Shock & Sepsis

Question 1

Define shock.

Answer 1

When circulatory system is unable to supply adequate amounts of oxygen to the tissues.

Question 2

What can result without immediate treatment of shock?

Answer 2

Organ system failure and death.

Question 3

Define hypovolemic shock.

Answer 3

Rapid intravascular fluid loss resulting in inadequate circulating volume.

Examples: hemorrhage, severe GI or renal fluid loss (vomiting/diarrhea), burns.

Question 4

Define cardiogenic shock.

Answer 4

Inadequate pumping ability of the heart muscle .

Examples: acute MI, severe heart failure, stroke.

Question 5

Define obstructive shock.

Answer 5

Mechanical barrier to ventricular filling or emptying resulting in decreased cardiac output.

Examples: cardiac tamponade (chest trauma- pressure on the heart), pneumothorax, severe valvular disease, arterial stenosis.

Question 6

Define distributive shock.

Answer 6

Vasodilation and poor vascular tone, results in venous pooling, decreased venous return to the heart and decreased intravascular volume.

Examples: anaphylaxis, sepsis, neurogenic or spinal shock

Question 7

Define anaphylactic shock.

Answer 7

Life-threatening systemic hypersensitivity reaction.

Distributive/hypovolemic shock

Question 8

What happens to the body during an allergic reaction?

Answer 8

Release of histamine-
< widespread vasodilation
> increased capillary permeability
< smooth muscle contraction

Question 9

What are clinical manifestations for anaphylactic shock?

Answer 9

Respiratory distress: tachypnea, wheezing, stridor, cyanosis,hypoxia, airway edema, agitation and confusion.

Hypovolemia: tachycardia, hypotension, weak pulses, pale cap; and clammy skin.

Systemic: angioedema and urticaria.

Question 10

What nursing management is needed for anaphylactic shock?

Answer 10

Removing trigger, if possible
Maintain airway (O2, incubation)
Prevent shock (IV fluids, CPR)
Prevent resurgence
Medications:
< antihistamines 
< epinephrine 
< bronchodilators
< leukotriene inhibitors 
< steroids

Question 11

What do antihistamines do?

Answer 11

Inhibit vasodilation and vascular permeability.

Benadryl

Question 12

What does epinephrine do?

Answer 12

Vasoconstriction and relaxes smooth muscle

Question 13

What does a bronchodilator do?

Answer 13

Relaxes smooth muscle

Question 14

What does a leukotriene inhibitor do?

Answer 14

Deceased smooth muscle contraction

Question 15

What do steroids do?

Answer 15

Decrease inflammation

Question 16

Explain the process of septic shock.

Answer 16

Inflammation
Body unable to control infection
Vasodilation and increased capillary permeability 
Cytokines damage blood vessels
Coagulation system is activated 
Clotting factors are used up resulting in hemorrhaging 
Multiple organ dysfunction
Death

Question 17

List the clinical manifestations of the early phase of septic shock.

Answer 17

Tachycardia
Bounding pulses
Flushed skin
Fever
Increased WBC
Hypotension
Confusion 
Decreased urine output

Question 18

List clinical manifestations of the late phase of septic shock.

Answer 18

Tachycardia
Weak pulses
Hypothermia
Peripheral vascular collapse
Multiple organ failure

Question 19

Nursing management for septic shock.

Answer 19

Thorough assessment of: neuro, cardio, respiratory and renal

Monitor labs: WBC, lactate, see rate, renal and LFTs

Hand washing
Aseptic technique
Airway
Oral care
IV fluids
Strict input and output 
Teaching