CEN - Shock
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| The five major types of stroke: | anphalactic; cardiogenic; hypovolemic; neurogenic; septic
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| The 4 stages of shock: | initial; compensatory; progressive; refractory
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| What happens to metabolism when blood supply to cells decrease? | metabolism switchs from aerobic to anaerobic as a source of energy
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| Which lab value increases with anaerobic metabolism? | Lactic Acid
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| Anaerobic metabolism also effects the pH of the cell resulting in metabolic _______. | Acidosis
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| Body cells require a constant supply of ____ and ______ and elimination of __________ and waste products. | oxygen, nutrients, carbon dioxide
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| 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
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| 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)
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| Anaphylactic shock S/S: | generalized pruritis; angioedema; hoarseness; respiratory distress; hives; restlessness; bronchospasm
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| Cardiogenic Shock S/S: | altered mentation; pale,cool,clammy skin; hypotension; tachycardia; oliguria;
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| 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.
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| Perfusion is dependent on 3 components of the circulatory system: | pump(heart); fluid volume(blood); container (blood vessels)
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| Risk Factors for Cardiogenic Shock in Older Adults: | diabetes mellitus, presence of cardiomyopathies, pulmonary hypertension, cancer, anemia.
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| 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
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| Risk Factors for Neurogenic Shock in Older Adults: | peripheral neuropathy, stroke.
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| Risk Factors for Septic Shock in Older Adults: | diminished immune response, reduced skin integrity, institutionalization.
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| Septic Shock results from: | infection progressing to bacteremia (bact. in blood) and eventually mutli-organ system failure (MODS-multi organ dysfunction syndrome).
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| Shock definition: | inadequate tissue perfusion
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| Name 3 types of shock caused by a massive dilation of blood vessels | Neurogenic Shock; Anaphylactic Shock; Septic Shock
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| Tissue perfusion is dependent on the ______ system and _______ by the respiratory system. | circulatory, oxygenation
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| Young people can compensate for ___% of blood loss. | 15
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| Treatment of Shock: Neutrogenic | stabilize spine
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| Treatment of Shock: Septic | antibiotics
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| Treatment of Shock: Anaphylactic | remove/neutralize antigen
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| Treatment of Shock: Hypovolemic | replace fluid/stop fluid loss
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| The compensatory mechanisms of shock are mediated by the ___________ nervous system | sympathetic
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| What are the three mechanisms of response mediated by the sympathetic nervous system | neural, hormonal and chemical
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| What is the function of the neurohormonal response in shock compensation. | maintains cardiac output
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| What is the effect of catecholamine release in compensatory shock | increased contractility
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| 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
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| What is the effect of capillary hydrostatic pressure decreases in compensatory shock | shifts fluid to intravascular space
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| What is the effect of antidiuretic hormone release in compensatory shock | conservation of sodium and water causing decreased urine output
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| What is the effect of epinephrine and norepinephrine release by the SNS in compensatory shock | increased heart rate
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| 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
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| What is the purpose of the neurohormonal compensatory mechanism triggered in shock | maintain arterial blood pressure despite a fall in cardiac output
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| Shock results from a state of decreased tissue perfusion and increased cardiac output True or False | False
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| The neuroendocrine response to shock activates medjchanisms to maintain circlating volume True or False | True
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| Lactic acidosis develops in the initial stage of shock and results in cellular damage True or False | True
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| As a compensatory mechanism in shock, anaerobic metabolism results in optimum energy production True or False | False
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| Shock results from a state of decreased tissue perfusion and increased cardiac output. True or False | False
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| the neuroendocrine response to shock activates mechanisms to maintain circulating volume. True or False | True
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| Lactic acidosis develops in the initial stage of shock and results in cellular damage. True or False | True
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| As a compensatory mechanism in shock, anaerobic metabolism results in optimum energy production. True or False | False
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| In cardiogenic shock why is the myocardial dysfunction difficult to treat? | The underlying cell damage is often irreversible.
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| In cardiogenic shock you would expect to see distended neck veins in ___________ ventricular failure. Right or Left | Right
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| In cardiogenic shock you would expect to auscultate crackles, a s/s of pulmonary edema, in ___________ ventricular failure. Right or Left | Left
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| 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
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| Name 4 treatment goals of cardiogenic shock | enhanced contractility; decreased oxygen demands; increased myocardial oxygen supply; increased cardiac output
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| Cardiogenic shock results in both systolic and diastolic dysfunction. True or False | True
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| Cardiogenic shock occurs in to 10 of patients with an MI. True of False | True
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| Fluid resuscitation is indicated in cardiogenic shock when no evidence of pulmonary edema exists. True or false | True
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| 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.
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| Initial stage of hypovolemic shock s/s: | 15% volume loss (750mL); compensatory mechanisms maintain cardiac output; Patient is asymptomatic.
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| 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
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| 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
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| 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.
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| Name 3 treatment goals of hypovolemic shock | treat the underlying cause; control additional fluid loss; replace fluid losses
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| Hypovolemic shock occurs when volume loss exceeds 20% of the circulating volume. True or False | True
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| In the initial state of hypovolemic shock, the patient is asymptomatic. True or False | True
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| Impaired tissue perfusion occurs in the second (Compensatory) stage of hypovolemic shock. True or False | False
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| The fourth (Refractory) stage of hypovolemic shock occurs when more than 40% of volume loss occurs. True or False | True
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| Anaphylactic shock S/S: | generalized pruritis; angioedema; hoarseness; respiratory distress; hives; restlessness
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| what is the first-line drug used in treatment of anaphylaxis? | Epinephrine 1:1000, 0.3mL given subcutaneously
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| Anaphylactic shock is caused by an antigen-antibody response. True or False | True
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| Release if histamine causes profound vasoconstriction. Tru or False | False
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| Larnygeal edema is a life-threatening sign in anaphylaxis. True or False | True
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| Epinephrine is a first-line drug for patients with anaphylaxis. | True
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| Neurogenic shock S/S: | hypotension; bradycardia; pale,cool, clammy skine with warm, dry, pink skin below the level of the spinal cord injury.
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| Neurogenic shock results from loss of parasympathetic vasomotor tone. True or False | False
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| In spinal cord injury, neurogenic shock usually occurs shortly after injury. True or False | True
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| Bradycardia can result from unopposed vagal tone in neurogenic shock. True or False | True
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| Loss of normal sympathetic tone can result in hyperthermia. True or False | False
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