Shock

Question 1

What are the 4 stages of shock?

Answer 1

Initial, nonprogressive, progressive, refractory.

Question 2

Define shock.

Answer 2

It is the whole body response to poor tissue perfusion

Question 3

During shock, what type of cellular respiration occurs and what builds up?

Answer 3

Anaerobic. Lactic acid

Question 4

What are the 4 types of shock?

Answer 4

Hypovolemic, cardiogenic, distributive, obstructive

Question 5

What causes distributive shock?

Answer 5

Loss of sympathetic stimulation, either through damage or chemicals

Question 6

What causes obstructive shock?

Answer 6

In this case the heart muscle is OK, but other factors deter the pumping action.

Question 7

What are the signs of early shock?

Answer 7

MAP falls 10mm or less, while BP stays the same due to the body’s ability to compensate

Question 8

Describe non-progressive (compensatory) shock.

Answer 8

MAP falls 10-15 mm from baseline. Kidney and hormonal responses begin since the cardiovascular system can’t maintain balance by itself

Question 9

Describe progressive (non-compensatory) shock.

Answer 9

MAP falls 20 mm or more. Compensatory mechanisms can’t keep up, vital organs become hypoxic, less vital organs become anoxic and ischemic

Question 10

Describe the last stage of shock.

Answer 10

Refractory stage. It is irreversible. Too much damage has occured

Question 11

What stage of shock is emergent?

Answer 11

Progressive (non-compensatory)

Question 12

What is the primary intervention for any stage of shock?

Answer 12

Correct the condition that is causing the shock. Shock is not a disease, but a condition. It always has an underlying cause

Question 13

Where does MODS begin?

Answer 13

In the brain, heart, liver, kidneys

Question 14

What are some interventions for MODS?

Answer 14

Airway, IV fluids, O2, be gentle, HOB 30 deg, VS q5min until stable, heparin for phase 1, platelets/plasma/clotting factors for phase 2, do not leave client!

Question 15

What nursing diagnosis is a major factor in MODS? What drug is given for this?

Answer 15

Potential for bleeding (DIC). Xigris (activated C protein), interlukin/cytokines (experimental)

Question 16

What is the earliest manifestation of shock?

Answer 16

Increased heart rate

Question 17

An O2 sat below _____% is considered a life threatening emergency and may signal irreversible shock.

Answer 17

70

Question 18

Why is DIC a problem with severe sepsis/septic shock?

Answer 18

Because microthrombi formation is widespread

Question 19

What happens to blood sugar when septic shock occurs?

Answer 19

It rises and must be controlled

Question 20

Define cardiogenic shock.

Answer 20

The heart muscle is damaged and cannot pump enough blood. MI is the most common cause.

Question 21

Define hypovolemic shock.

Answer 21

Lack of circulating blood volume. Most commonly caused by hemorrhage and dehydration.

Question 22

What are the 2 types of distributive shock?

Answer 22

Neural-induced and chemical-induced.

Question 23

Describe neural-induced distributive shock.

Answer 23

Sympathetic nerve impulses decrease to the extent that map falls, vessels relax, vasodilation occurs.

Question 24

What are some causes of neural-induced distributive shock?

Answer 24

Pain, anesthesia, stress, spinal cord/head trauma.

Question 25

What are some causes of chemical-induced distributive shock?

Answer 25

Anaphalaxis. sepsis, capillary leak from burns, trauma, liver impairment, hypoproteinuria.