Shock PP 20 on

Question 1

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

Answer 1

Anaphylactic Shock

Question 2

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

Answer 2

anaphylactic; hypotension

Question 3

Name 4 causes of anaphylactic shock

Answer 3

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

Question 4

Urticaria
Bronchoconstriction
symptoms of ________ shock

Answer 4

anaphylactic

Question 5

Stridor
Angioedema
symptoms of ______ shock

Answer 5

anaphylactic

Question 6

Wheezing
Itching
symptoms of ______ shock

Answer 6

anaphylactic

Question 7

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

Answer 7

anaphylactic

Question 8

Treatment includes antihistamines, vasopressors, and IV fluids

Answer 8

anaphylactic

Question 9

Results from loss of sympathetic activation of arteriolar smooth muscle

Answer 9

Neurogenic shock

Question 10

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

Answer 10

medullary; sympathetic

Question 11

Treatment includes vasopressors, fluids, elevation of the legs

Answer 11

Neurogenic shock

Question 12

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

Answer 12

Neurogenic shock

Question 13

Results from severe systemic inflammatory response to infection

Answer 13

Septic Shock

Question 14

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

Answer 14

septic; SIRS

Question 15

3 common causes of septic shock

Answer 15

Gram-negative and gram-positive bacteria, fungal infections

Question 16

Endotoxins in bacterial cell walls stimulate massive immune system activation

Answer 16

Gram negative shock

Question 17

Characterized by release of immune mediators resulting in widespread inflammation

Answer 17

septic shock

Question 18

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

Answer 18

clotting, complement, kinin

Question 19

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

Answer 19

septic; hypotension; hypoxia; edema

Question 20

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

Answer 20

septic shock

Question 21

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

Answer 21

hypoxia; septic shock

Question 22

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

Answer 22

SvO2

Question 23

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

Answer 23

septic shock; ischemia

Question 24

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

Answer 24

Septic Shock

Question 25

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

Answer 25

Septic Shock

Question 26

Which of the following types of shock is septic shock? Cardiogenic shock Distributive shock Obstructive shock Hypovolemic shock

Answer 26

Distributive

Question 27

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

Answer 27

Hemodynamic Monitoring

Question 28

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

Answer 28

Hemodynamic Monitoring

Question 29

Hemodynamic Monitoring monitors_____(3)

Answer 29

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

Question 30

Oxygen delivery

Answer 30

DO2

Question 31

Oxygen Consumption

Answer 31

VO2

Question 32

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

Answer 32

25%; 75%

Question 33

Low CO results in _____ oxygen extraction and ____ SVO2

Answer 33

greater; lower

Question 34

Maldistribution of flow results in ____ oxygen extraction and _____SVO2

Answer 34

less; higher

Question 35

Left atrial pressure is important because it indicates left ventricular _______

Answer 35

preload

Question 36

Right atrial pressure used to manage right _____

Answer 36

preload

Question 37

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

Answer 37

jugular; CO; SVO2

Question 38

Mixed venous oxygen saturation

Answer 38

SVO2

Question 39

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

Answer 39

SVO2

Question 40

________ used to detect pulmonary complications

Answer 40

pulmonary pressure

Question 41

Pulmonary artery diastolic pressure reflects _______

Answer 41

left preload

Question 42

Pulmonary capillary occlusion pressure is a direct measure of ________

Answer 42

left atrial pressure

Question 43

A nurse is monitoring pulmonary capillary occlusion pressure. What does this measure? Oxygen delivery Ventricular contractility Left atrial pressure Endotoxins

Answer 43

left atrial pressure

Question 44

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

Answer 44

shock

Question 45

Shock complications are _______ in nature

Answer 45

inflammatory

Question 46

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

Answer 46

inflammation; endotoxin

Question 47

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

Answer 47

capillaries; clotting, complement, kinin

Question 48

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

Answer 48

inflammatory cytokines

Question 49

ARDS is most commonly associated with ______ shock

Answer 49

septic

Question 50

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

Answer 50

ARDS; pulmonary edema

Question 51

Primary cause of death in ARDS:

Answer 51

multiple organ failure, not severe hypoxemia

Question 52

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

Answer 52

ARDS; radicals; inflammatory

Question 53

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

Answer 53

ARDS; pulmonary gas exchange

Question 54

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

Answer 54

ARDS; 2

Question 55

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

Answer 55

septic; clotting

Question 56

Microcirculation obstructions lead to ischemic tissue damage in ________

Answer 56

Disseminated Intravascular Coagulation

Question 57

Widespread clot formation consumes platelets and clotting factors in ________

Answer 57

Disseminated Intravascular Coagulation

Question 58

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

Answer 58

low; elevated

Question 59

Kidneys undergo long periods of hypoperfusion

Answer 59

Acute Renal Failure

Question 60

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

Answer 60

vasoconstriction; filtration

Question 61

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

Answer 61

Acute tubular necrosis (ATN); acute renal failure

Question 62

May need _____ in acute renal failure

Answer 62

dialysis

Question 63

When 2 or more systems affected

Answer 63

Multiple Organ Dysfunction Syndrome | MODS

Question 64

Most common causes of secondary MODS:

Answer 64

sepsis and septic shock

Question 65

Initiated by immune mechanisms that are overactive and destructive

Answer 65

MODS

Question 66

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

Answer 66

endothelium; neutrophils; inflammation

Question 67

``` 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)

Answer 67

DIC

Question 68

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

Answer 68

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.

Question 69

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

Answer 69

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).