Shock

Question 1

Hemineglect syndrome

Answer 1

Patient loses awareness of opposite side of stroke injury. Usually occurs in R brain injury.

Question 2

T or F. During shock, all body systems are affected?

Answer 2

TRUE

Question 3

Shock

Answer 3

A clinical syndrome characterized by impaired cellular metabolism that results from inadequate tissue perfusion and oxygenation, or cellular dysfunction.

Question 4

T or F. Shock is a life-threatening condition characterized by insufficient delivery of oxygenated blood to cells and tissues. It can also be defined a decrease in global perfusion resulting in cellular hypoxia and end- organ damage.

Answer 4

TRUE

Question 5

How is shocked classified?

Answer 5

It can be classified by cause, pathophysiologic process, or clinical manifestations.

Question 6

There are 6 different TYPES of Shock, what are they?

Answer 6

Cardiogenic shock, Neurogenic or Vasogenic shock, Anaphylactic shock, Septic shock, Hypovolemic shock, Traumatic shock.

Question 7

Cardiogenic Shock

Answer 7

Caused by abnormal cardiac functioning or “pump failure”. Causes include heart failure, MI, CHF, myocardial or pericardial infections, dysrhythmias, and drug toxicity.

Question 8

Neurogenic or Vasogenic Shock

Answer 8

Widespread vasodilatation from an imbalance between parasympathetic and sympathetic stimulation. Caused by alterations in smooth muscle tone. Rare and generally associated with significant spinal trauma.

Question 9

Anaphylactic shock

Answer 9

Results from an overwhelming immune response to an allergen or antigen. Caused by HYPERSENSITIVITY.

Question 10

Septic Shock

Answer 10

Caused by infection. Most often associated with release of endotoxins from Gram-negative bacteria into the bloodstream.

Question 11

Hypovolemic Shock

Answer 11

Caused by insufficient intravascular fluid. Loss of whole blood, blood plasma, interstitial fluid, or fluid sequestration. Loss of volume is from obvious hemorrhaging, extracellular fluid and/ or plasma loss from burns, peritonitis, or ruptured aneurysms. Other causes of fluid loss include inadequate intake, excessive sweating, diuretic usage, third-spacing, vomiting, diarrhea, and gastric suctioning

Question 12

T or F. Traumatic Shock has similar components of Hypovolemic and Septic shock?

Answer 12

TRUE

Question 13

T or F. Shock is responsible for the impairment of glucose use?

Answer 13

True. Shock impairs glucose delivery or glucose uptake. Cells shift to glycogenolysis, gluconeogenesis, and lipolysis.

Question 14

S/S of MILD Hypovolemic shock include:

Answer 14

Minimal tachycardia, cool hands/ feet, slight drop in BP.

Question 15

S/S of MODERATE Hypovolemic shock include:

Answer 15

Decreased pulse pressure, sweating, pallor, restlessness, oliguria.

Question 16

S/S of SEVERE Hypovolemic shock include:

Answer 16

HR >120, SBP <60, anuria, acidosis, mental stupor.

Question 17

What causes persistent vasodilatation and creates relative hypovolemia?

Answer 17

Neurogenic (Vasogenic) Shock

Question 18

Severe pain and stress, anesthesia, and depressant drugs are most often associated with:

Answer 18

Neurogenic shock

Question 19

T or F. Anaphylactic shock is a widespread hypersensitivity reaction that leads to vasodilatation, peripheral pooling, and relative hypovolemia?

Answer 19

TRUE

Question 20

T or F. Septic shock is initiated by the infectious process?

Answer 20

True, and bacteremia, endotoxins, and exotoxins cause the host to initiate the inflammatory process.

Question 21

What does the inflammatory response initiate?

Answer 21

Widespread vasodilatation.

Question 22

Identify the 2 phases of Septic Shock

Answer 22

Warm phase (EARLY) and cold phase (LATE)

Question 23

What characteristics would you expect to see during the EARLY shock phase?

Answer 23

Skin flushed, warm and moist d/t vasodilatation, tachycardia, tachypnea, hyperthermia.

Question 24

What characteristics would you expect to see during the LATE shock phase?

Answer 24

Skin cool and pale d/t fluid deficit with shock, hypotension, tachypnea

Question 25

What are COMMON non-specific S/S of Shock?

Answer 25

Weakness, sick, nauseated. cold/hot, dizzy, confused, afraid, thirst, SOB

Question 26

What are variable S/S of Shock?

Answer 26

Decreased BP, Decreased CO, Decreased UO, Increased RR, Increased HR.

Question 27

What diagnostic tests would you expect to be ordered for patients in Shock?

Answer 27

H&H, ABGs, Electrolytes, BUN, Creat., Osmolarity, Blood Cultures, WBC and Diff., Cardiac Enzymes (LDH, CPK, SGOT).

Question 28

In regards to Hypovolemic Shock, what is the best diagnostic test?

Answer 28

H&H

Question 29

What is the purpose of ABGs?

Answer 29

Identifies body compensatory mechanisms, such as acidosis.

Question 30

Patients in Septic Shock would benefit from having blood cultures drawn, why?

Answer 30

Blood cultures help the identify causative organism

Question 31

Diagnosis of cardiogenic shock enzymes include:

Answer 31

LD, CPK, SGOT

Question 32

What is the best approach to treating shock?

Answer 32

Correct the underlying cause! Treat heart failure (enhance CO), Stop hemorrhage, Stabilize spine and surrounding tissue, Remove or neutralize the antigen, Eradicate the infective agents, Give IV fluids, O2, cardiotonic meds, steroids, stress ulcer prophylaxis.

Question 33

What are the most appropriate Nursing Dx for Shock?

Answer 33

Acute fluid volume deficit, Decreased CO r/t decreased ventricular function, Decreased CO r/t vasodilatation.

Question 34

You walk into your patient’s room and you realize that they’re in shock, what will you need to do?

Answer 34

Place PT in the shock position (elevate FOOT of bed), keep PT warm and comfortable, Turn the PT’s head to one side if neck injury is not suspected