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137 Cards in this Set

  • Front
  • Back
An acute condition caused by a toxin from Staphylococcus aureus. Causes high fever, vomiting, diarrhea, weakness, myalgia, and sunburn like rash

a)NEUROGENIC SHOCK
b)TOXIC SHOCK SYNDROME
c)RELATIVE HYPOVOLEMIA
d)SEPTIC SHOCK
TOXIC SHOCK SYNDROME
An immediate hypersensitivity reaction to an allergen to which the patient is exposed, doesn’t occur with first exposure to the allergen:

a)NEUROGENIC SHOCK
b)TOXIC SHOCK SYNDROME
c)ANAPHYLACTIC SHOCK
d)SEPTIC SHOCK
ANAPHYLACTIC SHOCK
When fluid moves from the vascular space to the extravascular space (third spacing):

a)NEUROGENIC SHOCK
b)TOXIC SHOCK SYNDROME
c)RELATIVE HYPOVOLEMIA
d)SEPTIC SHOCK
RELATIVE HYPOVOLEMIA
Occurs when the heart can no longer pump blood efficiently to all parts of the body:

a)NEUROGENIC SHOCK
b)TOXIC SHOCK SYNDROME
c)CARDIOGENIC SHOCK
d)SEPTIC SHOCK
CARDIOGENIC SHOCK
A systemic inflammatory response to a documented or suspected infection:

a) neurogenic shock

b) sepsis

c) hypovolemia

d) hypervolemia
SEPSIS
Occurs when there is insufficient vascular blood volume due to actual or relative losses:

a)HYPOVOLEMIC SHOCK
b)TOXIC SHOCK SYNDROME
c)CARDIOGENIC SHOCK
d)SEPTIC SHOCK
HYPOVOLEMIC SHOCK
The presence of sepsis with hypotension despite fluid resuscitation along with the presence of tissue perfusion abnormalities:

a)HYPOVOLEMIC SHOCK
b)TOXIC SHOCK SYNDROME
c)CARDIOGENIC SHOCK
d)SEPTIC SHOCK
SEPTIC SHOCK
Medication used in cardiogenic shock with severe systolic dysfunction, used in septic shock if patient has normal cardiac output, monitor heart rate:

a)Dopamine- INTROPIN
b)Phenlyephrine-NEO-SYNEPHRINE
c)Dobutamine- DOBUTREX
d)Nitroglycerin- TRIDIL
Dobutamine- DOBUTREX
A vasoconstrictor, Increases entire cardiac cycle including BP, pulse, heart rate, etc. Used for neurogenic shock:

a)Dopamine- INTROPIN
b)Phenlyephrine-NEO-SYNEPHRINE
c)Dobutamine- DOBUTREX
d)Nitroglycerin- TRIDIL
Phenlyephrine-NEOSYNEPHRINE
A precursor to Epi and Norepi, Increases heart rate, blood pressure, and cardiac output, Used for cardiogenic shock

a)Dopamine- INTROPIN
b)Phenlyephrine-NEOSYNEPHRINE
c)Dobutamine- DOBUTREX
d)Nitroglycerin- TRIDIL
Dopamine- INTROPIN
A vasodilator, Dilates coronary arteries, Used for cardiogenic shock:

a)Dopamine- INTROPIN
b)Phenlyephrine-NEO-SYNEPHRINE
c)Dobutamine- DOBUTREX
d)Nitroglycerin- TRIDIL
Nitroglycerin- TRIDIL
A cardiac stimulant, peripheral A vasoconstrictor, Used for cardiogenic shock with after load reduction and anaphylactic shock. Increases BP and HR:

a)Dopamine- INTROPIN
b)Phenlyephrine-NEO-SYNEPHRINE
c)Epinephrine- ADRENALIN
d)Nitroglycerin- TRIDIL
Epinephrine- ADRENALIN
An arterial and venous vasodilator. Decrease BP, HR, and CO. Used in cardiogenic shock:

a)Sodium nitroprisside-NIPRIDE
b)Phenlyephrine-NEOSYNEPHRINE
c)Epinephrine- ADRENALIN
d)Nitroglycerin- TRIDIL
Sodium nitroprisside- NIPRIDE
A cardiac stimulant, peripheral vasoconstrictor, increase BP and MAP, used for cardiogenic shock after MI, septic shock, and neurogenic shock

a)Sodium nitroprisside-NIPRIDE
b)Phenlyephrine-NEOSYNEPHRINE
c)Epinephrine- ADRENALIN
d)Norepinephrine- LEVOPHED
Norepinephrine- LEVOPHED
1.Which group of people is at the greatest risk for septic shock?

A. Those who have had an MI
B. Those patients with AIDS
C. Those who are immunodeficient
Those who are immunodeficient
Which type of shock is not treated with rapid fluid infusion?

A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Cardiogenic shock
Are vasodilators ever given for the treatment of shock?
Yes
What is the best way to treat shock?

A. Prevent it
B. Recognize it early
C. Treat it rapidly
Prevent it
How often should urine output be measured in a patient with shock?

A. q1h
B. q2h
C. q4h
D. q8h
q1h
Occurs when either systolic or diastolic dysfunction of the myocardium results in compromised cardiac output:

a) CARDIOGENIC SHOCK
b) ABSOLUTE HYPOVOLEMIA
c) HYPOVOLEMIC SHOCK
d) NEUROGENIC SHOCK
CARDIOGENIC SHOCK
Fluid volume moves out of the vascular space into extravascular space (e.g. interstitial or intracavitary space)/ third spacing / seen in sepsis, fluid in the colon from a bowel obstruction, loss of blood volume into a FX site, burns, and ascites:

a) SEPTIC SHOCK
b) ABSOLUTE HYPOVOLEMIA
c) HYPOVOLEMIC SHOCK
d) RELATIVE HYPOVOLEMIA SHOCK
RELATIVE HYPOVOLEMIA SHOCK
A systemic inflammatory response to a documented or suspected infection:

a) SEPTIC SHOCK
b) SEPSIS
c) HYPOVOLEMIC SHOCK
d) RELATIVE HYPOVOLEMIA SHOCK
SEPSIS
The presence of sepsis with hypotension despite fluid resuscitation along with the presence of tissue perfusion abnormalities:

a) SEPTIC SHOCK
b) SEPSIS
c) HYPOVOLEMIC SHOCK
d) RELATIVE HYPOVOLEMIA SHOCK
SEPTIC SHOCK
A rare disorder similar to septic shock caused by an exotoxin produced by certain strains of Staphylococcus aureus and group A streptococci/ seen in young women using tampons

a) SEPTIC SHOCK
b) SEPSIS
c) HYPOVOLEMIC SHOCK
d) TOXIC SHOCK SYNDROME
TOXIC SHOCK SYNDROME
Results when fluid is lost through hemorrhage, GI loss (e.g. vomiting, diarrhea), fistula drainage, diabetes insipidus, or diuresis:

a) SEPTIC SHOCK
b) ABSOLUTE HYPOVOLEMIC SHOCK
c) RELATIVE HYPOVOLEMIC SHOCK
d) TOXIC SHOCK SYNDROME
ABSOLUTE HYPOVOLEMIA
A hemodynamic phenomenon that occurs after a spinal cord injury at the fifth thoracic (T5) vertebra or above:

a) SEPTIC SHOCK
b) NEUROGENIC SHOCK
c) HYPOVOLEMIC SHOCK
d) TOXIC SHOCK SYNDROME
NEUROGENIC SHOCK
Fluid volume moves out of the vascular space into extravascular space (e.g. interstitial or intracavitary space)/ third spacing / seen in sepsis, fluid in the colon from a bowel obstruction, loss of blood volume into a FX site, burns, and ascites

a) SEPTIC SHOCK
b) NEUROGENIC SHOCK
c) HYPOVOLEMIC SHOCK
d) TOXIC SHOCK SYNDROME
RELATIVE HYPOVOLEMIA SHOCK
The presence of sepsis with hypotension despite fluid resuscitation along with the presence of tissue perfusion abnormalities:

a) SEPTIC SHOCK
b) RELATIVE HYPOVOLEMIA SHOCK
c) HYPOVOLEMIC SHOCK
d) TOXIC SHOCK SYNDROME
SEPTIC SHOCK
A rare disorder similar to septic shock caused by an exotoxin produced by certain strains of Staphylococcus aureus and group A streptococci/ seen in young women using tampons:

a) SEPTIC SHOCK
b) NEUROGENIC SHOCK
c) TOXIC SHOCK SYNDROME
d) RELATIVE HYPOVOLEMIA SHOCK
TOXIC SHOCK SYNDROME
Shock is a clinical syndrome resulting in decreased ___ ___ to body tissues causing ____ dysfunction and eventual ____ failure
blood flow

cellular

organ
The body’s ____ is absolutely dependent upon delivery of oxygenated blood to the _____
health

tissues
Without ____ of blood and/or without delivery of that oxygenated blood to the tissues, the end result is inadequate supply of oxygen and ____ or IMPAIRED ____ ____
oxygenation

nutrients

TISSUE PERFUSION
Shock can also be defined as a ____ arterial blood pressure (MAP) inadequate to meet the needs of the tissues.
mean
MAP is the ____ blood pressure over the whole of the ____ cycle. It reflects global tissue ____ and is not the same as the regular blood pressure readings commonly measured.
• Actually low blood pressure is a late finding in shock
average

cardiac

perfusion
MAP stands for what?
mean arterial blood pressure
There is no specific MAP at which shock occurs for all patients as demand for oxygen and delivery of oxygen is a ____ ____.
relative state
It is generally acknowledged that a MAP of less than _____ inhibits renal, coronary, and cerebral perfusion. In some patients, such as those with a history of ______ a much ____ MABP is required
60 mmHg

hypertension

higher
In order to maintain tissue perfusion at normal levels the body must have a working ____ (heart), an adequate, stable amount of ____ to pump (blood), and control over the ____ of the area the the fluid is being pumped through (good vascular tone, controls size of the vascular bed.)
pump

fluid

size
Without these three elements, shock occurs:

1-
2-
3-
Heart – a working pump

Blood - an adequate, stable amount of fluid to pump

Control over the size of the area the fluid is being pumped through - (good vascular tone, controls size of the vascular bed)
Shock can be classified as:

Low blood flow -
due to pump failure or intravascular fluid depletion which is ____or____ shock.

or:

Maldistribution of blood flow

resulting in ____, ____,or ____ shock.
Cardiogenic or Hypovolemic

Septic
Anaphylactic
Neurogenic
Shock can also be thought of as occurring because there is one of more of the following factors:

Failure to deliver ____

Inability to use ____

High demand for ____
oxygen

oxygen

oxygen
Shock can also be thought of as occurring because there is one of more of the following factors:

____ to deliver oxygen

____ to use oxygen

____ demand for oxygen
Failure

Inability

High
The clinical presentation of the patient will depend upon the ____ ____ of shock and the ____ of shock at which the patient is presenting. Depending on the underlying pathology, age, and premorbid status of the patient, stages of ____ may not always be clearly definable
originating cause

stage

shock
The 4 Stages of Shock are:

1-
2-
3-
4-
• Initial
• Compensatory
• Progressive
• Irreversible/Refractory
During the Initial stage of shock there is a sustained ____ in MAP detected by the baroreceptors in the aortic arch and ____ sinuses which is detected by a subtle drop of less than ____ from normal levels. Sympathetic nervous system is stimulated and the stress response is ____. Assessment during the Initial stage may have no outward signs of ____ tissue perfusion and there will be a normal to slightly ____ pulse, a normal to slightly ____ blood pressure, and pale, cool, ____ skin over face and extremities and ____. The signs are so subtle that they are likely to be overlooked. On the cellular level there will be ____ acid accumulation.
decrease

carotid

10 mmHG

stress

initiated

decreased

increased

decreased

moist

Thirst

Lactic
The Compensatory Stage begins after the ___ falls 10-15 mmHG below normal levels. Compensatory mechanisms are able to maintain ___ ___ and tissue perfusion to ____ ____, thereby preventing cell damage. Compensatory mechanisms are ____nervous system stimulations, the Renin-Angiotensin response, the release of hypothalamic and pituitary ____, and a volume ____ in fluid compartments.
MAP

blood pressure

vital organs

sympathetic

hormones

shift
• In the compensatory styage of shock, SNS stimulation results in the release of _____ from the adrenal medulla and release of ____ from the adrenal medulla and the sympathetic fibers. This causes ____ in the blood vessels supplying the skin and most of the abdominal viscera. SNS stimulation also causes ____ in vessels supplying the heart and skeletal muscles, and increase of heart rate and force of cardiac ____. Blood vessels in the respiratory system dilate and the respiratory rate ____.
epinephrine

norepinephrine

vasoconstriction

vasodilation

contraction

increases
In the compensatory stage of shock the Renin-Angiotensin response occurs as blood flow to the kidney ____. Renin causes release of angiotension II which causes ____ and release of aldosterone which causes the kidneys to ____ water and sodium and to lose ____. This helps to maintain circulating blood volume, ____ systemic vascular resistance which helps to maintain central vascular volume and ____ blood pressure.
decreases

vasoconstriction

reabsorb

potassium

increases

raises
During the compensatory stage of shock there is a release of hypothalamic and pituitary hormones. The Hypothalamus releases _______ hormone (ACTH) which causes the adrenal glands to secrete aldosterone, which promotes _____ of water and sodium by the kidneys, preserving blood volume and pressure. The Posterior pituitary gland releases ____ which ____ renal reabsorption of water to increase intravascular volume.
adrenocorticoid

reabsorption

antidiuretic hormone (ADH)

increases
During the compensatory stage of shock, Volume shifts in fluid compartments occur. As the ___ falls, the decreased capillary ______ pressure causes a fluid shift from the interstitial spaces into the ____. This “net gain” of fluid in the intravascular volume ____ the blood volume.
MAP

hydrostatic

capillaries

raises
Compensatory stage assessment

Restlessness
Oriented
Pupils are ____
Heart rate is ____
Pulses are ____ to ____
Systolic B/P is normal or slightly ____
Diastolic B/P normal or slight increase
Respirations faster and ____
Output = or <
Pale
Cool
May be ____
Normal to ____ BS
normal

increased

bounding to thready

decreased

increase

deeper

thirsty

hypoactive
The role of the RN during the compensatory stage is continuous in-depth assessment of the patient’s _____ status, prompt _____ of problems, accurate use of _____orders, prompt and accurate reports of deviations in assessment to ____, reducing patient ____, promote patient ____.
hemodynamic

recognition

emergency

physician

anxiety

safety
The Progressive Stage of shock occurs after a sustained ____ in MAP of ____ or more below normal levels. Compensatory mechanisms in the previous state remain activated, but they are no longer able to maintain ____ at a level sufficient to ensure perfusion of ____ ____.

The Progressive Stage of Shock is a compensation that is actually beginning to become detrimental to the patient’s ________. Vasoconstriction causes diffuse cellular ____ and anaerobic metabolism, cellular ____-____ pumps fail, Acidotic environment and diffusion of water ____ cells destroy cellular integrity, and fluid shifts out of capillaries back into the _______ spaces.
decrease

20 mmHg

MAP

vital organs

homeostasis

hypoxia

sodium-potassium

into

interstitial
Assessment findings during the Progressive stage are:

Listlesness
Agitation
Apathetic
Confusion
Speech slowed
Pupils are ____

Pulse is ____ & thready

Peripheral pulses may be absent

Systolic B/P is less than ___
Diastolic B/P will be ____
Dysrhythmias
Respirations will be rapid & ____

Generalized edema
Oliguria
Cold, clammy, cyanotic, pale

Marked increase in ____
BS < or absent
Areflexic
dilated

Rapid

< 90

falling

shallow

thirst
The Role of the RN during the Progressive Stage of shock requires expertise in ____ and understanding shock and the significance of changes in assessment data. The RN also manages, implements and documents treatments, medications, and fluids along with continuous assessment and ____.
assessing

collaboration
In the Irreversible/refractory stage of shock, tissue ____ has become so generalized and cellular ____ so widespread that no treatment can reverse the ____. Even if the ____ is temporarily restored, too much cellular damage has occurred to maintain ____. Death of cells is follow by death of ____, which results in death of ____, and death of vital organs contributes to subsequent ____ of the patient.
anoxia

death

damage

MAP

life

tissues

organs

death
Assessment findings of Irreversible shock are:

Confused, disoriented or unconscious
Areflexia
Pupils ____ with minimal response to light
Rapid, ____, or irregular pulse
Rapid, ____ respirations
Crackles and ____
Severe hypotension
Anuresis
Skin cold, clammy, mottled
BS absent
Cardiac arrest and death
dilated

weak

shallow

wheezes
The Role of the RN with a patient in Irreversible shock is to continue the astute assessment and interventions begun in previous ____, recognize the patient is ____, Initiating ____ and end-of-life activities, Support and explanation to family members.
stages

terminal

palliative
Types of shock are identified according to its ____ ____.
Shock is classified in three ways:

1 - ______

2 - ______

3 - ______


Septic: caused by infection-produced toxins, Neurogenic, and Anaphylactic shock are types of ____ shock.
underlying cause

– Hypovolemic
– Cardiogenic
– Distributive

– Distributive
Hypovolemic Shock occurs when there is insufficient ____ blood volume due to actual or relative losses, there is no ____ in pumping ability of heart or increase in ____ space. Hypovolemic shock is a ____ form of shock that occurs from ____ fluid loss which is known as actual or absolute hypovolemia, or from ____ fluid shifts which is also known as ____ ____.
intravascular

decrease

vascular

common

external

internal

relative hypovolemia
Actual or Absolute Hypovolemia is when fluid is actually lost ____ the body from a hemorrhage, surgery, traumatic injuries, GI bleeding, blood coagulation disorders. As well as from a Loss of _____ fluid from the skin due to injuries such as burns, a Loss of blood volume from dehydration, Loss of fluid from the GI system due to persistent and severe vomiting or diarrhea or continuous NG suctioning, Renal losses from use of _____ or to endocrine disorders such as ____ ____.
outside

intravascular

diuretics

Diabetes Insipidus
Relative hypovolemia is when Fluid moves from one the vascular space to ____ space which is also known as ___ ___. This is seen with Ascites, Profound edema, Blood loss into a muscle, and ____ effusion.
extravascular

third spacing

Pleural
Who is at Risk for Hypovolemic shock?
• Anyone who loses fluids from the intravascular volume

- Trauma
- Metabolic disorders causing third spacing
- Burns
During the Initial stage of shock, the patient's blood pressure, urine output, and capillary refill is normal to slightly decreased, and:

a) mental status is alert and oriented

b) mental status is confused and disoriented
mental status is alert and oriented
A patient experiencing shock will have a _____ blood and the pulse will become increasingly ____.
decreased

rapid
A patient experiencing shock will have decreasing blood pressure, skin becomes increasingly cool, pale, and moist, and urine output _____.
decreases
During the Compensatory & Progressive stage of shock, the skin becomes:

a)increasingly warm & edematous, with poor turgor, fluid shift

b) cool, pale, poor turgor with fluid loss, edematous with fluid shift

c) cool, pale, mottled with cyanosis

d) cool, pale, and moist
cool, pale, poor turgor with fluid loss, edematous with fluid shift
Cardiogenic Shock occurs when the heart can no longer pump blood efficiently to all parts of the body. There is Systolic & Diastolic dysfunction and ____. There is no ____ in intravascular volume and no ____ in size the of the vascular bed.
Arrhythmia

decrease

increase
Patient's with MI, cardiomyopathy, cardiac tamponade, bradycardia, tachycardia, valvular abnormality, papillary muscle dysfunction, acute ventricular defect are at risk for?
Cardiogenic Shock
With cardiogebnic shock, the decrease in the heart’s ability to pump effectively causes a decrease in ___ ___. This causes a decrease in ____ and the heart rate increases in response to ____ mechanisms. This tachycardia ____ myocardial oxygen consumption and decreases ____ ____. The myocardium becomes progressively depleted of oxygen, causing further myocardial ischemia and ____. Since the myocardium is not able to function normally, compensatory mechanisms are not as effective, the stages of shock may occur more rapidly. Mortality rate is about ___-___
cardiac output

MAP

compensatory

increases

coronary perfusion

necrosis

50-80%
Assessment findings for cardiogenic shock are:

- Blood pressure: ____

- Pulse: ___, ___, ___ of veins of hands and neck

- Respirations: ___, ___,
crackles, wheezes, pulmonary
edema

- Skin: pale, cold, moist and
____.

- Mental status: restless,
anxious, lethargic and
progressing to ____

- Urine output: oliguria to
___

- Other: dependent edema; ____ CVP; elevated pulmonary capillary wedge pressure; arrhythmias
hypotension

rapid, thready, distention of veins of hands and neck

increased, labored

cyanotic

comatose

anuria

elevated
In cardiogenic shock, Cyanosis is ____ common because the blood becomes stagnant in the capillary beds and this stagnation ____ extraction of oxygen from the hemoglobin, resulting in the blue color.
more

increases
With Distributive Shock, ____ increases the size of the vascular space and results in altered ____ of the blood volume rather than actual loss of volume.

Name 3 types of distributive shock:
1-
2-
3-
Vasodilatation

distribution


• Types
– Septic
– Neurogenic
– Anaphylactic
Septic shock is the presence of sepsis with ____despite fluid resuscitation along with the presence of tissue ____ abnormalities. This results from endotoxin activity which causes widespread ____ and is most commonly caused by gram-negative or gram-positive bacteria. Mortality is greater from ___-___ organisms.
hypotension

perfusion

vasodilation

gram-negative
Those at risk for Septic shock are Hospitalized patients, anyone who is susceptible to ____ or who has infection: debilitating chronic ____, poor nutritional status, those subjected to invasive procedures, extremes of age, and those who are ____.
infection

illnesses

immunocompromised
The leading cause of death in non-coronary ICU’s is?
Septic Shock
Septic Shock begins with septicemia (presence of pathogens and their toxins in the blood). As these pathogens are ____, their ruptured cell membranes allow endotoxins to be released into the ____. These endotoxins disrupt the vascular system, coagulation mechanism and immune system and trigger an immune and ____ response.
destroyed

plasma

inflammatory
The initial effects of septic shock differ from those of ____ and cardiogenic shock. The Cardiac output is ___ & Systemic vascular resistance is low. Septic shock occurs in phases which are the the warm phase also known as ____ septic shock and the cold phase which is also known as ____ septic shock.
hypovolemic

high

Early

Late
In Early septic shock, ____ results in weakness and warm, flushed skin. Septicemia often causes ___ ___ & ___.
Vasodilation

high fever and chills
Assessment of early septic shock includes:

Blood pressure: normal to ___

Pulse: ____, thready

Respirations: rapid and ___

Skin: flushed & ____

Mental status: alert, ___,
anxious

Urine output: ____

Body temperature: ___ w/chills

weakness, nausea, vomiting, diarrhea, decreased CVP
hypotension

increased

deep

warm

oriented

normal

increased
with Late septic shock ____ and the activity of the compensatory mechanisms result in the more typical shock manifestations & Death may result from ____ failure, ____ failure, or ____ failure
hypovolemia

respiratory

cardiac

renal
Assessment of late septic shock includes:

Blood pressure: ____

Pulse: ____, arrhythmias

Respirations: ____ & shallow,
dyspneic

Skin: cool, pale, ____

Mental status: lethargic to
____

Urine output: oliguria to anuria

Other: normal to ____ body temperature, decreased CVP
hypotension

tachycardia

rapid

edematous

comatose

decreased
Neurogenic shock is caused by massive ____ as a result of loss of sympathetic tone. The Etiology includes:

Spinal cord injury at level of 5th ____ vertebra or above

Spinal disease

Spinal anesthesia, deep general, epidural

Vasomotor center depression

Insulin reactions

Severe pain

Prolonged exposure to ___
vasodilatation

thoracic

heat
Those at risk for Neurogenic Shock are anyone whose injury or illness causes decreased impulse transmission from the ___ resulting in loss of sympathetic tone. Because there is ____ of the venous and arterial system there is a ____ of venous return to the heart with resultant decrease ____ ____ and cardiac output
CNS

vasodilation

decrease

stroke volume
The pathophysiology of neurogenic shock is it causes dramatic reduction in systemic vascular ____ which causes pressure in the blood vessels to become too low to drive ____ across capillary membranes. This results in impaired ____ metabolism
resistance

nutrients

cellular
Assessment of neurogenic shock includes:

Blood pressure: ______

Pulse: ____ & and bounding,
tachycardia when
compensatory mechanisms
kick in

Respirations: vary

Skin: ____, dry at first to ____ and pale later

Mental status: anxious,
restless, lethargic
progressing to comatose

Urine output: oliguria to anuria

Body temperature: ____
hypotension

slow

warm
cool

lowered
Anaphylactic Shock is an immediate _____ reaction to an allergen to which the patient is exposed. It does not occur with the ___ exposure to an allergen. The patient must have produced specific ____ antibodies against the allergen.
hypersensitivity

first

immunoglobulin E
Persons at risk for Anaphylactic shock have a history of ____ to medications, foods, insect bites, etc. Common substances are antibiotics, vaccines, antitoxins, local anesthetics, iodine dyes, blood and blood products, narcotics, Legumes, nuts, seeds, ____, ___ white, milk and ____ products
allergies

shellfish

egg

milk
With anaphalytic shock a reaction of the antigen with the IgE antibodies results in large amounts of ____and other ____ amines being released. Increased ____ permeability and massive vasodilation occurs in response to the hypersensitivity reaction. This causes pooling of blood in the ____ which causes hypovolemia and profound ____ interrupting cellular metabolism. Histamine also causes ____ muscle to constrict causing ____ distress. Plasma leaks into the alveoli, impairing gas exchange and causing ____ edema. Death can occur in ___ minutes.
histamine
vasoactive

capillary

periphery

hypotension

smooth

respiratory

pulmonary

20
Assessment of anaphylactic shock includes:

Blood pressure: ____

Pulse: ____, dysrhythmias

Respirations: dyspnea, stridor, wheezes, laryngospasm, bronchospasm, pulmonary edema

Skin: warm, ____ (lips, eyelids, tongue, hands, feet, genitals)

Mental status: restless, anxious, lethargic to comatose

Urine output: oliguria to anuria

Other: paresthesias, pruritis, abdominal cramps, vomiting, ____
hypotension

increased

edematous

diarrhea
Overall Collaborative Management of shock:

Most critical factor is early ____

Interventions are:

____ patient at high risk for shock (extremes of age, chronic, debilitating illnesses, surgery, trauma, decreased immunity, hospitalization)

Control or alleviate the primary ____

Implement measures to correct pathologic changes and enhance ____ ____.
recognition

identify

assessment

cause

tissue perfusion
Several models and scoring systems for shock have been developed to predict survivability in the intensely ill patient.

Examples:

Mortality ____ Model (MPM II)

____ Acute Physiology Score (SAPS II)

Acute Physiology and ____ Health Evaluation (APACHE II and III)

Some of these scales are being used to guide therapy as well as to predict mortality. Many of these scales are referred to in the current literature regarding patients suffering shock syndrome, particularly those in ____ or ____ shock
Probability

Simplified

Chronic

hypovolemic
septic
Emergency care for shock focuses on maintaining a level of tissue _____ adequate to sustain life. Treatment begins as soon as medical rescuers arrive on the scene and continues through transport and ____ to the ED or hospital.
perfusion

admission
Things to assess and expect with shock are the ____, ___, & ___.

Interventions will include positioning, oxygen and ____ support.

Anticipate ______ the patient.

Fluid replacement will be necessary if the patient is not in ____ shock.

Expect Acid-base imbalance and Cardiac dysrhythmias.

Requires medication administration
airway
breathing
circulation

ventilatory

intubation

cardiogenic

vasoactive
Name 3 forms of fluid replacement for patients experiencing shock:

1-
2-
3-
Crystalloids
Colloids
Blood
Crystalloid fluid replacement for patients with shock are ___ & ___. These are used primarily for initial volume ____, are easily available, and have no ____ carrying capacity. Nursing implications are to Monitor for circulatory ____. LR should not be used in patients with ____ failure
NS and LR

replacement

oxygen

overload

liver
Name 4 Colloid fluid replacements for shock:
1-
2-
3-

These are ____ molecules that pull fluids ____ tissues. They are harder to obtain, more expensive and run risk of an ____ reaction. They have no ____ carrying capacity.

Nursing implications:
Some increase risk for ____ and be sure to watch for an ____ reaction
Hetastarch
Albumin
Dextran
Plasmanate

Large
into
allergic

oxygen

bleeding

allergic
Blood replacement is Whole blood or ____ red blood cells used to replace blood loss and does have ____ carrying capacity. Blood products are harder to obtain and must be ___-___. Nursing implications with blood replacemnet are the same as with any blood transfusion. **CAUTION: Remember, if the patient has sustained loss of blood and that blood has been replaced by any fluid rather than blood, ____ results may be skewed.
packed

oxygen

cross-matched

laboratory
Vasoactive medications are:

Vasopressors: name 2

Vasodilators: name 2

Other medications used in treatment of shock are:


• Corticosteroids
• Antibiotics
• Diuretics
• Antiarrhythmic agents
Intropin (dopamine)
Dobutrex (dobutamine)

Nipride (nitroprusside)
Tridil (nitroglycerine
Nutritional Therapy for patients with shock are:

Feedings should be restarted within ___hours & Oral or enteral ____. Parenteral if above not tolerated or feasible.
24

first
Goals of therapy for shock are adequate tissue ____ & no ____ related to shock.

Acute interventions are:
perfusion

complications



• LOOK FOR SHOCK
• LOOK FOR SHOCK
• LOOK FOR SHOCK
Health Promotion for shock is to PREVENT ____ FROM HAPPENING IN THE FIRST PLACE!!!

You need to ____ those at risk

You need to ____ to decrease risk

Close ____ of fluid balance; prevention of infection (think basic infection control)
SHOCK

identify

Intervene

assessment
Once shock is suspected:

Neuro checks should be conducted ___. The patient’s LOC is the best indicator of ___ blood flow. Look for subtle changes in ___ status. Orient to time, place, person, and events. Avoid sensory ____ or ____

VS should be checked up to ___ & monitor hemodynamics if available.

Monitor ECG & assess for development of ___/___ and assess for response to ____ medications.

Monitor peripheral pulses. If these are weak is your patient getting benefit from peripheral ____????

Assess ____ efforts, chest sounds, pulse ox or ABG’s. How ____ is pulse oximetry on the finger or toe?

If the patient is on mechanical ventilation, monitor ____ of support

Monitor output ___, think about what ___ pt is getting, & monitor ___ & serum creatinine

Monitor body temp & keep pt comfortably warm, watch skin color, goose-bumps, diaphoresis, & monitor ____ ___ times

Auscultate BS at least every ___ hours. The patient may need to be kept ___ or other feedings. Watch for abdominal distention & measure ___ ___. Monitor NG output for amount & presence of ___ ___ & check stools for blood

Attend to patient’s personal hygiene, especially ___ ___ & skin integrity measures. The patient is at risk for impaired skin ____ from inadequate tissue perfusion. Patient should have ROM __-__ times per day & good positioning w/turning ____.
Do not ____ the patient.
q1h
cerebral
neurologic
overload/deprivation

q 5-15 minutes

S3/S4
vasoactive

IV sites

respiratory
accurate

adequacy

hourly
meds
BUN

capillary refill

4
NPO
abdominal girth
occult blood

oral care
integrity
3-4
q 1-2
overtax
For patient's w/shock use compassionate ____ in dealing w/family & patient. Anxiety, fear & pain may ____ shock. Communicate w/the patient & support methods of patient communication w/family, staff & environment. Support the patient/family in spiritual matters

Provide support for the patient & family interactions.

Link the patient to the outside ____ to facilitate decision making & advise the patient. Assist w/activities of daily living. Act as liaison to advise HCT of patient’s wishes for ___. Provide safe, caring, familiar relationships for the patient

Keep the family as informed as possible because they are not as familiar w/the surroundings as you are, explain equipment, procedures, responses, etc. Provide as much ____ as possible for the patient and the family.

Be creative in your interventions and support the whole patient: mind, body, and ____
understanding
aggravate

world
care

privacy
spirit
What is the the major cause for hypovolemic shock?
fluid deficit or hemmorhage
Name 3 of the earliest symptoms of an anaphylactic reaction:

1-
2-
3-
acute shortness of breath

acute hypotension (systolic between 85 & 100)

tachycardia
Hypotension is determined by systolic or diastolic blood pressure:
systolic between 85 & 100
Hypertension is determined by systolic or diastolic blood pressure?
systolic 120 - 139

or

diastolic 80 - 89
Tachycardia is ?
an excessively fast heart rate

> 100 beats per minute
Red blood cell count, hematocrit, and hemoglobin are ____ ("increased" or "decreased")in non-hemorrhagic shock due to actual hypovolemia because fluid does not contain _____.
increases

erythrocytes
Indicates impaired kidney fxn due to hypoperfusion as a result of severe vasoconstriction & is a more sensitive indicator of renal fxn than BUN.

a) CBC

b) Creatinine

c) Na+

d) K+
b) Creatinine
In the early stage of shock, laboratory results will show ____ as increased because of increased secretion of aldosterone. An increased secretion of Aldosterone will also _____ (increase? or decrease?) K+ (potassium).

a) CBC

b) Creatinine

c) Na+

d) K+
c) Na+

In early shock lab values will present SODIUM as INCREASED and POTASSIUM as DECREASED.

Increased secretion of aldosterone causes renal retention of sodium and excretion of potassium.
In early shock Glucose will be ____ (increased or decreased?) b/c of the release of liver glycogen stores in response to sympathetic nervous system stimulation & cortisol. Insulin insensitivity develops.


a) CBC

b) Creatinine

c) Na+

d) K+
increased glucose w/ shock
In early shock, lab tests will reveal respiratory ____ secondary to hyperventilation, and in late shock metabolic ____ occurs when organic acids accumulate in blood from ____ metabolism.
alkalosis

acidosis

anerobic
Elevations indicate liver cell destruction in progressive stage of shock:

a) CBC

b) PTT, FSP, PT

c) Troponin

d) ALT, AST, GGT
d) ALT, AST, GGT
Interventions for anaphylactic shock are:

* ensure patent ____
* remove insect stinger if present
* Epinepherine repeated at ___ minute intervals for mild symptoms or ___ minute intervals for severe reaction
* Administer ___ (high or low) flow 02 via ____
* place patient in a _____ position w/legs in ___ position
* keep patient ____
*administer _____ (diphen hydramine) IM or IV
* Administer ____ blockers such as cimetidine (Tagamet)
* Maintain blood pressure w/ ___, ___, ___.

Ongoing monitoring would include:
VS
respiratory effort
02 sat
LOC
Cardiac rhythm

**Anticipate intubation w/severe resp. distress

**Anticipate cricothyrotomy or trach w/ severe larygeal edema
airway

20-minute intervals for mild

10-minute intervals for severe

high

non-rebreather mask

recumbant
elevate legs

warm

Benadryl

histamine

fluids
volume expanders
vasopressors
(dopamine [Itropin], norepinepherine [Levophed])
All of the following are vasoconstrictors EXCEPT:

a) Phenylepherine-Neo Synepherine

b) norephenepherine-Levophed

c) nitroglycerine-Tridil

d) sodium nitroprisside-Nipride
VASODILATORS:

c) nitroglycerine-Tridil

d) sodium nitroprisside-Nipride
Which of the following is contraindicated with head trauma:

a) Phenylepherine-Neo Synepherine

b) norephenepherine-Levophed

c) nitroglycerine-Tridil

d) sodium nitroprisside-Nipride
c) nitroglycerine-Tridil
Hypovolemic shock begins to develope when volume has decreased by ___%?

a) 10%
b) 15%
c) 20%
d) 25%
15%
Massive vasodilation that results from imbalance between parasympathetic & sympathetic stimulation of vascular smooth muscle & extreme, persistant vasodilation is:

a) hypovolemic shock
b) cardiogenic shock
c) septic shock
d) neurogenic shock
e) anaphylactic shock
neurogenic shock
Treatment of anaphylactic shock:

A) epinepherine-Adrenaline

b) LR

c) antihistamines

d) steroids

e) nitoglycerine-Nipride
epinephrine to cause vasoconstriction & reverse airway constriction

volume expanders given IV (lactated ringers),

antihistamines & steroids to stop the inflammatory reaction
This type of shock can lead to death within 20 minutes:

a) hypovolemic
b) cardiogenic
c) septic
D) anaphylactic
e) neurogenic
anaphylactic
This type of shock leads to death in 50-80% of incidence:

a) hypovolemic
b) cardiogenic
c) septic
D) anaphylactic
e) neurogenic
cardiogenic
Smooth muscle constriction leading to respiratory failure is the most detrimental sign in this type of shock:

a) hypovolemic
b) cardiogenic
c) septic
D) anaphylactic
e) neurogenic
anaphylactic
Septic shock begins with an___, progresses to____, then____, then____, then___.
infection
bacteremia
sepsis
septic shock
Septic shock is most often caused by:
gram negative bacteria
Low BP, hypoxia, tachycardia, temp. instability, renal dysfunction, jaundice, clotting problems, deterioration of mental status and tachypnea are signs of what type of shock:

a) hypovolemic
b) cardiogenic
c) septic
d) neurogenic
e) anaphylactic
septic
Treatment of septic shock:

A) multiple drug antimicrobial therapy

B) fluid resusitation

C) vasoactive medications
all are correct
The Early (warm) phase and Late (cold phase) are catagories of:

a) hypovolemic shock
b) cardiogenic shock
c) septic shock
d) neurogenic shock
e) anaphylactic shock
septic shock
Multiple organ dysfunction as a result of pathogenic organisms in the blood resulting in VASODILATION and changes in permeability of capillaries is:

a) hypovolemic shock
b) cardiogenic shock
c) septic shock
d) neurogenic shock
e) anaphylactic shock
septic shock
Anaphylactic Symptoms
Anaphylactic Treatment
Anxiety
Urticaria
Wheezing progressing to cyanosis
Shock
Cardiac arrest

Anaphylactic Treatment
Stop Transfusion, Aspirate Line and discard, Flush with Saline Initiate CPR if indicated
Have epinephrine ready for injection (0.4 mL of a I: 1000 solution SC)
Cardiogenic shock is caused by:

1. Decreased venous return
2. Decreased pumping ability of the heart
3. Increased blood pressure.
4. Massive vasodilation.
Decreased pumping ability of the heart

Rationale:
Cardiogenic shock is also known as pump failure. The heart fails to adequately pump the blood. Decreased venous return is a symptom of cardiogenic shock but not a cause.
The major pathophysiological mechanism causing distributive shock is:

1. Failure of the heart as a pump.
2. Massive blood loss.
3. Increased cardiac output.
4. Massive vasodilation.
Massive vasodilation.
Rationale:
The major pathophysiological mechanism in distributive shock is massive vasodilation.
Which clinical manifestations are a direct outcome of the altered tissue perfusion associated with shock?

1. Elevated body temperature
2. Tachypnea
3. Urine output greater than 30 ml/hr
4. Peripheral vasodilation
Tachypnea
Rationale: 2. Decreased tissue perfusion results in hypoxia and the body attempts to compensate for the low oxygen by hyperventilating. The body temperature is usually low during shock and high fever would further increase hypoxia, as would vasodilation. Urine output would be low in shock (< 30 ml/hr).
When a client is suffering from cardiogenic shock, the CVP reading will be:

1. High, usually above 15 cm H2O
2. Low, usually below 5 cm H2O
3. Normal, between 5 - 10 cm H2O
4. Extremely low, less than 1 cm H2O
High

usually above 15 cm H2O
Rationale:
With cardiogenic shock, the venous pressure is often elevated because of the back-up of pressure into the venous system when the heart can't pump the blood through the heart effectively.
Inotropic drugs such as dobutamine are often used to treat shock. One of the negative effects of these drugs is:

1. Increased myocardial oxygen need
2. Increased cardiac output and tissue perfusion
3. Increased renal blood flow and output
4. Decreased coronary perfusion
Rationale:

1)
Inotropic drugs increase the force of heart contraction thus increasing the amount of oxygen the heart needs, which can result in angina.

2 & 3
are positive effects of inotropic drugs. These drugs do not cause decreased coronary perfusion.
Symptoms of a patient in Shock
Skin
1. Pale
2. Clammy
3. Cool

Respiratory
1. Rapid breathing
2. Shallow respirations

Metabolism
1. Low temperature
2. Thirst
3. Acidosis
4. Low urine output

Neurologic
1. Restlessness
2. Anxiety
3. Lethargy
4. Confusion

Cardiovascular
1. Tachycardia
2. Thready pulse
3. Low cardiac output
4. Low Blood pressure