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Patho Exam 3 > Shock PP 20 on > Flashcards

Shock PP 20 on Flashcards

1
Q

Result of excessive mast cell degranulation mediated by IgE antibodies in response to antigen

A

Anaphylactic Shock

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2
Q

In _________ shock, mast cells release vasodilatory mediators resulting in severe ______

A

anaphylactic; hypotension

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3
Q

Name 4 causes of anaphylactic shock

A

Antibiotic therapy (in particular β-lactams), peanuts and tree nuts, insect stings, and snake bites

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4
Q

Urticaria
Bronchoconstriction
symptoms of ________ shock

A

anaphylactic

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5
Q

Stridor
Angioedema
symptoms of ______ shock

A

anaphylactic

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6
Q

Wheezing
Itching
symptoms of ______ shock

A

anaphylactic

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7
Q

Treatment includes maintenance of airway patency, use of epinephrine, bronchodilators_________ shock

A

anaphylactic

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8
Q

Treatment includes antihistamines, vasopressors, and IV fluids

A

anaphylactic

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9
Q

Results from loss of sympathetic activation of arteriolar smooth muscle

A

Neurogenic shock

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10
Q

Neurogenic shock causes include ______ depression (brain injury, drug overdose) or lesions of ______ nerve fibers (spinal cord injury)

A

medullary; sympathetic

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11
Q

Treatment includes vasopressors, fluids, elevation of the legs

A

Neurogenic shock

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12
Q

Treatment includes slow position changes, and the use of pressure stockings on the legs

A

Neurogenic shock

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13
Q

Results from severe systemic inflammatory response to infection

A

Septic Shock

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14
Q

In ________ shock, Body’s response to infection or other insults results in systemic signs and symptoms of widespread inflammation: leading to ______

A

septic; SIRS

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15
Q

3 common causes of septic shock

A

Gram-negative and gram-positive bacteria, fungal infections

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16
Q

Endotoxins in bacterial cell walls stimulate massive immune system activation

A

Gram negative shock

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17
Q

Characterized by release of immune mediators resulting in widespread inflammation

A

septic shock

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18
Q

______ cascade, _______ system, and _ system are activated in septic shock

A

clotting, complement, kinin

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19
Q

In _______ shock, widespread inflammation leads to profound peripheral vasodilation with ____, maldistribution of blood flow with cellular _____, and increased capillary permeability with _____ formation

A

septic; hypotension; hypoxia; edema

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20
Q

Initially characterized by high CO due to sympathetic activation of the heart and warm extremities

A

septic shock

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21
Q

Even though CO is high, cellular ______ is present in _____ shock

A

hypoxia; septic shock

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22
Q

Reduced cellular oxygen utilization is manifested as high ____ in septic shock

A

SvO2

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23
Q

______ can deteriorate to a hypodynamic phase, causing decreased CO and organ _____

A

septic shock; ischemia

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24
Q

Therapy aimed at improving the distribution of blood flow and managing infection with antibiotics

A

Septic Shock

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25
Q

Administration of fluids and drugs to improve cardiac and vascular performance to improve distribution of blood flow

A

Septic Shock

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26
Q

Which of the following types of shock is septic shock?

Cardiogenic shock
Distributive shock
Obstructive shock
Hypovolemic shock

A

Distributive

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27
Q

Used to guide management of cardiac preload, afterload, and contractility to optimize CO and minimize workload

A

Hemodynamic Monitoring

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28
Q

Helpful for assessing CO, volume status, and oxygen delivery and consumption

A

Hemodynamic Monitoring

29
Q

Hemodynamic Monitoring monitors_____(3)

A

Right atrial pressure, pulmonary artery pressure, and left atrial pressure

30
Q

Oxygen delivery

A

DO2

31
Q

Oxygen Consumption

A

VO2

32
Q

Normally _____of oxygen in arterial blood is extracted from tissues, so mixed venous oxygen saturation is ____

A

25%; 75%

33
Q

Low CO results in _____ oxygen extraction and ____ SVO2

A

greater; lower

34
Q

Maldistribution of flow results in ____ oxygen extraction and _____SVO2

A

less; higher

35
Q

Left atrial pressure is important because it indicates left ventricular _______

A

preload

36
Q

Right atrial pressure used to manage right _____

A

preload

37
Q

Pulmonary artery catheter inserted via _____ or subclavian vein allows measurement of intracardiac pressures, _____, and _____

A

jugular; CO; SVO2

38
Q

Mixed venous oxygen saturation

A

SVO2

39
Q

Reflects the amount of oxygen left over after the tissues remove what they need

A

SVO2

40
Q

________ used to detect pulmonary complications

A

pulmonary pressure

41
Q

Pulmonary artery diastolic pressure reflects _______

A

left preload

42
Q

Pulmonary capillary occlusion pressure is a direct measure of ________

A

left atrial pressure

43
Q

A nurse is monitoring pulmonary capillary occlusion pressure. What does this measure?

Oxygen delivery
Ventricular contractility
Left atrial pressure
Endotoxins

A

left atrial pressure

44
Q

_____- states result in reduced or inadequate cellular oxygen consumption and may affect all organs and systems of the body

A

shock

45
Q

Shock complications are _______ in nature

A

inflammatory

46
Q

In shock, _____ is triggered by hypoxic injury to cells, by antigen or _____

A

inflammation; endotoxin

47
Q

In shock, excessive immune response leads to leaking ______, damage from proteolytic enzymes, and systemic activation of the _____ , ______, and _____ systems

A

capillaries; clotting, complement, kinin

48
Q

mediate organ damage by altering metabolism, recruiting neutrophils, initiating the coagulation cascade, and altering capillary permeability

A

inflammatory cytokines

49
Q

ARDS is most commonly associated with ______ shock

A

septic

50
Q

______ includes development of refractory hypoxemia, decreased pulmonary compliance, and radiographic evidence of _______

A

ARDS; pulmonary edema

51
Q

Primary cause of death in ARDS:

A

multiple organ failure, not severe hypoxemia

52
Q

In _______, neutrophils release proteolytic enzymes, produce oxygen-free ____, and secrete ______ chemicals that make pulmonary capillaries leaky

A

ARDS; radicals; inflammatory

53
Q

In _______, exudate leaks into the interstitial spaces and alveoli of the lung, where it interferes with ________

A

ARDS; pulmonary gas exchange

54
Q

In _____, Inflammation may also damage type ___ pneumocytes, which normally produce surfactant

A

ARDS; 2

55
Q

Disseminated Intravascular Coagulation usually caused by _______ shock, and due to immune activation of the _____ cascade

A

septic; clotting

56
Q

Microcirculation obstructions lead to ischemic tissue damage in ________

A

Disseminated Intravascular Coagulation

57
Q

Widespread clot formation consumes platelets and clotting factors in ________

A

Disseminated Intravascular Coagulation

58
Q

In Disseminated Intravascular Coagulation, platelet count and fibrinogen levels are ____, fibrin degradation products (D-dimer) are ______

A

low; elevated

59
Q

Kidneys undergo long periods of hypoperfusion

A

Acute Renal Failure

60
Q

In acute renal failure, _________causes decreased glomerular blood flow—causing reduced hydrostatic pressure and _______rates

A

vasoconstriction; filtration

61
Q

________- associated with decreased urinary excretion of waste products (creatinine and urea) in ________

A

Acute tubular necrosis (ATN); acute renal failure

62
Q

May need _____ in acute renal failure

A

dialysis

63
Q

When 2 or more systems affected

A

Multiple Organ Dysfunction Syndrome

MODS

64
Q

Most common causes of secondary MODS:

A

sepsis and septic shock

65
Q

Initiated by immune mechanisms that are overactive and destructive

A

MODS

66
Q

Cytokines affect ______, recruit ______, and activate _____ in vascular beds leading to tissue destruction and organ dysfunction in MODS

A

endothelium; neutrophils; inflammation

67
Q 
If a nurse observes these signs and symptoms in a patient, which complication of shock is the patient experiencing? 
  Decreased platelets
  Decreased fibrinogen
  Elevated D-dimer
  Ischemia of fingers and toes

Acute respiratory distress syndrome (ARDS)
Acute renal failure (ARF)
Disseminated intravascular coagulation (DIC)
Multiple organ dysfunction syndrome (MODS)

A

DIC

68
Q

What is the most common pathophysiologic precipitating event for ACS? What differentiates Unstable Angia (USA) from MI?

A

In most cases of ACS, plaque rupture followed by thrombus formation at the site is the precipitating event.
In USA, the thrombus is lysed before cell death occurs. In an MI, ischemia is prolonged and tissue death ensues.

69
Q

Why are morphine and nitroglycerin used to manage ischemic chest pain?

A

Morphine sulfate reduces anxiety and catecholamine secretion and is a preload reducer through its effect on systemic veins.

Nitroglycerin causes relaxation of vascular smooth muscle, which decreases preload and reduces MVO2 (myocardial oxygen consumption).

Patho Exam 3 (12 decks)

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