shock foundation
What is the fundamental problem in all types of shock?
Inadequate tissue perfusion and oxygen delivery to meet metabolic demand
Which stage of shock is typically irreversible?
Refractory/irreversible stage
Which vasopressor is first-line for septic shock?
Norepinephrine (Levophed)
What is the first step in the sepsis bundle when hypotension or lactate > 4 mmol/L?
Administer 30 mL/kg fluids
What infection requires droplet isolation and immediate IV antibiotics?
Bacterial meningitis
Which compensatory mechanism activates when baroreceptors sense decreased blood pressure?
The SNS triggers vasoconstriction and releases epinephrine and norepinephrine
What clinical sign differentiates early from late septic shock?
Early: warm flushed skin; Late: cool pale skin
A patient remains hypotensive after fluids. Which order should the nurse expect next?
Start vasopressor to maintain MAP > 65
When should antibiotics be given in sepsis?
Within the first hour, after cultures are drawn
What finding differentiates bacterial from viral meningitis in CSF results?
Bacterial: glucose < 40 mg/dL; viral: normal glucose
During the compensatory stage, what finding indicates effective neural compensation?
Narrow pulse pressure due to vasoconstriction and maintained MAP
A patient has HR 115, BP 110/85, and urine output 15 mL/hr. What stage of shock are they likely in?
Compensatory stage
In cardiogenic shock, which drug should the nurse question?
Metoprolol – decreases contractility
A patient develops pink frothy sputum during resuscitation. What complication do you suspect?
Pulmonary edema from fluid overload
What is the nurse’s priority during spinal shock?
Maintain spinal immobilization
Why does lactic acid rise during shock?
The body shifts to anaerobic metabolism due to decreased oxygen delivery
What assessment indicates progression to the progressive stage of shock?
Hypotension despite fluids and metabolic acidosis
What finding shows dopamine is effective?
Urine output increases from 15 → 35 mL/hr
What labs confirm DIC in septic shock?
Elevated D-dimer, prolonged PT/PTT, decreased platelets
A patient with a spinal cord injury suddenly develops severe hypertension, bradycardia, and flushing. What emergency is this?
Autonomic dysreflexia
Which nursing assessment best determines tissue perfusion?
Mean arterial pressure (MAP ≥ 65 mmHg)
What is the priority nursing goal during the refractory stage?
Provide comfort care and psychosocial support
Why should fluids be given cautiously in neurogenic shock?
Hypotension is caused by vasodilation, not fluid loss
What does a lactate level of > 4 mmol/L indicate?
Severe tissue hypoxia and need for fluids and vasopressors
How can nurses prevent increased ICP in bacterial meningitis?
Avoid rectal meds, minimize stimulation, keep environment quiet