Shock

Question 1

what type of shock has inadequate circulating volume?

Answer 1

hypovolemic shock

Question 2

Causes of hypovolemic shock

Answer 2

sudden blood loss from trauma, severe dehydration, significant fluid shifts from burns

Question 3

decreased blood volume, causes decreased venous return, causes decreased SV, causes decreased C.O. which causes decreased perfusion, is what type of shock?

Answer 3

hypovolemic shock

Question 4

increased HR, decreased BP, decreased C.O., increased SVR, decreased wedge, and decreased CVP are for what type of shock?

Answer 4

hypovolemic shock

Question 5

Treatment for hypovolemic shock

Answer 5

fluid (crystalloids and isotonic- for burn pt give LR, for N/V/D give saline- then move to blood products if necessary like albumin and ptls), warm fluids, observe for a response to therapy and fluid overload

Question 6

what position to place a patient in hypovolemic shock in?

Answer 6

modified trendelenburg position

Question 7

what type of shock is extreme congestive heart failure

Answer 7

cardiogenic shock

Question 8

causes of cardiogenic shock

Answer 8

Left ventricular MI, valvular disease, dysrhythmias, cardiomyopathy, and sort of heart issue

Question 9

decreased cardiac contractility leads to decreased SV and C.O., which leads to pulmonary congestion, decreased systemic tissue perfusion, and decreased coronary artery perfusion is indicative of what type of shock?

Answer 9

cardiogenic shock

Question 10

thready, rapid pulse; narrow pulse pressure; distended neck veins; arrhythmias; chest pain; cool, pale, moist skin; oliguria; decreased mentation; enlarged heart, pulmonary congestion; dyspnea; increased RR; insp rales, and wheezing; decreased PaO2; respiratory alkalosis are all S/S of what type of shock?

Answer 10

Cardiogenic shock

Question 11

increased HR, decreased BP, decreased C.O, increased SVR; increased wedge and CVP are for what type of shock?

Answer 11

cardiogenic shock

Question 12

goals of treatment for cardiogenic shock?

Answer 12

increase myocardial oxygen delivery, maximize C.O by management of fluids, monitor and replace elctroolytes, avoid arrhythmias/treat them, positive inotropes and decreased left ventricular work load, give vasoconstrictors

Question 13

what medications do you give a patient in cardiogenic shock?

Answer 13

vasoconstrictors (nerepi, phenylephrin, vasopressin), inotropes (amrinone, milrinone, dobutamine, dopamine), vasodilators (nitroprusside, nitroglycerin, ACE inhibitors)

Question 14

What type of shock is an allergic reaction to a specific antigen?

Answer 14

anaphylactic shock

Question 15

penicillin, sulfa drugs, NSAIDS, narcotics, blood products, dies, eggs, milk, nuts, fish, bees, wasps, latex are all common antigens for what type of shock?

Answer 15

anaphylactic shock

Question 16

puffy face or hands, itching/hives, anxiety, restlessness, dyspnea, wheezing, stridor, flushing, diaphoresis, tachycardia, weakening pulses, poor cap refill, increased RR, laryngeal edema, hypotension, bronchospasms are S/S of what type of shock?

Answer 16

anaphylactic shock

Question 17

increased HR, decreased BP, decreased C.O., decreased SVR, decreased wedge and CVP are for what type of shock?

Answer 17

anaphylactic shock

Question 18

management of anaphylactic shock

Answer 18

oxygen, benadryll, possilby sup-Q epinephrine to bronchodilate and vasoconstrict, corticosteroids, bronchodilators, vasoconstrictors, positive inotropes

Question 19

Nursing management of anaphylactic shock

Answer 19

maintain airway, provide supplemental oxygen, intubate or trach if necessary, monitor response to treatment, patient education on avoidance of antigen and use of epi-pen

Question 20

loss or disruption of sympathetic tone causing peripheral vasodilation and decresed tissue perfusion, loss or disruption of the autonomic nervous system causes bradycardia, dysrhythmias is what type of shock?

Answer 20

neurogenic shock

Question 21

most common cause of neurogenic shock?

Answer 21

spinal cord injury above T6

Question 22

vasodilation, maldistribution of blood volume leads to decreased venous return which leads to decreased SV and C.O., and decreased perfusion. this is indicative of what type of shock?

Answer 22

neurogenic shock

Question 23

decreased HR, decreased BP, decreased C.O., decreased SVR, decreased wedge and CVP are indicative of what type of shock?

Answer 23

neurogenic shock

Question 24

management of neurogenic shock

Answer 24

fluid administration to support BP, vasopressors, atropine for bradycardia, pacemaker if bradycardia persists

Question 25

Shock that initiated by an infection?

Answer 25

Septic Shock

Question 26

presence of viable bacteria in the blood

Answer 26

bacteremia

Question 27

presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention

Answer 27

Multiple Organ dysfunction syndrome (MODS)

Question 28

systemic response to infection, characterized by 2 or more of the following:

1. T> 38c or < 36c
2. HR >90
3. RR>20 or PaCO2 12,000 or 10% bands (immature RBC)

Answer 28

Sepsis

Question 29

Sepsis with hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include all of the above

Answer 29

Septic Shock

Question 30

the systemic inflammatory response to a variety of severe clinical insults. has 2 or more of the following:

1. T> 38c or 90
2. RR>20 or PaCO2 12,000 or 10% bands (immature RBC)

Answer 30

SIRS- Systemic Inflammatory Response Syndrome

Question 31

Inflammatory response to infection:

1. cytokines are released form WBC- they produce vasodilation, hypotension, increased cap permeability, fever, and decreased myocardial contractility
2. Neutrophils are released- they adhere to vessel walls and travel to site of infection, Cytokines released increase inflammatory response and destroy organisms. The same cytokines damage endothelium, which releases more cytokines.
3. bacteria and neutophils release inflammatory factors such as tissue factor
4. Tissue factor stimulates a procoagulant state and formation of fibrin clots.
5. Microcirculatory clots form that inhibit tissue perfusion. this is pivitol for progression from sepsis to SIRS, MODS, and death

What shock

Answer 31

Septic shock

Question 32

mental status change, increased RR, edematous but intravascularly depleted, spontaneous bleeding, C.O. unusually high, SVR unusually low are S/S of what type of shock

Answer 32

Septic Shock

Question 33

HR increased, BP decreased; C.O. increased/decreased, SVR decreased, wedge and CVP decreased are indicative of what type of shock?

Answer 33

Septic Shock

Question 34

Treatment goals for Septic shock

Answer 34

maximize O2 delivery; halt the exaggerated inflammatory response; prevention (handwashing aseptic technique); early identification and tx of infection; aggressive restoration of intravascular volume; maintenance of adequate C.O., maintenance of adequate ventilation and oxygenation; restoration of coagulation balance, maintenance of appropriate metabolic environment

Question 35

hypoperfusion, hypercoagulability, activation of the inflammatory response, shock is an acute widespread process of impaired tissue perfusion are common features of what?

Answer 35

Shock