Shock PP 1-19

Question 1

Imbalance between oxygen supply and oxygen requirements at the cellular level

Answer 1

Shock

Question 2

Common factor among all types of shock is ______

and impaired cellular oxygen utilization

Answer 2

hypo perfusion

Question 3

Inadequate cellular oxygenation may result from (3):

Answer 3

Decreased cardiac output
Maldistribution of blood flow
Reduced blood oxygen content

Question 4

Cardiogenic causes of shock: inadequate _______despite sufficient vascular volume

Answer 4

cardiac output

Question 5

Obstructive causes of shock: circulatory blockage, such as a large _______ or ________, disrupts cardiac output

Answer 5

pulmonary embolus; cardiac tamponade

Question 6

Hypovolemic causes of shock: loss of blood volume as a result of ______ or excessive loss of extracellular fluids

Answer 6

hemorrhage

Question 7

Distributive causes of shock: greatly expanded _____space because of inappropriate _______

Answer 7

vascular; vasodilation

Question 8

MI and cardiomyopathy examples of ______ shock

Answer 8

cardiogenic

Question 9

Valvular heart disease and ventricular rupture examples of _______ shock

Answer 9

cardiogenic

Question 10

Congenital heart defects and papillary muscle rupture examples of _______ shock

Answer 10

cardiogenic

Question 11

Pulmonary embolism and cardiac tamponade examples of _______ shock

Answer 11

obstructive

Question 12

Dissecting aortic aneurysm and tension pneumothorax examples of _______shock

Answer 12

obstructive

Question 13

Acute hemorrhage and dehydration from vomiting examples of ________ shock

Answer 13

hypovolemic

Question 14

Overuse of diuretics, burns, pancreatitis signs of _____ shock

Answer 14

hypovolemic

Question 15

Anaphylaxis, neurotrauma signs of ________ shock

Answer 15

distributive

Question 16

Spinal cord trauma, spinal anesthesia, sepsis signs of ______ shock

Answer 16

distributive

Question 17

Disrupts function and, if ongoing or severe, may lead to cell death, organ dysfunction, and stimulation of inflammatory reactions

Answer 17

Impaired oxygen utilization by cells

Question 18

Lack of oxygen causes production of _____ and

Failure of ion pumps leads to _____ and ______accumulation in the cell (hydropic swelling)

Answer 18

lactate; sodium and water

Question 19

Lack of oxygen causes formation of oxygen ____ and

and induction of inflammatory _______

Answer 19

radicals; cytokines

Question 20

Impaired tissue oxygenation results in cellular hypoxia, which causes (3)_______

Answer 20

Anaerobic metabolism
Free radical production
Macrophage induction

Question 21

In _______ injury, ischemic cells may produce oxygen-free radicals when oxygen supplies are restored

Answer 21

reperfusion

Question 22

_______ and ______ cytokines increase in ____ shock and are thought to be important mediators of vascular failure and progressive organ damage

Answer 22

TNF-a and IL-1; septic

Question 23

TNF-a and IL-1 cytokines increase activity of inducible ______ synthase leading to excess NO

Answer 23

nitric oxide

Question 24

Failure of microcirculation to autoregulate blood flow leads to activation of ______, leading to _____ debt in tissues

Answer 24

coagulation; oxygen

Question 25

What are the 3 clinical stages of shock?

Answer 25

compensated shock, progressive shock, and refractory shock

Question 26

Homeostatic mechanisms are sufficient to maintain adequate tissue perfusion despite a reduction in CO

Answer 26

Compensatory stage

Question 27

_____ activation attempts to maintain blood pressure even though CO has fallen, leading to increased ____ and _____ resistance

Answer 27

SNS; CO and vascular

Question 28

Progressive stage of shock is marked by ______ and marked tissue ______

Answer 28

hypotension; hypoxia

Question 29

In the ______ stage, lactate production increases with ______ metabolism

Answer 29

progressive; anaerobic

Question 30

In the ______ stage, lack of _____ leads to cellular swelling, dysfunction, and death

Answer 30

progressive; ATP

Question 31

In the _______ stage, Cellular and organ dysfunction result from oxygen-free _____, release of inflammatory _____, and activation of the _____ cascade

Answer 31

progressive; radicals; cytokines; clotting

Question 32

In shock, ______ and _______ are increased

Answer 32

HR and RR

Question 33

In shock, there is decrease in _____ output and increase in specific _____

Answer 33

urine; gravity

Question 34

In shock, there is release of ______ and _____

Answer 34

aldosterone and cortisol

Question 35

In shock, there is constriction of _____ vessels, causing ____

Answer 35

splanchnic; nausea/abdominal pain

Question 36

In shock, there is ______ and decreased pulse pressure

Answer 36

hypotension

Question 37

In shock there is decreased _____ refill and ______ color

Answer 37

capillary; cool/clammy/blue-gray

Question 38

_____ pupils, release of _____, and _____ signs of shock

Answer 38

dilated; ADH, thirst/restlessness

Question 39

Usually result of severe ventricular dysfunction associated with MI

Answer 39

Cardiogenic shock

Question 40

Features of cardiogenic shock include decreased _____, ______ edema, ______ heart sounds, and _____ pulse pressure

Answer 40

CO, pulmonary, S3, narrow

Question 41

Features of cardiogenic shock include elevated ____

Answer 41

preload

Question 42

In cardiogenic shock, low _____ leads to low _____

Answer 42

CO; SVO2

Question 43

In _______ shock, therapy aimed at improving ____ and myocardial oxygen delivery, decreasing workload

Answer 43

cardiogenic; CO

Question 44

Inotropic, preload reducing, and afterload reducing agents used to treat ______ shock

Answer 44

cardiogenic

Question 45

Intraaortic balloon counterpulsation, ventricular assist devices, heart transplantation used to treat ______ shock

Answer 45

cardiogenic

Question 46

Results from mechanical obstructions that prevent effective cardiac filling and stroke volume

Answer 46

obstructive shock

Question 47

Common causes of obstructive shock include (3)

Answer 47

pulmonary embolism, cardiac tamponade, and tension pneumothorax

Question 48

Obstructive shock manifests as ____-sided heart failure

Answer 48

right

Question 49

Rapid management of underlying obstruction is required to prevent cardiovascular collapse in _____ shock

Answer 49

obstructive

Question 50

Results from inadequate circulation blood volume precipitated by hemorrhage, burns, dehydration, or leakage of fluid into interstitial spaces

Answer 50

Hypovolemic shock

Question 51

Most common cause of hypovolemic shock

Answer 51

External hemorrhage

Question 52

In _______ shock, low CO and preload lead to SNS activation = elevated _____, _______, and increased ______

Answer 52

Hypovolemic; HR, vasoconstriction, contractility

Question 53

What are the 4 classes of hypovolemic shock?

Answer 53

Four classes: I (15% loss), II (15% to 30%), III (30% to 40%), IV (>40%)

Question 54

Therapy is aimed at fluid replacement and controlling the source of volume loss

Answer 54

Hypovolemic shock

Question 55

Name 3 things used for therapy regarding hypovolemic shock?

Answer 55

Crystalloids, colloids, blood products

Question 56

Characterized by excessive vasodilation and peripheral pooling of blood

Answer 56

Distributive shock

Question 57

CO inadequate due to reduced preload

Answer 57

Distributive shock

Question 58

3 types of distributive shock?

Answer 58

Anaphylactic shock
Neurogenic shock
Septic shock