Shock

Question 1

Overview of shock

Answer 1

failure in tissue perfusion, oxygen and nutrients cannot support cellular function, neither linear or predictable

Question 2

Types of shock

Answer 2

hypovolemic, cardiogenic, distributive

Question 3

Types of distributive shock

Answer 3

septic, neurogenic, anaphylactic

Question 4

Common physiologic response in all types of shock

Answer 4

hypoperfusion, hypermetabolism, activation of inflammatory response

Question 5

What is occurring with hypoperfusion

Answer 5

activation of sympathetic nervous system, vasoconstriction

Question 6

What is happening with hypermetabolism

Answer 6

uses all glucose and ATP, cells cannot keep up with energy demand

Question 7

Stages of shock

Answer 7

initial, compensatory, progressive, irreversible/refractory

Question 8

Initial stage of shock

Answer 8

blood flow drops slightly and cells start to lack oxygen, no obvious s/s, cells switch to emergency energy production (anaerobic metabolism)

Question 9

Compensatory stage of shock

Answer 9

the body tries to compensate by increasing heart rate and narrowing blood vessels to maintain blood pressure

Question 10

When does the sympathetic nervous system activate fight or flight response

Answer 10

compensatory stage of shock

Question 11

s/s of compensatory stage of shock

Answer 11

tachycardia, cool/pale skin, tachypnea, restlessness, confusion, bp is normal, diaphoresis, decreased urine output, respiratory alkalosis

Question 12

When and how does metabolic acidosis happen

Answer 12

build-up of lactic acid from increased respiratory rate during the compensatory stage of shock

Question 13

Treatment for compensatory stage of shock

Answer 13

identify the cause and maintain tissue perfusion

Question 14

Progressive stage of shock

Answer 14

the body can no longer compensate, blood flow to the organs decrease, hypoperfusion to all organs

Question 15

Where is blood shunting happening during compensatory stage of shock

Answer 15

blood is being shunted to most important organs (heart, brain, lungs)

Question 16

s/s of progressive stage of shock

Answer 16

hypotension, cold/clammy skin, weak/absent pulses, severe confusion, shallow and rapid respirations, clotting cascade, impaired liver function

Question 17

When does MODS begin

Answer 17

progressive stage of shock

Question 18

Irreversible/refractory stage of shock

Answer 18

organs start to fail and damage is beyond repair, patient does not respond to treatment

Question 19

s/s of irreversible/refractory stage of shock

Answer 19

complete organ failure, unconsciousness, death

Question 20

Appearance of shock

Answer 20

cold/clammy skin, pallor, cyanosis of hands/feet, jaundice

Question 21

vital sign changes during shock

Answer 21

hypotension, tachycardia, tachypnea

Question 22

Assessment findings of shock

Answer 22

confusion, decreased LOC, low urine output, hypoactive bowel sounds, impaired liver function

Question 23

What effect does the impaired liver have on the body

Answer 23

less able to metabolize meds and metabolic waste products, cannot filter bacteria from the blood

Question 24

When to report BP changes

Answer 24

SBP <100, 40 mmHg drop from baseline, MAP <65

Question 25

Early indicator of shock

Answer 25

narrowing/decreased pulse pressure

Question 26

Use of supplemental oxygen during shock

Answer 26

increased and optimize O2 saturations in the bloodstream

Question 27

Why is fluid resuscitation used

Answer 27

restore preload and increase cardiac output to optimize oxygen delivery

Question 28

What is the first preferred solution for fluid resuscitation

Answer 28

lactated ringers

Question 29

What should be monitored for during fluid resuscitation

Answer 29

cardiovascular overload, pulmonary edema, abdominal compartment syndrome

Question 29

How to decrease oxygen consumption

Answer 29

sedation, paralytics, reduce pain and anxiety, maintain normothermia, maintain normal serum glucose

Question 30

General management of shock

Answer 30

tissue perfusion, vital sign changes, supplemental oxygen, fluid resuscitation, decrease oxygen consumption

Question 30

What to do before administering paralytic

Answer 30

intubated and sedated

Question 31

Propofol

Answer 31

drug of choice for sedation, metabolized in liver, turn urine green, can worsen hypotension because it works as vasodilator

Question 32

Vasopressor action

Answer 32

increase strength of myocardial contractility, regulate heart rate, reduce myocardial resistance, initiate vasoconstriction

Question 33

Vasopressor action

Answer 33

increase BP through vasoconstriction

Question 34

Inotropes action

Answer 34

improve heart contractility, increase stroke volume, increase cardiac output

Question 35

What medication can cause and worsen hypotension

Answer 35

vasodilators