Colloids (Plasma expanders)

Question 52

Given due to hemorrhage; infusion of blood and blood products

Answer 52

Blood products

Question 53

To improve the patient's hemodynamic stability when fluid therapy cannot maintain adequate MAP.

Answer 53

Vasoactive medication

Question 54

Recommended positioning for hypovolemic shock

Answer 54

Modified Trendelenburg