Shock and Trauma

Question 1

What is the Physio Response during the Ebb phase?

Answer 1

Decreased BMR, decreased temp., Decreased O2 consumption, Vasoconstriction, Increased CO, Increased HR, Acute phase proteins.

Question 2

What 3 hormones are released during the Ebb phase?

Answer 2

Catecholamines, Cortisol, Aldosterone

Question 3

What is the Physio Response during the Catabolic phase?

Answer 3

Increased BMR, Increased Temp, Increased O2 consumption, Negative Nitrogen Balance

Question 4

What hormones are released during the Catabolic phase?

Answer 4

Increased glucagon, insulin, cortisol, catecholamines, but insulin RESISTANCE.

Question 5

What is the Physio Response during the Anabolic phase?

Answer 5

Positive nitrogen balance

Question 6

What hormones are released during the Anabolic phase?

Answer 6

Growth hormone, IGF

Question 7

Who gets aneurysms?

Answer 7

Patients with arthrosclerosis and HTN

Question 8

Hemineglect syndrome

Answer 8

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

Question 9

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

Answer 9

TRUE

Question 10

Shock

Answer 10

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

Question 11

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 11

TRUE

Question 12

How is shocked classified?

Answer 12

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

Question 13

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

Answer 13

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

Question 14

Cardiogenic Shock

Answer 14

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

Question 15

Neurogenic or Vasogenic Shock

Answer 15

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 16

Anaphylactic shock

Answer 16

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

Question 17

Septic Shock

Answer 17

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

Question 18

Hypovolemic Shock

Answer 18

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 19

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

Answer 19

TRUE

Question 20

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

Answer 20

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

Question 21

S/S of MILD Hypovolemic shock include:

Answer 21

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

Question 22

S/S of MODERATE Hypovolemic shock include:

Answer 22

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

Question 23

S/S of SEVERE Hypovolemic shock include:

Answer 23

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

Question 24

What causes persistent vasodilatation and creates relative hypovolemia?

Answer 24

Neurogenic (Vasogenic) Shock

Question 25

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

Answer 25

Neurogenic shock

Question 26

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

Answer 26

TRUE

Question 27

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

Answer 27

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

Question 28

What does the inflammatory response initiate?

Answer 28

Widespread vasodilatation.

Question 29

Identify the 2 phases of Septic Shock

Answer 29

Warm phase (EARLY) and cold phase (LATE)

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What are variable S/S of Shock?

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

H&H

Question 36

What is the purpose of ABGs?

Answer 36

Identifies body compensatory mechanisms, such as acidosis.

Question 37

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

Answer 37

Blood cultures help the identify causative organism

Question 38

Diagnosis of cardiogenic shock enzymes include:

Answer 38

LD, CPK, SGOT

Question 39

What is the best approach to treating shock?

Answer 39

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 40

What are the most appropriate Nursing Dx for Shock?

Answer 40

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

Question 41

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

Answer 41

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