Hypovolemic Shock
What are the two types of Hypovolemic Shock?
Relative and Absolute
Define Obstructive Shock
Physical obstruction impeding the filling or outflow of blood resulting in reduce cardiac output.
What is the main cause of cardiogenic shock?
myocardial infaraction
What are the three types of Distributive Shock?
Septic, Anaphylactic and Neurogenic Shock
Name three causes of neurogenic shock?
Spinal cord injury (car accident)
Spinal anesthesia
Medications (opioids)
What is the first line treatment for hypovolemic shock?
Administering IV fluid
What are the four distinct stages of shock?
Initial, compensatory, progressive and refractory.
Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?
a. Check temperature every 2 hours.
b. Monitor breath sounds frequently.
c. Maintain patient in supine position.
d. Assess skin for flushing and itching.
ANS: B
Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently.
What is the first line treatment for Anaphylactic Shock?
Epinephrine
Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been effective?
a. Hemoglobin is within normal limits.
b. Urine output is 60 mL over the last hour.
c. Central venous pressure (CVP) is normal.
d. Mean arterial pressure (MAP) is 72 mm Hg.
ANS: B
Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful.
Select all the conditions below that increases a patient’s risk for absolute hypovolemic shock:
A. Burns
B. Vomiting
C. Long bone fracture
D. Surgery
E. Diarrhea
F. Sepsis
The answers are: B, D, and E. Vomiting, diarrhea, and surgery can all increase the loss of fluid volume outside the body, which are absolute hypovolemic shock types
What is one of the most pertinent late signs of shock?
Falling blood pressure.
A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The nurse will anticipate an order for which medication?
a. 5% human albumin
b. Furosemide (Lasix) IV
c.Epinephrine (Adrenalin) drip
d.Hydrocortisone (Solu-Cortef)
ANS: B
The PAWP indicates that the patient’s preload is elevated, and furosemide is indicated to reduce the preload and improve cardiac output
What is the most common cause of septic shock?
Gram-negative bacteria.
The emergency department (ED) nurse receives report that a patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for the patient’s arrival, the nurse will obtain
a. hypothermia blanket.
b. lactated Ringer’s solution.
c. two 14-gauge IV catheters.
d. dopamine (Intropin) infusion.
ANS: C
A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline.
Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been effective?
a. Hemoglobin is within normal limits.
b. Urine output is 60 mL over the last hour.
c. central venous pressure (CVP) is normal.
d. Mean arterial pressure (MAP) is 72 mm Hg.
ANS: B
Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful.
A patient is admitted to the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to
a. administer oxygen.
b. obtain a 12-lead electrocardiogram (ECG).
c. obtain the blood pressure.
d. check the level of consciousness.
ANS: A
The initial actions of the nurse are focused on the ABCs—airway, breathing, and circulation—and administration of oxygen should be done first.
A nurse is caring for a patient with shock of unknown etiology whose hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure. Which collaborative intervention ordered by the health care provider should the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.
ANS: A
The patient’s elevated pulmonary artery wedge pressure indicates volume excess. A saline infusion at 250 mL/hr will exacerbate the volume excess. The other actions are appropriate for the patient
. A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 104 F, and blood glucose 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?
•A. Give normal saline IV at 500 mL/hr.
•B. Give acetaminophen (Tylenol) 650 mg rectally.
•C. Start insulin drip to maintain blood glucose at 110 to 150mg/dL.
• D. Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.
A. Give normal saline IV at 500 mL/hr.
Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions also are appropriate, and should be initiated quickly as well.
A 19-year-old patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?
a. Inspiratory crackles.
b. Cool, clammy extremities.
c. Apical heart rate 45 beats/min.
d. Temperature 101.2° F (38.4° C).
ANS: C
Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock.
A 35-year-old male arrives to the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Patient’s vital signs are: Blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation on 2 L nasal cannula 96%, temperature 99.3 ‘F, pain 6 on 1-10 scale. During assessment it is noted the skin is cool and clammy. The nurse will make it priority to?
A. Collect a urine sample
B. Obtain an EKG
C. Establish 2 large-bore IV access sites
D. Place a warming blanket on the patient
C. Establish 2 large-bore IV access sites
A 198-lb patient is to receive a dobutamine infusion at 5 mcg/kg/minute. The label on the infusion bag states: dobutamine 250 mg in 250 mL normal saline. When setting the infusion pump, the nurse will set the infusion rate at how many mL per hour?
In order to administer the dobutamine at the prescribed rate of 5 mcg/kg/minute from a concentration of 250 mg in 250 mL, the nurse will need to infuse 27 mL/hour.
A nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock. Which finding indicates that the medication is effective?
a. No new heart murmurs
b. Decreased troponin level
c. Warm, pink, and dry skin
d. Blood pressure 92/40 mm Hg
Warm, Pink and dry skin
A patient is developing anaphylactic shock. What should the nurse expect to observe in this patient? (select all that apply)
A. Polyuria
B. Urticaria
C. Bronchospasm
D. Muscle cramps
E. Laryngeal edema
•B, C, E
Ana halitic shock symptoms include urticaria, pruritus, wheezing, laryngeal edema, angioedema, and sever bronchospasm. A decreased urine rather than increased urination would be seen in a patient in shock. Muscle cramps are not associated with anaphylactic shock.
A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse rate is 120/minute and the central venous pressure and pulmonary artery wedge pressure are low. Which order by the health care provider will the nurse question?
a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d.Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg.
ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. The other orders are appropriate.