Shock

Question 1

What is Shock?

Answer 1

a condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function

Question 2

when cells die what do they release?

Answer 2

lactic acid

Question 3

stages of shock

Answer 3

compensatory
progressive
irreversible

Question 4

compensatory stage of shock

Answer 4

SNS causes vasoconstriction, increased HR, and heart contractility 
perfusion of tissues is inadequate 
acidosis 
increased respiratory rate 
confusion

Question 5

progressive stage of shock

Answer 5

BP and MAP decrease
all organs suffer hypoperfusion
vasoconstriction
decreased cerebral perfusion and hypoxia

Question 6

irreversible stage of shock

Answer 6

organ damage is so severe that the pt does not respond to treatment and cannot survive

Question 7

hypovolemic shock

Answer 7

inadequate circulating volvume

caused by sudden blood loss or severe dehydration and burns

Question 8

management of hypovolemic shock

Answer 8

• restore circulating volume with crystalloids first
• blood products
• O2, monitor VS, labs, respiratory status, mentation and urine output

Question 9

cardiogenic shock

Answer 9

loss of critical contractile function of the heart

Question 10

assessment findings of cardiogenic shock

Answer 10

chest pain 
hypotension 
cool skin 
oliguiria 
decreased mentation 
dyspnea 
crackles 
elevated myocardial markers, BNP

Question 11

management of cardiogenic shock

Answer 11

- increase myocardial O2 delivery, CO, decrease LV workload
correct reversible problems 
fluids
diuresis 
nitrates 
electrolyte repletion
analgesia
sedative 
monitor for dysrhythmias and hemodynamic status

Question 12

circulatory shock

Answer 12

an acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in cellular hypoxia

Question 13

causes of circulatory shock

Answer 13

• damage of the heart from MI
• ineffective pumping caused by arrhythmias
• ventricular septal defect
• ventricular aneurysm
• acute disruption of valvular function
• problems with open heart sx

Question 14

hypovolemic circulatory shock

Answer 14

• loss of whole blood
• loss of plasma
• loss of extracellular fluid

Question 15

obstructive circulatory shock

Answer 15

• inability of heart to fill properly

- obstruction to outflow from the heart

Question 16

distributive circulatory shock

Answer 16

• loss of sympathetic vasomotor tone
• presence of vasodilating substance in the blood
• presence of inflammatory mediators

Question 17

complications of shock

Answer 17

• acute respiratory distress syndrome
• acute renal failure
  -GI complication
  DIC
  MODS

Question 18

types of crystalloids

Answer 18

• NA saline
• lactated ringers
• hypertonic solutions (3% saline)

Question 19

types of colloids

Answer 19

albumin

dextran

Question 20

what does dextran interfere with?

Answer 20

platelet aggregation

Question 21

complication of fluid replacement

Answer 21

fluid overload

pulmonary edema

Question 22

clinical manifestations of cardiogenic shock

Answer 22

• decrease CO

- CI

Question 23

drug therapy for cardiogenic shock

Answer 23

NTG
Nipride 
diuretics 
dobutamine 
amrinine
digoxin 
dopamine 
IABP
PTCA
CABG

Question 24

effects of NTG

Answer 24

• dilates coronary arteries, improves collateral blood flow to ischemic areas withing the heart
• reduces preload
• reduces LV afterload, which deacreased myocardial O2 demand and consumption

Question 25

how often to assess pt with IV NTG

Answer 25

q 15 mins for the first hour then every hour

Question 26

effects of Nipride

Answer 26

• vasodilator, more potent the NTG

- may cause diversion of blood flow from ischemic to nonischemic zones

Question 27

what dose do you start Nipride at?

Answer 27

0.5 mcg/kg/min

Question 28

what dose is dobutamine started at

Answer 28

initiated at 5 mcg/kg.min and then can be increased to 10-20