Shock and DIC

Question 0

What is the most common cause of shock?

Answer 0

Hypovolemia

Question 1

Define shock.

Answer 1

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

Question 2

What causes septic shock?

Answer 2

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 3

What is the goal of treatment for hypovolemic shock?

Answer 3

Quick restoration of cardiac output and tissue perfusion.

Question 4

What intervention is used to restore cardiac output when hypovolemic shock exists?

Answer 4

Rapid infusion of volume-expanding fluids.

Question 5

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

Answer 5

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

Question 6

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 in the event of such an occurrence?

Answer 6

• Pulmonary edema
• Administer medications to manage preload, contractability and/or afterload. For example, to decrease afterload, nitroprusside (Nipride) may be administered.

Question 7

List five assessment findings that occur in most shock victims.

Answer 7

• tachycardia
• tachypnea
• hypotension
• cool, clammy skin
• decrease in urinary output

Question 8

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

Answer 8

• epinephrine (Bronkaid)
• dopamine (Intropin)
• dobutamine (Dobutrex)
• norepinephrine (Levophed)
• isoproterenol (Isuprel)

Question 9

What is the established minimum renal output per hour?

Answer 9

30 mL/hr

Question 10

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

Answer 10

• BP mean of 80 to 90 mm Hg
• PO2> 50 mm Hg
• CVP 2 to 6 mm HG H2O
• urine output at least 30 mL/hr

Question 11

Define DIC.

Answer 11

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

Question 12

What is the effect of DIC on PT, PTT, platelets, and FSPs (FDPs)?

Answer 12

• PT prolonged
• PTT prolonged
• platelets decreased
• FSPs increased

Question 13

What drug is used in the treatment of DIC?

Answer 13

Heparin

Question 14

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

Answer 14

• 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.