Shock

Question 1

catecholamines cause _____, _____, and ____ resulting in _______

Answer 1

increased HR, increased contractility, and vasoconstriction; resulting in increased CO

Question 2

Baroreceptors

Answer 2

(pressure receptors) located in the carotid sinus and aortic arch.

A decreased MAP causes decreased stretching of the baroreceptors which results in sympathetic response of the ANS

Question 3

Chemoreceptors

Answer 3

located in the aortic arch and carotid arteries

• receptive to oxygen changes in blood
• regulate BP and HR

Question 4

What is the compensation for metabolic acidosis?

Answer 4

increased RR, which causes resp alkalosis

Question 5

vasoconstriction increases _____, ____& ______

Answer 5

preload, SVR, and CO

Question 6

what is systemic vascular resistance (SVR)?

Answer 6

how hard the heart has to pump to get blood out into the system

Question 7

when the kidneys release rennin what happens?

Answer 7

it leads to the conversion of angiotensin I to angiotensin II (vasoconstrictor)

Question 8

what does aldosterone do?

Answer 8

causes retention of Na and H2O= ^BP, preload, and CO

Question 9

an increase in Na triggers…

Answer 9

release of ADH

Question 10

Shock causes “pre-renal” acute renal failure. Ischemia of tubule epithelium leads to…

Answer 10

vasoconstriction, decreased GFR, *oliguria, and azotemia

Question 11

What is stage 1 of shock also called?

Answer 11

Compensatory stage, Non-Progressive

Question 12

what do glucocorticoids do?

Answer 12

• save water
• increase blood glucose
• decrease inflammation
• decrease immune response

Question 13

What is stage 2 of shock also called?

Answer 13

Progressive shock

Question 14

what are some initial s/sx of the progressive shock stage?

Answer 14

decreased LOC, confusion, thirsty, dizzy, restless, nauseated

Question 15

What are some things that are going on during the 2nd stage of shock?

Answer 15

• Anaerobic metabolism leading to metabolic acisosis
• Cellular damage (Na enters cell, K leaves cell, cell ruptures)
• Coagulation defects- blood clots
• Cardiovascular changes- incrased HR, increase in O2 demands, circulating volume is decreased by 25-35%, vasoconstriction
• Signs of failure of more than one organ may be apparent

Question 16

**2 early signs of shock

Answer 16

decreased LOC and tachycardia

Question 17

Causes of hypovolemic shock

Answer 17

trauma
anticoagulants
diuretics
dehydration
third spacing
draining wounds and burns (weeping)
water loss from vomiting, diarrhea, sweating
diabetes insipidus

Question 18

*S/sx of hypovolemic shock

Answer 18

• altered mentation: lethargy to unconsciousness
• *rapid and deep or shallow respirations
• cool, clammy skin
• tachycardia (pulse weak and thready)
• decreased BP
• decreased CO
• decreased urinary output

Question 19

Diagnostic findings with hypovolemic shock

Answer 19

• low hematocrit
• decreased hemoglobin
• decreased RBCs and platelets
• elevated serum electrolytes, elevated creatinine and BUN
• increased urine SG (>1.02)
• decreased pH

Question 20

what kind of fluids do you give the hypovolemic pt?

Answer 20

Isotonic (Normal Saline, Lactated Ringers)

also may need to give blood products

Question 21

NSG care for hypovolemic pt

Answer 21

• Elevate lower extremities to prevent venous pooling and enhance return to heart
• Assess extent of fluid loss
• O2
• monitor VS, neuro stat, cardiac rhythm
• monitor hemodynamic parameters and I&Os
• admin blood products and monitor H&H
• monitor for pulm congestion
• observe for signs of impending coagulopathy, petechie, bruising, and blood or oozing from gums or puncture sites

Question 22

Complications that can occur from hypovolemic shock

Answer 22

renal damage
cerebral anoxia
death

Question 23

Causes of Cardiogenic Shock

Answer 23

• impaired tissue perfusion as a result of cardiac dysfuction (pump failure)
• MI or severe CHF
• cardiogenic drugs, penetrating wounds, papillary muscle rupture, cardiac tamponade, septal rupture, cardiomyopathy, myocarditis, valvular disease, or dysrhythmias, tension pneumothorax
• Heart or Vessels are obstructed/compressed

Question 24

what happens when SVR decreases?

Answer 24

the ventricle does not fully eject volume. Pressure backs up in the system to the lungs causing pulmonary congestion

Question 25

S/sx of cardiogenic shock

Answer 25

thready, rapid pulse
distended neck veins
arrhythmias
chest pain
cool, pale, moist skin
oliguria
decreased mentation

Question 26

Pulmonary s/sx of cardiogenic shock

Answer 26

dyspnea
increased RR
crackles, possible wheezing
ABGs show decrease in PaO2
respiratory alkalosis

Question 27

How does morphine help decrease the work load of the heart?

Answer 27

decreases preload and afterload, vasodilates

Question 28

List the vasoconstrictors

Answer 28

dopamine, epinephrine, norepinephrine, phenylephrine, vasopressin

Question 29

List the vasodilators

Answer 29

nitroprusside (for HTN emergencies), nitro, ACE inhibitors

Question 30

List the Inotropic agents

Answer 30

amrinone, milrinone, dobutamine

Question 31

What are the 3 types of distributive/normovolemic shock?

Answer 31

neurogenic, anaphylactic, and septic

Question 32

S/sx of septic shock

Answer 32

decreased LOC
tachycardia
fever
skin warm and dry
rash
desquamation (peeling & redness of palms)
decreased urinary output
decreased BP
decreased CO

Question 33

Hematologic alterations happening with septic shock

Answer 33

1) endotoxins cause platelet aggregation
2) these cause obstruction to blood flow
3) clotting factors get depleted
4) result: DIC