Shock

Question 1

is a life-threatening condition
that occurs when the body is
not getting enough blood flow.
➢ Affects all body systems

Answer 1

Shock

Question 2

Stages of Shock

Answer 2

1. Compensatory
2. Progressive
3. Irreversible

Question 3

▪ The patient’s blood pressure remains
within normal limits
▪ Vasoconstriction, HR, and contractility
of the heart contribute to maintaining
adequate cardiac output. release of
catecholamines (epinephrine and
norepinephrine).

Answer 3

Compensatory

Question 4

▪ The patient displays the often-described
“fight or flight” response.
▪ The body shunts blood from organs such
as the skin, kidneys, and gastrointestinal
tract to the brain and heart to ensure
adequate blood supply to these vital
organs.

Answer 4

Compensatory

Question 5

As a result, the patient’s skin is cold and
clammy, bowel sounds are hypoactive, and
urine output decreases in response to the
release of aldosterone and ADH
▪ It may only persist for minutes to hours
before progressing to decompensated or
irreversible shock if not treated promptly.

Answer 5

Compensatory

Question 6

the
mechanisms that regulate blood pressure can
no longer compensate and the MAP falls below
normal limits, with an average systolic blood
pressure of less than 90 mm Hg.
(Abraham et al., 2000)

Answer 6

Progressive

Question 7

(or refractory) stage of shock
represents the point along the shock continuum at
which organ damage is so severe that the patient
does not respond to treatment and cannot survive.
Despite treatment, blood pressure remains low.
Multiple organ dysfunction can occur as a
progression along the shock continuum or as a
syndrome unto itself.

Answer 7

Irreversible

Question 8

to restore intravascular volume

Answer 8

Fluid replacement

Question 9

to restore vasomotor tone
and improve cardiac function

Answer 9

Vasoactive medications

Question 10

to address the metabolic
requirements that are often dramatically increased
in shock

Answer 10

Nutritional support

Question 11

is administered in all types of
shock.

Answer 11

Fluid replacement

Question 12

are administered in all forms
of shock to improve the patient’s hemodynamic
stability when fluid therapy alone cannot maintain
adequate MAP.

Answer 12

Vasoactive medications

Question 13

o It occurs when there is LOW fluid volume
in the intravascular system
o occurs when there is a
reduction in intravascular volume of 15%
to 25%. This would represent a loss of 750
to 1,300 mL of blood in a 70-kg (154-lb)
person.

Answer 13

Hypovolemic shock

Question 14

Proper positioning for the patient who shows signs of shock The lower extremities are elevated to an angle of about 20 degrees; the
knees are straight, the trunk is horizontal, and the head is slightly elevated.

Answer 14

Tredelenburg

Question 15

occurs when the heart’s ability to contract
and to pump blood is impaired and the supply of oxygen is
inadequate for the heart and tissues.

Answer 15

Cardiogenic shock

Question 16

is more common in cardiogenic shock
• seen most often in patients with
myocardial infarction.
• occurs when a significant amount
of the left ventricular myocardium
has been destroyed (Price et al.,
1999)

Answer 16

Coronary cardiogenic

Question 17

causes can be
related to metabolic problems
and tension pneumothorax.
• not affected with disease or
involving the coronary vessels
of the heart

Answer 17

Non-coronary (cardiogenic)

Question 18

is a form of shock associated
with a physical obstruction/
blockage of the great vessels
or something interfering with
the filling or emptying of the
heart.

Answer 18

Obstructive shock

Question 19

Caused by a mechanical obstruction that
prevents an adequate volume of blood from
filling the heart chambers.

Answer 19

Obstructive shock

Question 20

Three of the most common examples of obstructive shock

Answer 20

Cardiac tamponade
Tension pneumothorax
Pulmonary embolism

Question 21

• Control airway
• Intubation
• Treat the underlying cause
• Tension Pneumothorax: Chest tube
• Pericardial Tamponade: Pericardiocentesis
• Pulmonary Embolism: Anticoagulation
• Isotonic fluids

Answer 21

Obstructive shock management

Question 22

➢ results from a maldistribution or mismatch
of blood flow to the cells.
➢ shock state resulting from displacement of
blood volume creating a relative hypovolemia
and inadequate delivery of oxygen to the
cells; also called distributive shock.

Answer 22

Circulatory shock

Question 23

Classification of circulatory shock

Answer 23

Septic shock
Neurogenic shock
Anaphylactic shock

Question 24

It can occur in any person with impaired
immunity, but elderly people are at greatest risk.
o The disorder is thought to be a response to that
release microbes or immune mediators, such as
tumor necrosis factor and interleukin- 1
Occurs due to sepsis and leads to a major
decrease in tissue perfusion to organs and tissues.

Answer 24

Septic shock

Question 25

Is a shock state resulting
from loss of sympathetic tone
causing relative hypovolemia.
This loss of sympathetic tone
results in massive
vasodilation and a decrease
in peripheral vascular
resistance, causing blood to
pool in the venous system.

Answer 25

Neurogenic shock

Question 26

Symptoms:
▪ low blood pressure
(hypotension)
▪ slow heart rhythm
(bradyarrhythmia)
▪ flushed, warm skin that
gets cold and clammy later
▪ lips and fingernails that
look blue
▪ lack of full consciousness

Answer 26

Neurogenic shock

Question 27

is caused by a severe
allergic reaction when a
patient who has already
produced antibodies to a
foreign substance (antigen)
develops a systemic antigen–
antibody reaction. occurs
rapidly and is life-threatening.

Answer 27

Anaphylactic shock