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CEN - Shock
| Question | Answer |
|---|---|
| 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
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