Shock

Question 1

Shock

Answer 1

Inability to perfuse the tissues for any reason with a MAP of less than 60

Question 2

Hypovolemic shock

Answer 2

Total body fluids decreased 
Hemorrhage
Dehydration 
Diabetes insipidus 
Vomiting
Diarrhea

Question 3

Cardiogenic shock

Answer 3

Direct pump failure

Fluid volume not affected

Question 4

Distributive shock

Answer 4

Fluid shift
Neural-induced
Chemical induced

Question 5

Neural induced

Answer 5

Pain
Anesthesia 
Stress
Spinal Cory injury 
Head trauma

Question 6

Chemical induced

Answer 6

Anaphalyxsis
Sepsis
Capillary leak

Question 7

Obstructive shock

Answer 7

Cardiac function by noncardiac factor 
Cardiac tamponade
Arterial stenosis
PE
Pulmonary HTN
Tumor 
Tension pneumothorax 
Constructive pericarditis

Question 8

Cardio manifestations

Answer 8

Decrease output 
Increase pulse 
Threats pulse
Decreased BP
Narrowed pulse pressure 
Postural hypotension 
Low central venous pressure 
Flat hand and neck veins 
Slow cap refill 
Diminished peripheral pulses

Question 9

Respiratory manifestations

Answer 9

Increased respirations 
Shallow respirations 
Increased CO2
Decreased O2
Cyanosis

Question 10

GI manifestations

Answer 10

Decreased motility
Diminished or absent bowel sounds
N&V
Constipation

Question 11

Neuromuscular manifestations

Early

Answer 11

Anxiety
Restlessness
Increased thirst

Question 12

Neuromuscular manifestations

Late

Answer 12

Lethargy
Coma
Muscle weakness
No DTR
Sluggish pupils

Question 13

Kidney manifestations

Answer 13

Decreased output
Increased gravity
Sugar and acetone present in urine

Question 14

Skin manifestations

Answer 14

Cold
Pale, mottled, cyanotic
Moist, clammy
Mouth dry, paste like coating present

Question 15

Anaphylaxis

Answer 15

Widespread loss of muscle tone

Chemical induced distributive

Question 16

Initial stage

Answer 16

MAP 5-10 below baseline 
Metabolism is still aerobic 
Increase HR, BP, RR
Difficult to detect 
Some lactic acid

Question 17

Non-progressive

Compensatory stage

Answer 17

MAP 10-15 below baseline 
Kidney and hormonal activation 
Decrease urine 
Fluid shift to vital organs 
Acidosis and lactic acid start 
Hyperkalemia 
Reversible if caught early

Question 18

Signs and symptoms of non-progressive stage

Answer 18

Anxiety 
Thirst
Tachycardia
Tachypnea 
O2 90-95%
Low urine 
Cool and clammy

Question 19

Labs for non-compensatory

Answer 19

Acidosis
Hyperkalemia 
Hypernatremia 
Hyperglycemia 
Lactic acid

Question 20

Progressive stage

Answer 20

MAP 20 over baseline
Vital organs hypoxic
Ischemia of non-vital organs
Can recover if reverse within one hour

Question 21

Signs and symptoms of progressive stage

Answer 21

Severe thirst
Impending doom 
Confusion 
Thready, tachy
O2 75-80
Hypotension 
Cyanosis
Cool and clammy
Anuria

Question 22

Refractory stage

Answer 22

Irreversible
Ischemia
Body cannot respond
Rapid progression to MODs

Question 23

MODS

Answer 23

Rapid loss of consciousness
Non-palpable pulse
Unmeasurable O2
Shallow, slow respirations

Question 24

Multiple organ dysfunction syndrome

Answer 24

Loss of vital organ due to microemboli
Occurs first in liver, heart, kidney
Irreversible even if MAP restored

Question 25

Early neuromuscular assessment

Answer 25

Anxious Restlessness Increased thirst

Question 26

Late neuromuscular assessment

Answer 26

``` Lethargy Coma Muscle weakness Pain Absent DTR Sluggish pupils ```

Question 27

GU assessment

Answer 27

Oliguria or anuria Sugar and acetone present Increased SP gravity

Question 28

Integumentary assessment

Answer 28

``` Cool and clammy Pale Cyanotic Mottled Dry mouth ```

Question 29

GI assessment

Answer 29

N&V Decreased or absent bowel sounds Constipation

Question 30

Nursing actions for hypovolemic shock

Answer 30

``` Oxygen!!! Trendelenburg Look for bleeding IV Vasopressors Monitor urine ```

Question 31

Cardiogenic shock signs symptoms

Answer 31

``` Cold, clammy Poor pulses. Agitation Pulmonary congestion Tachypnea Continuing chest discomfort!!!! ```

Question 32

Cardiogenic shock

Answer 32

``` Heart muscle or valve damage MI most common Tachycardia Hypotension BP systolic <90 MAP 30 less than baseline Low urine output ```

Question 33

Medical management of cardiogenic shock

Answer 33

``` Pain relief Preload and after load reduction Nitro Intra-aortic balloon pump Heart cath CABG ```

Question 34

Distributive shock

Answer 34

Fluid in interstitial spaces Loss of sympathetic tone Blood vessel dilation Capillary leak

Question 35

Obstructive shock

Answer 35

``` Outside the heart Pericarditis Tamponade PE Pneumothorax Aortic dissection Surgical emergency!!! ```

Question 36

Vasoconstrictors

Answer 36

Dopamine Epinephrine Norepinephrine Phenylephrine

Question 37

Heart contractility

Answer 37

Doubutamine | Milrinone

Question 38

Myocardial perfusion

Answer 38

Nitro