Week 3

Question 1

Name the 3 Major types of shock

Answer 1

Hypovolaemic, Cardiogenic, and Distributive Shock

Question 2

When does Shock occur?

Answer 2

Shock occurs when:
There is an inability to meet metabolic demands of the tissues, When hypoperfusion results in cellular dysfunction,
There is a homeostatic imbalance between nutrient supply
and demand, when adaptive responses can no longer accommodate circulatory changes

Question 3

What are the Clinical Markers of shock?

Answer 3

Ph
Serum Lactate
BE

Question 4

What does an increase in lactate indicate?

Answer 4

An increase in lactate levels is a warning sign of organ failure.

Question 5

Name the early indicators of Shock.

Answer 5

Tachycardia
Altered consciousness
Cold diaphoretic skin
Tachypnoea
Shallow resps
Decreased urine output (<90) – Late/misleading -
emergency

Question 6

What is Hypovolaemic shock?

Answer 6

Typically ‘Low Volume of Blood’, however this can be any fluid.

Question 7

Name some causes of Hypovolaemic Shock.

Answer 7

Bleeding – internal/external, Diarrhoea / vomiting, Dehydration, Burns

Question 8

What is Cardiogenic Shock?

Answer 8

Cardiogenic Shock is the inability to maintain adequate perfusion despite adequate circulatory volume.

Question 9

What can cause Cardiogenic Shock?

Answer 9

Circulatory failure from cardiac dysfunction

Question 10

What are the Clinical Manifestations of Cardiogenic Shock?

Answer 10

Low Cardiac output, Hypotension (< Peripheral perfusion, Anxiety, Dyspnoea/tachypnoea, Resp alkalosis/acidosis,
Distended neck veins, Cause of cardiogenic shock ie CP, Cardiac arrhythmias etc

Question 11

What are 3 types of Disruptive Shock?

Answer 11

Septic shock
Anaphylaxis
Neurogenic Shock

Question 12

What is another term for Septic Shock?

Answer 12

Systemic Inflammatory Response Syndrome (SIRS)

Question 13

What are some causes of Septic Shock?

Answer 13

Sepsis
Burns
Pancreatitis
Trauma

Question 14

What can we expect to see in a patient with Septic Shock?

Answer 14

Infectious agents in blood cause haemodynamic
compromise, Ineffective tissue oxygen delivery,
Inappropriate vasodilation, Normal or increased CO,
Hypovolaemic due to >vasodilation
**Pt presentation
Warm, pink well perfused

(Cell death Caused by decompensation leads to
multiple organ failure)

Question 15

What is Anaphylaxis?

Answer 15

Sever allergic reaction

Question 16

What can we expect to see in a patient with Anaphylaxis?

Answer 16

Nervous
( Anxiety, dizziness, syncope )

Respiratory
( Stridor, wheeze, Pharyngeal/laryngeal oedema, dyspnoea,
bronchospasm, tachypnoea, cyanosis )

Cardiovascular
( Tachycardia, hypotension, arrhythmias )

Abdominal
( Nausea, vomiting, diarrhoea )

Other
( Flushing, pruritis, urticarial, angioedema, erythema, rash, itching )

Question 17

What is Neurogenic shock? (Spinal Shock)

Answer 17

Loss of Vasomotor tone (sympathetic)
Disruption/inhibition neural output - 
Spinal cord injury above T6 causing a
Decrease in vascular resistance and 
Vascular dilation

Question 18

What are the signs and symptoms of Neurogenic Shock?

Answer 18

Hypotension HR does not occur ***

Question 19

Name the 5 places someone can bleed out in Hypovolaemic Shock.

Answer 19

Externally, Thoracic Cavity, Abdominal Cavity,

Pelvic Cavity, Around the Long Bones (Femur)

Question 20

What does an Inatrope do?

Answer 20

Inotropes promote myocardial contractility to improve CO (Cardiac Output) and BP (Blood Pressure).

Question 21

Name some of the common inatropes used today.

Answer 21

Dobutamine, Dopamine, Adrenaline, Noradrenaline , and Vasopressin

Question 22

What are the actions in Nursing Practice for Anaphylaxis?

Answer 22

Assessment
   Accurate History
   Allergies
   Time of onset
ABC's Assessed
Remove causative agent
Secure Airway *** Early intubation (if required)
Administer
   IM Adrenaline
   Antihistimine
   Corticosteroid

Question 23

What are the actions in Nursing Practice for Sepsis?

Answer 23

Similar to Hypovolaemia
   Assessment
 Correct physiological deterioration
 Fluid Management
 Address underlying infection
Administer Inotrope - Vasopressin

Question 24

What are the actions in Nursing Practice for Neurogenic Shock?

Answer 24

ABC Assessment

Stabilise Neck/Torso
Consider fluids
Respiratory assessment and monitoring
Risk of pneumonia/actelectasis
Maintain core temp
Initiate NBM (NIL by Mouth)
Pressure area care