Shock and DIC

Question 1

Define shock.

Answer 1

Widespread, serious reduction of tissue perfusion, which leads to generalized impairment of cellular function.

Question 2

What is the most common cause of shock?

Answer 2

Hypovolemia

Question 3

What causes septic shock?

Answer 3

Release of endotoxins by bacteria, which act on nerves in vascular spaces in the periphery, causing vascular pooling, reduced venous return, and decreased cardiac output and result in poor systemic perfusion.

Question 4

What is the goal of treatment for hypovolemic shock?

Answer 4

Quick restoration of cardiac output and tissue perfusion.

Question 5

What intervention issued to restore cardiac output when hypovolemic shock exists?

Answer 5

Rapid infusion of volume-expanding fluids

Question 6

It is important to differentiate between hypovolemic and cardiogenic shock. How might the nurse determine the existence of cardiogenic shock?

Answer 6

History of MI with left ventricular failure or possible cardiomyopathy, with symptoms of pulmonary edema.

Question 7

If a client is in cardiogenic shock, what might result from administration of volume-expanding fluids, and what intervention can the nurse expect to perform int he event of such an occurrence?

Answer 7

Pulmonary edema
Administer medications to manage preload, contractility, and/or afterload
To decrease afterload, nitroprusside may be administered

Question 8

List five assessment findings that occur in most shock victims.

Answer 8

Tachycardia
Tachypnea
Hypotension
Cool, clammy skin
Decrease in urinary output

Question 9

Once circulating volume is restored, vasopressors may be prescribed to increase venous return. List the main drugs that are used.

Answer 9

Epinephrine
Dopamine
Dobutamine
Norepinephrine
Isoproterenol

Question 10

What is the established minimum renal output per hour?

Answer 10

30 ml/hr

Question 11

List four measurable criteria that are the major expected outcomes of a shock crisis.

Answer 11

BP mean of 80 to 90 mm Hg
Po2 >50 mm Hg
CVP 2 to 6 mm HG H20
Urine output at least 30 ml/hr

Question 12

Define DIC.

Answer 12

A coagulation disorder in which there is paradoxical thrombosis and hemorrhage.

Question 13

What is the effect of DIC on PT, PTT, platelets, and FSP’s?

Answer 13

PT - Prolonged
PTT - Prolonged
Platelets - Decreased
FSP’s - Increased

Question 14

What drug is used in the treatment of DIC?

Answer 14

Heparin

Question 15

Name four nursing interventions to prevent injury in clients with DIC.

Answer 15

Gently provide oral care with mouth swabs.
Minimize needle sticks and use the smallest gauge needle possible when injections are necessary.
Eliminate pressure by turning the client frequently.
Minimize the number of BP measurements taken by cuff.
Use gentle suction to prevent trauma to mucosa.
Apply pressure to any oozing site.