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137 Cards in this Set
- Front
- Back
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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
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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
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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
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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
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A systemic inflammatory response to a documented or suspected infection:
a) neurogenic shock b) sepsis c) hypovolemia d) hypervolemia |
SEPSIS
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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
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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
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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
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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
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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
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A vasodilator, Dilates coronary arteries, Used for cardiogenic shock:
a)Dopamine- INTROPIN b)Phenlyephrine-NEO-SYNEPHRINE c)Dobutamine- DOBUTREX d)Nitroglycerin- TRIDIL |
Nitroglycerin- TRIDIL
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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
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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
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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
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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
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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
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Are vasodilators ever given for the treatment of shock?
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Yes
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What is the best way to treat shock?
A. Prevent it B. Recognize it early C. Treat it rapidly |
Prevent it
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How often should urine output be measured in a patient with shock?
A. q1h B. q2h C. q4h D. q8h |
q1h
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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
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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
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A systemic inflammatory response to a documented or suspected infection:
a) SEPTIC SHOCK b) SEPSIS c) HYPOVOLEMIC SHOCK d) RELATIVE HYPOVOLEMIA SHOCK |
SEPSIS
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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
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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
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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
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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
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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
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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
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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
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Shock is a clinical syndrome resulting in decreased ___ ___ to body tissues causing ____ dysfunction and eventual ____ failure
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blood flow
cellular organ |
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The body’s ____ is absolutely dependent upon delivery of oxygenated blood to the _____
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health
tissues |
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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 ____ ____
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oxygenation
nutrients TISSUE PERFUSION |
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Shock can also be defined as a ____ arterial blood pressure (MAP) inadequate to meet the needs of the tissues.
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mean
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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 |
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MAP stands for what?
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mean arterial blood pressure
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There is no specific MAP at which shock occurs for all patients as demand for oxygen and delivery of oxygen is a ____ ____.
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relative state
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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
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60 mmHg
hypertension higher |
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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.)
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pump
fluid size |
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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) |
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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 |
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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 |
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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 |
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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
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originating cause
stage shock |
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The 4 Stages of Shock are:
1- 2- 3- 4- |
• Initial
• Compensatory • Progressive • Irreversible/Refractory |
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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.
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decrease
carotid 10 mmHG stress initiated decreased increased decreased moist Thirst Lactic |
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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.
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MAP
blood pressure vital organs sympathetic hormones shift |
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• 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 ____.
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epinephrine
norepinephrine vasoconstriction vasodilation contraction increases |
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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.
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decreases
vasoconstriction reabsorb potassium increases raises |
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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.
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adrenocorticoid
reabsorption antidiuretic hormone (ADH) increases |
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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.
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MAP
hydrostatic capillaries raises |
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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 |
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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 ____.
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hemodynamic
recognition emergency physician anxiety safety |
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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 |
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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 |
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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 ____.
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assessing
collaboration |
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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.
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anoxia
death damage MAP life tissues organs death |
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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 |
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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.
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stages
terminal palliative |
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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 |
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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 ____ ____.
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intravascular
decrease vascular common external internal relative hypovolemia |
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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 ____ ____.
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outside
intravascular diuretics Diabetes Insipidus |
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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.
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extravascular
third spacing Pleural |
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Who is at Risk for Hypovolemic shock?
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• Anyone who loses fluids from the intravascular volume
- Trauma - Metabolic disorders causing third spacing - Burns |
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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
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A patient experiencing shock will have a _____ blood and the pulse will become increasingly ____.
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decreased
rapid |
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A patient experiencing shock will have decreasing blood pressure, skin becomes increasingly cool, pale, and moist, and urine output _____.
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decreases
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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
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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.
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Arrhythmia
decrease increase |
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Patient's with MI, cardiomyopathy, cardiac tamponade, bradycardia, tachycardia, valvular abnormality, papillary muscle dysfunction, acute ventricular defect are at risk for?
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Cardiogenic Shock
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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 ___-___
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cardiac output
MAP compensatory increases coronary perfusion necrosis 50-80% |
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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 |
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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.
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more
increases |
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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 |
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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.
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hypotension
perfusion vasodilation gram-negative |
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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 ____.
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infection
illnesses immunocompromised |
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The leading cause of death in non-coronary ICU’s is?
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Septic Shock
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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.
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destroyed
plasma inflammatory |
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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.
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hypovolemic
high Early Late |
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In Early septic shock, ____ results in weakness and warm, flushed skin. Septicemia often causes ___ ___ & ___.
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Vasodilation
high fever and chills |
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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 |
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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
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hypovolemia
respiratory cardiac renal |
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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 |
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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 |
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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
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CNS
vasodilation decrease stroke volume |
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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
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resistance
nutrients cellular |
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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 |
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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.
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hypersensitivity
first immunoglobulin E |
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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
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allergies
shellfish egg milk |
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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.
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histamine
vasoactive capillary periphery hypotension smooth respiratory pulmonary 20 |
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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 |
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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 |
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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 |
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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.
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perfusion
admission |
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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 |
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Name 3 forms of fluid replacement for patients experiencing shock:
1- 2- 3- |
Crystalloids
Colloids Blood |
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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
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NS and LR
replacement oxygen overload liver |
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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 |
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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.
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packed
oxygen cross-matched laboratory |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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What is the the major cause for hypovolemic shock?
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fluid deficit or hemmorhage
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Name 3 of the earliest symptoms of an anaphylactic reaction:
1- 2- 3- |
acute shortness of breath
acute hypotension (systolic between 85 & 100) tachycardia |
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Hypotension is determined by systolic or diastolic blood pressure:
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systolic between 85 & 100
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Hypertension is determined by systolic or diastolic blood pressure?
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systolic 120 - 139
or diastolic 80 - 89 |
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Tachycardia is ?
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an excessively fast heart rate
> 100 beats per minute |
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Red blood cell count, hematocrit, and hemoglobin are ____ ("increased" or "decreased")in non-hemorrhagic shock due to actual hypovolemia because fluid does not contain _____.
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increases
erythrocytes |
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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
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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. |
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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
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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.
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alkalosis
acidosis anerobic |
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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
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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]) |
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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 |
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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
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Hypovolemic shock begins to develope when volume has decreased by ___%?
a) 10% b) 15% c) 20% d) 25% |
15%
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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
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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 |
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This type of shock can lead to death within 20 minutes:
a) hypovolemic b) cardiogenic c) septic D) anaphylactic e) neurogenic |
anaphylactic
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This type of shock leads to death in 50-80% of incidence:
a) hypovolemic b) cardiogenic c) septic D) anaphylactic e) neurogenic |
cardiogenic
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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
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Septic shock begins with an___, progresses to____, then____, then____, then___.
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infection
bacteremia sepsis septic shock |
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Septic shock is most often caused by:
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gram negative bacteria
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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
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Treatment of septic shock:
A) multiple drug antimicrobial therapy B) fluid resusitation C) vasoactive medications |
all are correct
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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
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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
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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) |
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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. |
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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. |
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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). |
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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. |
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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. |
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Symptoms of a patient in Shock
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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 |
