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CEN - Shock

QuestionAnswer
The five major types of stroke: anphalactic; cardiogenic; hypovolemic; neurogenic; septic
The 4 stages of shock: initial; compensatory; progressive; refractory
What happens to metabolism when blood supply to cells decrease? metabolism switchs from aerobic to anaerobic as a source of energy
Which lab value increases with anaerobic metabolism? Lactic Acid
Anaerobic metabolism also effects the pH of the cell resulting in metabolic _______. Acidosis
Body cells require a constant supply of ____ and ______ and elimination of __________ and waste products. oxygen, nutrients, carbon dioxide
Causes of Neurogenic Shock: spinal cord trauma at T5 or higher; disruptions to the supply of glucose or oxygen to the medulla; depressive drugs, anesthetics; severe emotional stress & pain resulting in disruption of autonomic nervous system control over vasoconstriction
Inadequate tissue perfusion is caused by: Inadequate pump (damage to heart itself, inadequate HR);Inadequate Fluid Volume (hypovolemia); Inadequate Container (excessive dilation w/o change in fluid volume, excessive systemic vascular resistance)
Anaphylactic shock S/S: generalized pruritis; angioedema; hoarseness; respiratory distress; hives; restlessness; bronchospasm
Cardiogenic Shock S/S: altered mentation; pale,cool,clammy skin; hypotension; tachycardia; oliguria;
Hypovolemic Shock S/S: pale, cool, clammy skin; systolic blood pressure is less than 90 mmHg or 40 mmHg below baseline; delayed capillary refill; tachycardia; tachypnea; oliguria; anxiety; and decreased consciousness.
Perfusion is dependent on 3 components of the circulatory system: pump(heart); fluid volume(blood); container (blood vessels)
Risk Factors for Cardiogenic Shock in Older Adults: diabetes mellitus, presence of cardiomyopathies, pulmonary hypertension, cancer, anemia.
Risk Factors for Hypovolemic Shock in Older Adults: diuretic therapy, diminished thirst reflex, immobility, use of aspirin-containing products, use of integrative therapies such as ginkgo Biloba, anticoagulant therapy
Risk Factors for Neurogenic Shock in Older Adults: peripheral neuropathy, stroke.
Risk Factors for Septic Shock in Older Adults: diminished immune response, reduced skin integrity, institutionalization.
Septic Shock results from: infection progressing to bacteremia (bact. in blood) and eventually mutli-organ system failure (MODS-multi organ dysfunction syndrome).
Shock definition: inadequate tissue perfusion
Name 3 types of shock caused by a massive dilation of blood vessels Neurogenic Shock; Anaphylactic Shock; Septic Shock
Tissue perfusion is dependent on the ______ system and _______ by the respiratory system. circulatory, oxygenation
Young people can compensate for ___% of blood loss. 15
Treatment of Shock: Neutrogenic stabilize spine
Treatment of Shock: Septic antibiotics
Treatment of Shock: Anaphylactic remove/neutralize antigen
Treatment of Shock: Hypovolemic replace fluid/stop fluid loss
The compensatory mechanisms of shock are mediated by the ___________ nervous system sympathetic
What are the three mechanisms of response mediated by the sympathetic nervous system neural, hormonal and chemical
What is the function of the neurohormonal response in shock compensation. maintains cardiac output
What is the effect of catecholamine release in compensatory shock increased contractility
What is the effect of renin release in compensatory shock formation of angiotension 1, converted to angiotension 2, causing vasoconstriction, shunts blood to major organs; Aldosterone released causes water conservation
What is the effect of capillary hydrostatic pressure decreases in compensatory shock shifts fluid to intravascular space
What is the effect of antidiuretic hormone release in compensatory shock conservation of sodium and water causing decreased urine output
What is the effect of epinephrine and norepinephrine release by the SNS in compensatory shock increased heart rate
Activation of the neuroendocrine response in compensatory shock stimulate the release of Adenocorticotropin hormone from the pituitary glans; glucocoroicoids from the adrenal cortex; Epinephrine & norepinephrine from the SNS
What is the purpose of the neurohormonal compensatory mechanism triggered in shock maintain arterial blood pressure despite a fall in cardiac output
Shock results from a state of decreased tissue perfusion and increased cardiac output True or False False
The neuroendocrine response to shock activates medjchanisms to maintain circlating volume True or False True
Lactic acidosis develops in the initial stage of shock and results in cellular damage True or False True
As a compensatory mechanism in shock, anaerobic metabolism results in optimum energy production True or False False
Shock results from a state of decreased tissue perfusion and increased cardiac output. True or False False
the neuroendocrine response to shock activates mechanisms to maintain circulating volume. True or False True
Lactic acidosis develops in the initial stage of shock and results in cellular damage. True or False True
As a compensatory mechanism in shock, anaerobic metabolism results in optimum energy production. True or False False
In cardiogenic shock why is the myocardial dysfunction difficult to treat? The underlying cell damage is often irreversible.
In cardiogenic shock you would expect to see distended neck veins in ___________ ventricular failure. Right or Left Right
In cardiogenic shock you would expect to auscultate crackles, a s/s of pulmonary edema, in ___________ ventricular failure. Right or Left Left
In cardiogenic shock an S3 heart sound may be present and can indicate the presence of _____________ and the development of _______________________. pulmonary edema, congestive heart failure
Name 4 treatment goals of cardiogenic shock enhanced contractility; decreased oxygen demands; increased myocardial oxygen supply; increased cardiac output
Cardiogenic shock results in both systolic and diastolic dysfunction. True or False True
Cardiogenic shock occurs in to 10 of patients with an MI. True of False True
Fluid resuscitation is indicated in cardiogenic shock when no evidence of pulmonary edema exists. True or false True
What are the causes of Hypovolemic shock Loss of blood, loss of plasma volume of more than of 20% of the circulating volume or from profound dehydration.
Initial stage of hypovolemic shock s/s: 15% volume loss (750mL); compensatory mechanisms maintain cardiac output; Patient is asymptomatic.
Compensatory stage of hypovolemic shock s/s: 15% to 30% (750mL to 1500mL) volume loss; Cardiac output falls ( incr heart rate, incr resp rate, decr urine output, altered LOC
Progressive stage of hypovolemic shock s/s: 30% to 40% (1500mL to 2000mL) volume loss; impared tissue perfusion develops; dysrhythmias from myocardial ischemia, metabolic acidosis and respiratory distress
Refractory stage of hypovolemic shock s/s: Over 40% (more than 2000mL) volume loss; organ failure occurs; severe tachycardia; hypotension; marrow pulse pressure and cardiac arrest.
Name 3 treatment goals of hypovolemic shock treat the underlying cause; control additional fluid loss; replace fluid losses
Hypovolemic shock occurs when volume loss exceeds 20% of the circulating volume. True or False True
In the initial state of hypovolemic shock, the patient is asymptomatic. True or False True
Impaired tissue perfusion occurs in the second (Compensatory) stage of hypovolemic shock. True or False False
The fourth (Refractory) stage of hypovolemic shock occurs when more than 40% of volume loss occurs. True or False True
Anaphylactic shock S/S: generalized pruritis; angioedema; hoarseness; respiratory distress; hives; restlessness
what is the first-line drug used in treatment of anaphylaxis? Epinephrine 1:1000, 0.3mL given subcutaneously
Anaphylactic shock is caused by an antigen-antibody response. True or False True
Release if histamine causes profound vasoconstriction. Tru or False False
Larnygeal edema is a life-threatening sign in anaphylaxis. True or False True
Epinephrine is a first-line drug for patients with anaphylaxis. True
Neurogenic shock S/S: hypotension; bradycardia; pale,cool, clammy skine with warm, dry, pink skin below the level of the spinal cord injury.
Neurogenic shock results from loss of parasympathetic vasomotor tone. True or False False
In spinal cord injury, neurogenic shock usually occurs shortly after injury. True or False True
Bradycardia can result from unopposed vagal tone in neurogenic shock. True or False True
Loss of normal sympathetic tone can result in hyperthermia. True or False False
Created by: Vandkvinde