CH 14 Shock

Question 1

second stage of shock, mechanisms that regulate BP no longer compensate, and the MAP falls below normal limits. Patients are hypotensive.

• Respirations are shallow and deep crackles can be heard.
• Tachy, could have dysrhythmias, and ischemia, CK-MB, troponin, and BNP could be increased.
• decreased LOC
• MAP falls below 70, BUN, creatinine increased.
• ALT, AST, LDH, and bilirubin are elevated
• GU ischemia causes risk of ulcers, and GI bleed.

Answer 1

progressive stage of shock

Question 2

compensatory, progressive, and irreversible.

Answer 2

stages of shock

Question 3

the first stage of shock in which the BP remains WNL, vasoconstriction, increased HR, and increased contractility( bc of epinephrine, and norepinephrine).

• blood is shunted from the organs such as skin, kidneys, GI to the brain, heart, and lungs to ensure adequate blood supply for vital organs.
• Patient may be cool, clammy with hypoactive bowel sounds, and decreased urine output

Answer 3

compensatory stage of shock

Question 4

the body is typically in a state of metabolic acidosis, the respiratory system will try to compensate by removing excess co2 but usually ends up in compensatory respiratory alkalosis.

Answer 4

Compensatory stage of shock

Question 5

a condition in which widespread perfusion to the cells is inadequate to deliver oxygen and nutrients to support vital organs and cellular function

Answer 5

shock

Question 6

also called refractory stage of shock, it is the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.

• BP remains low.
• Renal and liver failure
• Overwhelming metabolic acidosis
• Respiratory failure

Answer 6

irreversible stage of shock

Question 7

These measures can be taken in all types and phases of shock

• support the respiratory system with supplemental oxygen/ mechanical vent.
• fluid replacement to restore intravascular volume
• vasoactive meds to restore vasomotor tone and improve cardiac function
• nutritional support

Answer 7

general management strategies of shock

Question 8

electrolyte solutions that move freely between intravascular and interstitial spaces. Can be used to restore fluid volume however; need more fluid with to restore volume than with a colloid.

Answer 8

crystalloid

Question 9

large molecule IV solution

Answer 9

colloids

Question 10

4-12 Hg

Answer 10

A normal right arterial pressure

Question 11

the most common type of shock that is characterized by a decreased intravascular volume. Shock occurs when there is a decrease of 15%-30% or 750-1500 mL of blood.

Answer 11

hypovolemic shock

Question 12

External fluid losses include: trauma, surgery, vomiting, diarrhea, diuresis, diabetes insipidus.

Internal fluid shifts: hemorrhage, burns, ascites, peritonitis, dehydration.

Answer 12

risk factors for hypovolemic shock

Question 13

3: 1

- 3 mL of crystalloid solution for every 1 mL of estimated blood loss

Answer 13

3:1 rule

Question 14

occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate( HR and SV are compromised) for the heart and tissues.

• The causes are either coronary(most often) or non coronary.
• Pt’s with an anterior wall MI are at greatest risk

Answer 14

Cardiogenic shock

Question 15

• 2 to 6 L/min of oxygen want o2 sats above 90
• IV morphine for pain,anxiety and to dilate blood vessels
• hemodynamic monitoring
• Cardiac enzymes are monitored
• Fluid status maintained
• Vasoactive meds

Answer 15

inital treatment for cardiogenic shock

Question 16

occurs when blood volume pools in peripheral blood vessels.
-Can be caused by a loss of sympathetic tone or by release of biochemical mediators from cells.
Three types are septic, neurogenic, and anaphylactic shock.

Answer 16

circulatory shock

Question 17

immunosuppression
extremes of age( very young and very old)
malnourishment
chronic illness
invasive procedures
diabetes

Answer 17

risk factors for sepsis

Question 18

caused by widespread infection

Answer 18

sepsis

Question 19

presents clinically like sepsis and is part of the initial continuum of sepsis. It is similar to sepsis except there is no identifiable source of infection.

Answer 19

SIRS systemic inflammatory response syndrome

Question 20

vasodilation occurs as a result of a loss of balance between  parasympathetic and sympathetic stimulation.
Can be caused by:
-spinal cord injury
-spinal anesthesia
-depressant action of medications
-glucose deficiency

Answer 20

neurogenic shock

Question 21

this type of shock occurs rapidly, and is life threatening. Ir occurs in patients already exposed to an antigen and who have developed antibodies to it.
Exposure to the antigen causes the mast cells to release potent vasoactive substances such as histamine or bradykinins.

Answer 21

anaphylactic shock

Question 22

altered organ function in acutely ill patients that requires medical intervention to support continued organ function. It is another phase in the progression of shock states.

Answer 22

MODS multiple organ dysfunction syndrome